Journal of Foot and Ankle Surgery via MedWorm.com

Journal of Foot and Ankle Surgery — Sun, 25 Dec 2011 16:56:24 +0100

(Source: Journal of Foot and Ankle Surgery)

Editorial Board

Journal of Foot and Ankle Surgery — Sun, 25 Dec 2011 16:56:24 +0100

(Source: Journal of Foot and Ankle Surgery)

Thanks to Our Peer Reviewers

Journal of Foot and Ankle Surgery — Sun, 25 Dec 2011 16:56:24 +0100

Once again, we would like to thank all of the individuals who served as peer reviewers for the manuscripts submitted to The Journal of Foot & Ankle Surgery®. Peer review is the foundation upon which the articles published in The Journal of Foot & Ankle Surgery® are refined and considered for publication. From October 1, 2010, to November 1, 2011, the following individuals provided commentary that our editors used to decide which manuscripts would be published, revised, or rejected, and we appreciate the efforts of every peer reviewer. (Source: Journal of Foot and Ankle Surgery)

Lateral Supramalleolar Flap for Coverage of Ankle and Foot Defects in Children

Journal of Foot and Ankle Surgery — Sun, 25 Dec 2011 16:56:24 +0100

Abstract: The lower part of the leg, the ankle and the foot, is a difficult region to cover especially with exposure of bones or tendons. There are many options for covering soft tissue defect in these areas. The supramalleolar flap is an interesting procedure. The lateral supramalleolar flap was used in 8 cases for the reconstruction of skin defects of the ankle, heel, and foot that compromised the Achilles tendon and the osteoarticular system. Of the 8 patients, 5 were males and 3 were females, with an average age of 6.4 (range 2 to 10) years. The skin defect was secondary to trauma in all cases. The mean follow-up period was 31 (range 19 to 47) months; at the last follow-up visit, the region had been successfully covered in all cases. No necrosis of the flap was reported. The donor site...

Surgical Intervention for Congenital Nail Fold Hypertrophy

Journal of Foot and Ankle Surgery — Sun, 25 Dec 2011 16:56:24 +0100

In this report, we describe the case of a 14-month-old boy presenting with nail fold hypertrophy of both great toes. The completely united skin bridge covering the nail on the right was excised and the nail folds recreated, with debulking of the left hypertrophic nail fold. We propose that management should be conservative in the first instance and that surgery should be reserved for cases in which 1) inflammation is unresponsive to conservative measures, 2) there is a dense condensation of tissue crossing the nail surface, or 3) there is significant hypertrophy persisting past 1 year of age with no signs of resolution. (Source: Journal of Foot and Ankle Surgery)

Incidence of Acute Deep Vein Thrombosis and Pulmonary Embolism in Foot and Ankle Trauma: Analysis of the National Trauma Data Bank

Journal of Foot and Ankle Surgery — Sun, 25 Dec 2011 16:56:24 +0100

Abstract: The incidence of deep vein thrombosis (DVT) after foot and ankle surgery is generally believed to be low. However, little information is available regarding DVT as it specifically relates to foot and ankle trauma. The National Trauma Data Bank data set (2007 to 2009) was used to evaluate the incidence of thromboembolism in foot and ankle trauma. Also, the risk factors associated with the thromboembolic events were identified. Data regarding the demographics, comorbidities, procedures, trauma types, and complications, including DVT and pulmonary embolism (PE), were collected from the data set for analysis. The incidence of DVT and PE was 0.28% and 0.21%, respectively. The risk factors statistically significantly associated and clinically relevant for both DVT and PE in foot and an...

Publication Rates of Poster Presentations at the American College of Foot and Ankle Surgeons Annual Scientific Conference Between 1999 and 2008

Journal of Foot and Ankle Surgery — Sun, 25 Dec 2011 16:56:24 +0100

Abstract: Publication is the desired end point of scientific research. Ultimately, it is desired that research presented in poster format at a scientific conference will be developed into a report and become published in a peer-reviewed scientific journal. Moreover, poster presentations of research studies are often referenced and, as a result, influence treatment care plans. No data exist for the actual publication rate of podiatric foot and ankle surgery poster presentations. Therefore, the objective of the present study was to determine the actual publication rates of poster presentations at the American College of Foot and Ankle Surgeons (ACFAS) annual scientific conference (ASC) during a 10-year period. Print or electronic media for the ACFAS ASC official program from 1999 to 2008 wer...

Bicortical Fixation of Medial Malleolar Fractures: A Review of 23 Cases at Risk for Complicated Bone Healing

Journal of Foot and Ankle Surgery — Sun, 25 Dec 2011 16:56:24 +0100

Abstract: Several methods have been described for fixation of unstable medial malleolar fractures. Certain patient populations, including the elderly, those with osteoporosis and osteopenia, and patients with diabetes mellitus, are generally known to be susceptible to complications associated with ankle fracture healing. The goal of the present retrospective investigation was to review the outcomes of a series of patients who had undergone medial malleolar fracture repair using fully threaded bicortical interfragmental compression screw fixation. Patients were included in the present series if they had undergone bicortical fixation of an unstable ankle fracture with a medial malleolar fracture component, in addition to having at least 1 of the following comorbidities: age 55 years or older...

Prognostic Difference Between Soft Tissue Abscess and Osteomyelitis of the Foot in Patients with Diabetes: Data from a Consecutive Series of 452 Hospitalized Patients

Journal of Foot and Ankle Surgery — Sun, 25 Dec 2011 16:56:24 +0100

This study demonstrates that the severity of a foot soft tissue abscess is not comparable with that of a chronic osteomyelitis not only because of a higher rate of major amputation, but also because of a much more proximal level of minor amputation. (Source: Journal of Foot and Ankle Surgery)

Extraosseous Talotarsal Stabilization Using HyProCure® in Adults: A 5-year Retrospective Follow-up

Journal of Foot and Ankle Surgery — Sun, 25 Dec 2011 16:56:24 +0100

Abstract: The purpose of this retrospective study was to determine long-term functional outcomes and device tolerance achieved in adult patients who chose to undergo an extraosseous talotarsal stabilization procedure HyProCure® for the treatment of flexible talotarsal joint deformity. Eighty-three adult patients participated in this study. Postoperative subjective assessment of device performance was evaluated using Maryland Foot Scores, which were collected at a mean follow-up period of 51 months. The mean postoperative Maryland Foot Score was 88 out of 100; postoperatively, 52% of cases reported complete alleviation of foot pain, 69% of cases had no limitations on their foot functional abilities, and 80% of cases reported complete satisfaction with the appearance of their feet. The impl...

Infected Internal Fixation after Ankle Fractures—A Treatment Path

Journal of Foot and Ankle Surgery — Sun, 25 Dec 2011 16:56:24 +0100

Abstract: In the emergency treatment of infected internal fixation after ankle fractures, the infection needs to be resolved quickly to protect the implants, bone, and tendons. Vacuum wound therapy (topical negative pressure therapy) has been used for more than 15 years to assist in closure and to accelerate healing of a wide range of wounds. In the present report, we describe the results of treatment of 7 angiopathic (dysvascular) patients who developed a deep wound infection after ankle osteosynthesis. Each patient was treated with initial surgical debridement, followed by vacuum wound therapy and meshed split-thickness skin graft transplantation. The mean inpatient length of vacuum wound therapy was 14.0 ± 4.31 days, and the mean total duration of vacuum treatment was 54.43 ± 7.74 day...

An Analysis of Outcomes after Use of the Maxwell-Brancheau Arthroereisis Implant

Journal of Foot and Ankle Surgery — Sun, 25 Dec 2011 16:56:24 +0100

Abstract: The authors present a retrospective study of 35 consecutive patients (60 feet) treated with the Maxwell-Brancheau Arthroereisis (MBA) implant. The mean age of the cohort at the time of surgery was 14.3 (range 5 to 46) years, and 22 (62.86%) men and 13 (37.14%) women were included. Preoperative and postoperative anteroposterior and lateral foot radiographs were compared at a mean of 36 (range 18 to 48) months postoperatively, and the following mean changes were reported: talocalcaneal angle 24.15° ± 7.97° to 18.53° ± 8.23°, calcaneocuboid angle 18.67° ± 8.72° to 11.76° ± 8.49°, first to second intermetatarsal angle 9.42° ± 2.67° to 7.61° ± 2.69°, calcaneal inclination angle 11.93° ± 6° to 14.93° ± 5.85°, and talar declination angle 34.0° ± 8.59° to 28.02...

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Journal of Foot and Ankle Surgery — Sun, 25 Dec 2011 16:56:24 +0100

(Source: Journal of Foot and Ankle Surgery)

Transverse Incision for Calcaneal Tuberosity Avulsion Fractures

Journal of Foot and Ankle Surgery — Thu, 24 Nov 2011 05:00:00 +0100

Abstract: A number of incision options are available to surgeons approaching the posterior aspect of the calcaneus for repair of fractures of the posterosuperior aspect of the body of the calcaneus. In this brief communication, we depict our preference for the use of a transverse posterior calcaneal incision for reduction and fixation of avulsion fractures of the calcaneus. The advantages of this particular incisional approach include adequate exposure to the underlying target structures, orientation of the scar in line with relaxed skin tension lines, which minimizes scar formation, and avoidance of dissection of the Achilles tendon. (Source: Journal of Foot and Ankle Surgery)

The Surgical Treatment of Peroneal Tendinopathy (Excluding Subluxations): A Series of 17 Patients

Journal of Foot and Ankle Surgery — Thu, 24 Nov 2011 05:00:00 +0100

Abstract: Peroneal tendon pathology is rare, but is probably underestimated because it is frequently undiagnosed. It should always be in the differential diagnosis of lateral ankle pain. Surgical treatment of peroneal tendinopathy is indicated after failure of conservative measures. The aim of this retrospective study is to evaluate the medium-term clinical results of 17 patients operated for peroneal tendinopathy without tendon subluxation. A series of 17 patients composed of 7 women and 10 men with a mean age of 53.6 ± 4.6 (range 45 to 60) years were reviewed. The mean preoperative Kitaoka score was 46.7 ± 17.1 (range 25 to 69) points. All patients had radiological evaluation, which demonstrated hindfoot varus in 6 of the 17. Surgical interventions comprised synovectomy, debridement, ...

Matrix-associated Autologous Chondrocyte Transplantation Combined with Iliac Crest Bone Graft for Reconstruction of Talus Necrosis due to Villonodular Synovitis

Journal of Foot and Ankle Surgery — Mon, 21 Nov 2011 05:00:00 +0100

We report the case of a 24-year-old driving instructor with osteonecrosis of the talus and a large articular cartilage and osseous defect. The cystic lesion was caused by villonodular synovitis. After magnetic resonance imaging detection and arthoscopic analysis, the defect was filled with a bone graft, followed by matrix-associated autologous chondrocyte transplantation (MACT) combined with a total synovectomy. In general, lesions similar to the one described in this case are treated using osteochondral autografts, but in our case the osseous defect was too large to perform an osteochondral autograft. Our choice of treatment with an iliac crest bone graft combined with a MACT simultaneously has not yet been published, as far as we know. The patient returned to his former activities of dai...

Management of Combined Soft Tissue and Osseous Defect of the Midfoot with a Free Osteocutaneous Radial Forearm Flap: A Case Report

Journal of Foot and Ankle Surgery — Tue, 15 Nov 2011 05:00:00 +0100

Abstract: Extensive soft tissue and osseous defects of the foot are difficult to manage and often result in amputation. Most of these wounds are created by trauma, but other causes, such as infection and malignancy, can create similar defects. A variety of wound management options exist for the treatment of these challenging wounds, including negative pressure wound therapy, autogenous skin grafting, and the use of skin substitutes, as well as internal and external fixation methods. In the present report, we describe the use of a free osteocutaneous radial forearm flap to manage a 10-cm × 5-cm dorsal soft tissue defect and a 2.5-cm second metatarsal diaphyseal defect in an adult male. (Source: Journal of Foot and Ankle Surgery)

Function after Total Calcanectomy for Malignant Tumor in a Child: Is Complex Reconstruction Necessary?

Journal of Foot and Ankle Surgery — Tue, 15 Nov 2011 05:00:00 +0100

This report also highlights the benefits of the Cincinnati incision for calcanectomy, and describes the gait abnormalities after the operation. To the best of our knowledge, a description of the gait abnormality observed after calcanectomy for tumor resection in a pediatric patient has not been reported up to now. (Source: Journal of Foot and Ankle Surgery)

Deep Soft Tissue Leiomyoma Mimicking Fibromatosis in a 5-year-old Male

Journal of Foot and Ankle Surgery — Mon, 14 Nov 2011 05:00:00 +0100

We present a rare case of deep soft tissue leiomyoma in the foot of a 5-year-old male. The tumor was misdiagnosed as a desmoid-type fibromatosis from the findings of both magnetic resonance imaging and needle biopsy. The unusual age of presentation, atypical location, and failure of magnetic resonance imaging and ultrasound-guided needle biopsy in diagnosing the lesion make the case interesting. The case also highlights the importance of treating such patients at specialist tertiary centers with a multidisciplinary setting. (Source: Journal of Foot and Ankle Surgery)

Removal of Osteoid Osteoma of the Tibia Using Two-portal Posterior Ankle Arthroscopy

Journal of Foot and Ankle Surgery — Mon, 14 Nov 2011 05:00:00 +0100

Abstract: The case of a 30-year-old male with a history of pain in his left ankle is presented. The pain was described as predominantly nocturnal and frequently relieved by the use of nonsteroidal anti-inflammatory drugs. Computed tomography indicated a diagnosis of an osteoid osteoma in the posteromedial portion of the tibia. The patient underwent excision of the tumor using 2-portal posterior ankle arthroscopy. A clearly visualized nidus was removed using a combination of a cochlea and shaver. Histopathologic analysis of the resected tissue confirmed the diagnosis of an osteoid osteoma. The patient reported immediate relief of the pain and was rapidly allowed to bear weight on the foot. During regular follow-up, he had no pain recurrence and his joint mobility was normal. To our knowledg...

Surgical Technique for Combined Dwyer Calcaneal Osteotomy and Peroneal Tendon Repair for Correction of Peroneal Tendon Pathology Associated with Cavus Foot Deformity

Journal of Foot and Ankle Surgery — Mon, 07 Nov 2011 05:00:00 +0100

Abstract: Peroneal tendon pathology is commonly seen in patients with underlying pes cavus. The Dwyer calcaneal osteotomy is a useful adjunctive procedure to address the heel varus component of the cavus foot deformity, especially in the presence of concomitant peroneal tendon pathology. The lateralizing heel osteotomy using a wedge resection can effectively reduce future stress on the repaired peroneal tendons, although technical challenges arise when attempting to perform both tendon repair and heel osteotomy through the same incision. Specific principles must be followed to achieve adequate exposure of the desired structures, obtain desired correction of the deformity, and avoid complications such as sural neuritis. In the present report, the surgical principles and technical pearls are...

Double Row Anchor Fixation: A Novel Technique for a Diabetic Calanceal Insufficiency Avulsion Fracture

Journal of Foot and Ankle Surgery — Mon, 07 Nov 2011 05:00:00 +0100

Abstract: Avulsion fractures of the calcaneal tuberosity represent only 1.3% to 2.7% of calcaneal fractures. These fractures are common pathologically in nature and attributed to decreased bone mineral density. Calcaneal insufficiency avulsion (CIA) fracture in patients with diabetes mellitus is most likely due to Charcot neuroarthropathy (CN) as described by the Brodsky classification (Brodsky 3B). Traditional open reduction and internal fixation is difficult in all calcaneal avulsion fractures because of poor bone quality. The authors report the first known description of the use of fracture fragment excision and double row anchor fixation.A 39-year-old woman with type I diabetes mellitus and a history of CN presented with an avulsion fracture of the calcaneal tuberosity. Excision of the...

A Case of “Fresh Rupture” after Open Repair of a Ruptured Achilles Tendon

Journal of Foot and Ankle Surgery — Mon, 07 Nov 2011 05:00:00 +0100

We present the case of Achilles tendon rupture in a 54-year-old man while rehabilitating after end-to-end open repair of an acute Achilles tendon rupture. Re-rupture after surgical repair of Achilles tendon is well known. The present case, however, is atypical, because the second rupture occurred significantly proximal to the first rupture. To our knowledge, this is the first time this has been described in English language studies. We have termed this incident a fresh rupture. A gastrocnemius turndown flap was used to repair the fresh rupture, which led to a satisfactory recovery. This case report serves to inform surgeons of the existence of this type of Achilles tendon rupture, while considering the possible etiologies and suggesting a technique that has been shown to be successful in t...

A Retrospective Analysis of Lesser Metatarsophalangeal Joint Fusion as a Treatment Option for Hammertoe Pathology Associated with Metatarsophalangeal Joint Instability

Journal of Foot and Ankle Surgery — Mon, 07 Nov 2011 05:00:00 +0100

Abstract: Complex hammer digit deformity is commonly associated with instability of the metatarsophalangeal joint. Restoring joint stability is critical for digit alignment and function and can be challenging and unpredictable. Lesser metatarsophalangeal joint fusion might be an alternative treatment to the current soft tissue balancing, repair, and extra-articular osseous procedures used to treat joint instability. The present study was a retrospective chart and radiographic review of the pooled outcomes of 31 consecutive lesser metatarsophalangeal joint fusion procedures performed by 3 independent surgeons from May 2004 to September 2009. The clinical and radiographic outcomes were analyzed with descriptive and inferential statistics. The overall interval to radiographic union was 8.69 �...

Radiofrequency Thermoneurolysis for the Treatment of Morton’s Neuroma

Journal of Foot and Ankle Surgery — Mon, 07 Nov 2011 05:00:00 +0100

Abstract: Pedal neuroma is a common disorder. The authors undertook a review of 32 feet in 29 patients with a symptomatic neuroma treated between January 2007 and January 2010 to evaluate the effectiveness of radiofrequency thermoneurolysis therapy in alleviating symptoms. Overall relief of symptoms was rated as complete by 24 (83%) patients, with 5 patients experiencing minimal to no relief. Two patients were lost to follow-up after 1 month, 2 patients opted for no further intervention, and 1 patient went to open resection of the neuroma. Average follow-up was 13 months and total recovery time was 2 days. Complications included 1 foot with cellulitis treated by a course of oral antibiotics. The results of this retrospective study indicate radiofrequency thermoneurolysis therapy is a safe...

Statement of Ownership

Journal of Foot and Ankle Surgery — Tue, 01 Nov 2011 04:00:00 +0100

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Journal of Foot and Ankle Surgery — Tue, 01 Nov 2011 04:00:00 +0100

(Source: Journal of Foot and Ankle Surgery)

Invitation to Authors to Submit Video Footage with Manuscripts

Journal of Foot and Ankle Surgery — Tue, 01 Nov 2011 04:00:00 +0100

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Editorial Board

Journal of Foot and Ankle Surgery — Tue, 01 Nov 2011 04:00:00 +0100

(Source: Journal of Foot and Ankle Surgery)

Information for Subscribers

Journal of Foot and Ankle Surgery — Tue, 01 Nov 2011 04:00:00 +0100

(Source: Journal of Foot and Ankle Surgery)

Subject Index

Journal of Foot and Ankle Surgery — Tue, 01 Nov 2011 04:00:00 +0100

Abscess of subextensor digitorum brevis, after blunt trauma (case report), 595–597 (Source: Journal of Foot and Ankle Surgery)

Author Index

Journal of Foot and Ankle Surgery — Tue, 01 Nov 2011 04:00:00 +0100

Abdelgawad, A.A., 607 Abicht, B.P., 707 (Source: Journal of Foot and Ankle Surgery)

Reply

Journal of Foot and Ankle Surgery — Tue, 01 Nov 2011 04:00:00 +0100

With regard to the commentaries concerning our article, we would like to express our gratitude for the opinions and suggestions that strengthen the content of the article. Dr. Crawford is right with his explanations about the vascular anatomy of the calcaneus. We also have described the artery that courses through the tarsal sinus that supplies approximately 10% of the calcaneus. We agree that this contribution to calcaneal blood supply is not enough to cause avascular necrosis (AVN) of the calcaneus. This artery is, however, the most important artery of the talus, passing through its undersurface in the tarsal canal (see also Fig. 2, original article []). Once the close association of the medial fracture line (the C subtype in the Sanders computed tomography scan classification) with th...

Sinus Tarsi Artery

Journal of Foot and Ankle Surgery — Tue, 01 Nov 2011 04:00:00 +0100

My name is Michael Crawford and I am a fourth year student at the California School of Podiatric Medicine. I was reading the most recent issue of The Journal of Foot & Ankle Surgery® and wanted to “respond” to the article by Ogut et al [Ogut T, Ayhan E, Kantarci F, Unlu MC, Salih M. Medial fracture line significance in calcaneus fracture. J Bone Joint Surg 50(5):517–521, 2011]. In the report, the authors hypothesize the following: “The C line, which is in close proximity to the tarsal canal, is related to the comminution and joint depression. The sinus tarsi artery runs through this canal and supplies the body of the talus and 10% of the calcaneus. Injury to this artery is inevitable, with such high energy trauma including the C line. Thus, we believe that this arterial injury is...

Editor's Comments

Journal of Foot and Ankle Surgery — Tue, 01 Nov 2011 04:00:00 +0100

I appreciate the points raised by Drs. Hyer, Saxena, and DiDomenico in regard to the article that we published by Drs. Menke, McGlamry, and Camasta. I also take responsibility for inadequately making sure that the authors re-updated their review of the literature as their manuscript went through the processes of editing and revision. I agree with Drs. Saxena, Hyer, and DiDomenico when they say that the most important point is that the published literature be correct. For this reason, we correct the literature by publishing the Erratum in this issue of The Journal of Foot & Ankle Surgery®. (Source: Journal of Foot and Ankle Surgery)

Reply

Journal of Foot and Ankle Surgery — Tue, 01 Nov 2011 04:00:00 +0100

In response to the remarks from Drs. Hyer, Saxena, and DiDomenico, we are in agreement that the reader should be made aware of all appropriate and relevant studies when considering new techniques or change in traditional protocols, as a single report is not as valuable as a body of multiple studies in support of change. In addition to our recent publication regarding early weight-bearing after Lapidus arthrodesis with the aid of locking plate technology, Saxena in 2009, Sorensen in 2009, and Blitz in 2010 also published results with their experience of earlier weight-bearing than previously described after Lapidus arthrodesis. (Source: Journal of Foot and Ankle Surgery)

Lapidus Arthrodesis

Journal of Foot and Ankle Surgery — Tue, 01 Nov 2011 04:00:00 +0100

We are writing in regard to the recent article by Menke et al about Lapidus arthrodesis [Menke CRD, McGlamry MC, Camasta CA. Lapidus arthrodesis with a single lag screw and a locking H-plate. J Foot Ankle Surg 50(4):377–382, 2011]. This is a powerfully corrective procedure that has undergone recent modifications to improve the healing rate and decrease the need for a lengthy non–weight-bearing regimen. A major drawback of the Lapidus procedure has been the morbidity and opportunity cost associated with extensive non–weight-bearing and lost time from work. (Source: Journal of Foot and Ankle Surgery)

Reply

Journal of Foot and Ankle Surgery — Tue, 01 Nov 2011 04:00:00 +0100

Thank you for the opportunity to respond to the letter submitted by Mr. DePace. Extracorporeal shockwave therapy (ESWT) is a developing field with changing terminology, such as high-energy versus low-energy, ultrasonic versus radial waves. Indeed, in our study, the correct terminology should be radial pressure waves. EPAT® is a proprietary term of Storz Medical AG (Taegerwilen, Switzerland), and radial shock waves is a historical term. The term EPAT shall clearly distinguish radial pressure waves from any type of shock waves/ESWT. (Source: Journal of Foot and Ankle Surgery)

Pulsed-activated Therapy

Journal of Foot and Ankle Surgery — Tue, 01 Nov 2011 04:00:00 +0100

I read with great interest the article, “Extra-corporeal Pulsed-activated Therapy (‘EPAT’ Sound Wave) for Achilles Tendinopathy: A Prospective Study” [Saxena A, Ramdath S Jr, O'Halloran P, Gerdesmeyer L, Gollwitzer H. J Foot Ankle Surg 50(3):315–319, 2011]. I would like to focus your attention on the following issues I have with this paper. (Source: Journal of Foot and Ankle Surgery)

Erratum

Journal of Foot and Ankle Surgery — Tue, 01 Nov 2011 04:00:00 +0100

This article also did not note that early weight-bearing following Lapidus arthrodesis also had been described . (Source: Journal of Foot and Ankle Surgery)

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Journal of Foot and Ankle Surgery — Tue, 01 Nov 2011 04:00:00 +0100

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Incorporation of Bovine-based Structural Bone Grafts Used in Reconstructive Foot Surgery

Journal of Foot and Ankle Surgery — Mon, 31 Oct 2011 04:00:00 +0100

Abstract: Timely incorporation of bone grafts is essential to the structural rigidity in most foot and ankle surgeries. Although bovine-based xenografts possess some of the key features necessary for foot and ankle surgery, the studies evaluating the efficacy of these grafts are limited. The aim of the present study was to determine the incorporation rate of bovine-based bone grafts in foot surgery. A total of 22 patients who had undergone reconstructive foot surgery using 31 bovine-based xenografts were identified, and the rate of radiographic incorporation of the grafts was evaluated. A survival analysis was used to show the trend of the incorporation of the xenografts over time. Of the 21 grafts observed for at least 12 weeks, none showed radiographic graft incorporation by 12 weeks. Th...

Adolescent Hallux Valgus Deformity with Bilateral Absence of the Hallucal Sesamoids: A Case Report

Journal of Foot and Ankle Surgery — Fri, 28 Oct 2011 04:00:00 +0100

Abstract: The absence of the hallucal sesamoid is a rare condition. Rarer still is the presentation of adolescent hallux valgus with the absence of both hallucal sesamoid. Seven cases of absence of the tibial sesamoid bone and 3 cases of absence of the fibular sesamoid bone have been found in the literature, and only a single case of bilateral absence of both sesamoid bones with hallux varus has been reported. We would like to present a unique case of bilateral absence of the hallucal sesamoid in an 18-year-old woman with severe adolescent hallux valgus but no other apparent congenital deformity. (Source: Journal of Foot and Ankle Surgery)

Myxoid Liposarcoma of the Ankle: A Case Report

Journal of Foot and Ankle Surgery — Mon, 24 Oct 2011 04:00:00 +0100

We report a case of myxoid liposarcoma arising in the ankle of a 19-year-old man. A diagnosis of myxoid liposarcoma was made by open biopsy, and a wide resection requiring plastic surgical reconstruction was performed. Cytogenetic analysis of the resected tumor exhibited a reciprocal translocation t(12;16)(q13;p11) as the sole anomaly, which is found in more than 90% of myxoid liposarcoma cases. The patient had no evidence of local recurrence or metastasis within 7 years of follow-up. Although myxoid liposarcoma is rare in the ankle, it should be considered in the differential diagnosis of a painless soft tissue mass in this region. (Source: Journal of Foot and Ankle Surgery)

Use of Allograft Cellular Bone Matrix in Multistage Talectomy with Tibiocalcaneal Arthrodesis: A Case Report

Journal of Foot and Ankle Surgery — Fri, 21 Oct 2011 04:00:00 +0100

This report describes the treatment of an adult man who presented with a right ankle fracture and subtalar joint dislocation after a motor vehicle accident. After initial treatment with open reduction and internal fixation, the patient developed avascular necrosis of the talus and septic arthritis of the tibiotalar and subtalar joints. After treatment of the infection, the patient was ultimately treated with multistage talectomy and tibiocalcaneal arthrodesis augmented with a cellular bone allograft. Approximately 3 months after the final operation, plain radiographs and computed tomography confirmed solid fusion at the arthrodesis interface. The patient’s recovery was uneventful thereafter, and amputation was avoided. This case, which presented additional challenges because of the larg...

Letter to the Editor

Journal of Foot and Ankle Surgery — Wed, 19 Oct 2011 04:00:00 +0100

In a recent article [Tosun B, Al F, Tosun A. Spontaneous osteonecrosis of the tarsal navicular in an adult: Mueller-Weiss syndrome. J Foot Ankle Surg 50(2):221–224, 2011], the authors presented a case of Müller-Weiss disease of the tarsal navicular in a 43-year-old male. Although this is a well-written article, we have questions about how the author arrived at the conclusion that the case presented was, indeed, Müller-Weiss disease. (Source: Journal of Foot and Ankle Surgery)

Reply

Journal of Foot and Ankle Surgery — Mon, 17 Oct 2011 04:00:00 +0100

We thank Dr. Nelson and Mr. Rivello for their comments regarding our article. As they point out, Maceira et al developed a five-stage system using lateral weight-bearing radiographs and compression and splitting of the tarsal navicular in classifying and describing the disease . (Source: Journal of Foot and Ankle Surgery)

Stand Up and Start Counting

Journal of Foot and Ankle Surgery — Mon, 17 Oct 2011 04:00:00 +0100

Everyone agrees that research is important. We use findings to shape how we practice. Patients use findings to see what treatment options appeal to them. Sometimes, practitioners and patients interpret studies differently, just as practitioners and patients may not agree on what constitutes a good outcome. An example is when a study shows statistical improvement between pre- and postoperative ACFAS or AOFAS scores and indicates to a practitioner that a procedure is worth using. A patient may disagree, however, as almost all studies fail to document activity level. A patient could have a 95+ AOFAS score after bunion or ankle surgery, but if that patient cannot run or perform daily activities without pain, the foot score is essentially meaningless. (Source: Journal of Foot and Ankle Surgery)

A Multicenter Retrospective Review of Outcomes for Arthrodesis, Hemi-Metallic Joint Implant, and Resectional Arthroplasty in the Surgical Treatment of End-Stage Hallux Rigidus

Journal of Foot and Ankle Surgery — Mon, 03 Oct 2011 04:00:00 +0100

Abstract: This is a retrospective, multicenter study examining the long-term results for the treatment of end-stage hallux rigidus using 3 different surgical procedures. A total of 158 subjects (105 females and 53 males) were included in the present study. They had undergone 1 of the following surgical procedures: arthrodesis, hemi-implant, or resectional arthroplasty. The long-term results for the subjective assessment of pain, function, and alignment, as well as objective radiographic and physical findings, were examined. The median interval to postoperative follow-up for the 3 procedure groups was 159 weeks. No statistically significant difference was found in age or the number of subjects included in the 3 treatment groups (p = .11 and p = .16, respectively). The body mass index was si...

An Anatomical Way of Treating Ankle Syndesmotic Injuries

Journal of Foot and Ankle Surgery — Mon, 03 Oct 2011 04:00:00 +0100

Abstract: Treatment of tibiofibular syndesmotic ankle injury remains controversial in regard to the best method, although surgeons agree that the goal of treatment is reduction and operative stabilization. Ideally, the implant should stabilize the syndesmosis and allow physiologic micromotion and early mobilization, and conventional screws are limited in this regard. We reviewed use of the Ankle TightRope® fixation device for repair of syndesmotic injuries. From April to September 2006, 16 patients with evidence of syndesmotic injury were treated by means of ankle fracture open reduction with internal fixation, combined with use of the Ankle TightRope® device for repair of the syndesmosis. The mean age of the 16 patients was 36.6 ± 16.71 (range 15 to 69) years; they were followed up for...

Fracture of the Talus as a Complication of Subtalar Arthroereisis

Journal of Foot and Ankle Surgery — Thu, 29 Sep 2011 04:00:00 +0100

Abstract: Subtalar joint arthroereisis remains a popular procedure for a flexible flatfoot deformity. Potential complications of the procedure have been discussed in published reports and are often believed to have resulted from shortcomings related to the mechanical properties of the biomaterial, implant size, and/or implant placement. In the present report, we describe the case of a talar neck fracture with migration of the implant after subtalar joint arthroereisis performed 10 years earlier. The 19-year-old patient was treated with implant removal and open reduction internal fixation and bone void filler and recovered unremarkably thereafter. (Source: Journal of Foot and Ankle Surgery)

Arthroereisis of the Subtalar Joint: An Uncommon Complication and Literature Review

Journal of Foot and Ankle Surgery — Wed, 28 Sep 2011 04:00:00 +0100

Abstract: Arthroereisis is an operation to prevent abnormal pronation in the subtalar joint in children and adults with symptomatic flexible flatfeet. In the present report, we describe an uncommon late complication of a former variation of this procedure, namely the case of an adult male who experienced migration of a xenogeneic bone graft that had been implanted 55 years earlier. A thorough review of the existing data was also undertaken to better understand the complications of this procedure. (Source: Journal of Foot and Ankle Surgery)

Tibiotalocalcaneal Arthrodesis Using a Femoral Locking Plate

Journal of Foot and Ankle Surgery — Mon, 26 Sep 2011 04:00:00 +0100

We describe a new technique using a 4.5-mm condylar plate for tibiotalocalcaneal arthrodesis. (Source: Journal of Foot and Ankle Surgery)

Painless Giant Angioleiomyoma in the Subfascia of the Lower Leg

Journal of Foot and Ankle Surgery — Mon, 26 Sep 2011 04:00:00 +0100

We report an unusual case of angioleiomyoma that was located in the subfascia of the lower leg and had grown to massive size (≤5 cm in diameter) during a 3-year period without pain. A 57-year-old female presented with a 3-year history of a slowly growing pain-free mass on the anterior portion of her right lower leg, just above the ankle joint. Magnetic resonance imaging revealed a well-demarcated lesion, measuring approximately 5 × 4 cm, located deep to the fascia of the anterior compartment of the lower leg and adjacent to the tibia, fibula, and interosseous membrane. The mass was isointense to skeletal muscle on T1-weighted images, hyperintense and heterogeneous on T2-weighted images, and enhanced intensely and heterogeneously after the intravenous administration of contrast medium. W...

Talar Neck Fracture Associated with Talonavicular Dislocation and Fracture of Posteromedial Process of Talus

Journal of Foot and Ankle Surgery — Fri, 16 Sep 2011 04:00:00 +0100

We describe a very unusual case of an adult male with a fracture of the neck of the talus with talonavicular dislocation, subtalar subluxation, an intact ankle joint, and a fracture of the posteromedial tubercle of talus. Open reduction and internal fixation of the talar neck and posteromedial tubercle was undertaken. The talar neck fracture united without any evidence of avascular necrosis, but the posteromedial tubercle remained un-united. Such an injury is unusual, and the injury pattern is unique and cannot be classified using existing systems. (Source: Journal of Foot and Ankle Surgery)

Evaluating Plantar Fascia Strain in Hyperpronating Cadaveric Feet Following an Extra-osseous Talotarsal Stabilization Procedure

Journal of Foot and Ankle Surgery — Fri, 16 Sep 2011 04:00:00 +0100

Abstract: Abnormal talotarsal joint mechanics leading to hyperpronation is implicated as one of the most common causes of plantar fasciopathy. In patients with hyperpronating feet, the plantar fascia experiences excessive tensile forces during static and dynamic weight-bearing activities because of excessive medial longitudinal arch depression. For the purposes of this study, we hypothesized that plantar fascia strain in hyperpronating cadaveric feet would decrease after intervention with an extra-osseous talotarsal stabilization (EOTTS) device. A miniature differential variable reluctance transducer was used to quantify the plantar fascia strain in 6 fresh-frozen cadaver foot specimens exhibiting flexible instability of the talotarsal joint complex (i.e., hyperpronation). The strain was m...

Argon Beam Coagulation in Foot and Ankle Surgery

Journal of Foot and Ankle Surgery — Mon, 12 Sep 2011 04:00:00 +0100

Abstract: In this brief report, we introduce the principles, indications, advantages, disadvantages, and surgical techniques involved in the use of argon beam coagulation in foot and ankle surgery. (Source: Journal of Foot and Ankle Surgery)

Three-wire Fixation Technique for Displaced Fifth Metatarsal Base Fractures

Journal of Foot and Ankle Surgery — Mon, 12 Sep 2011 04:00:00 +0100

We present a somewhat simplified fixation method for displaced fifth metatarsal fractures in a small set of patients who were all followed up to final healing of the fracture. (Source: Journal of Foot and Ankle Surgery)

Rate of Nonunion after First Metatarsal-Cuneiform Arthrodesis Using Joint Curettage and Two Crossed Compression Screw Fixation: A Systematic Review

Journal of Foot and Ankle Surgery — Mon, 12 Sep 2011 04:00:00 +0100

Abstract: First metatarsal-cuneiform joint arthrodesis is a commonly performed procedure to correct first ray pathology. The most widely accepted approach is curettage and 2 crossed compression screw fixation followed by a period of non–weight-bearing. Despite adequate joint preparation and stable internal fixation, nonunion has been cited as a known complication. This can lead to the need for revision surgery, which is undesirable and drives healthcare costs. To further investigate this topic, we conducted a systematic review to determine the rate of nonunion after the first metatarsal-cuneiform joint arthrodesis using curettage and 2 crossed compression screw fixation. Studies were eligible for inclusion only if they involved the following: arthrodesis of the first metatarsal-cuneiform...

Effect of Extra-osseous Talotarsal Stabilization on Posterior Tibial Tendon Strain in Hyperpronating Feet

Journal of Foot and Ankle Surgery — Mon, 12 Sep 2011 04:00:00 +0100

Abstract: Posterior tibial tendon dysfunction is considered one of the most common causes of progressive adult acquired flatfoot deformity. The etiology leading to the dysfunction of posterior tibial tendon remains controversial. The purpose of this study was to quantify strain on the posterior tibial tendon in cadaver feet exhibiting hyperpronation caused by flexible instability of the talotarsal joint complex. We hypothesized that posterior tibial tendon strain would decrease after a minimally invasive extra-osseous talotarsal stabilization procedure. A miniature differential variable reluctance transducer was used to measure the elongation of posterior tibial tendon in 9 fresh-frozen cadaver specimens. The elongation was measured as the foot was moved from its neutral to maximally prona...

Effect of Extra-osseous Talotarsal Stabilization on Posterior Tibial Nerve Strain in Hyperpronating Feet: A Cadaveric Evaluation

Journal of Foot and Ankle Surgery — Mon, 12 Sep 2011 04:00:00 +0100

Abstract: Excessive abnormal strain or tension on the posterior tibial nerve in feet exhibiting talotarsal instability has been considered one of the possible etiologic factors of tarsal tunnel syndrome. The suggested treatment options in such cases include stabilization of the talotarsal joint complex in a corrected position, which might help minimize the abnormal forces placed on the posterior tibial nerve due to over stretching. The primary goal of this study was to quantify strain on the posterior tibial nerve in feet exhibiting hyperpronation caused by talotarsal instability, before and after an extra-osseous talotarsal stabilization (EOTTS) procedure. We hypothesized that the excessive strain placed on the posterior tibial nerve in hyperpronating cadaveric feet would be reduced signi...

Assessment of Medial and Lateral Neurovascular Structures after Percutaneous Posterior Calcaneal Displacement Osteotomy: A Cadaver Study

Journal of Foot and Ankle Surgery — Mon, 12 Sep 2011 04:00:00 +0100

Abstract: A prospective investigation of the effects on the medial and lateral neurovascular structures of the rearfoot after percutaneous posterior calcaneal displacement osteotomy was performed using 20 below the knee fresh frozen cadaver specimens. This anatomic study aimed to examine the medial and lateral neurovascular structures to determine whether they were jeopardized during execution of the osteotomy. After completion of the osteotomy, the medial plantar, lateral plantar, medial calcaneal, sural, and posterior tibial neurovascular structures, along with their respective branches, were inspected for iatrogenic injury. Our findings demonstrated that the percutaneous, subperiosteal osteotomy minimized trauma to the local soft tissue envelope and protected the adjacent neurovascular ...

Statistical Reliability of Bone Biopsy for the Diagnosis of Diabetic Foot Osteomyelitis

Journal of Foot and Ankle Surgery — Mon, 12 Sep 2011 04:00:00 +0100

The objective of the present study was to quantify the reliability of the histopathologic analysis of bone with respect to the diagnosis of diabetic foot OM. Four pathologists, kept unaware of the previous pathology reports and specific patient clinical characteristics, retrospectively reviewed 39 consecutive tissue specimens and were informed only that it was “a specimen of bone taken from a diabetic foot to evaluate for OM.” As a primary outcome measure, the pathologists were asked to make 1 of 3 possible diagnoses: (1) no evidence of OM, (2) no definitive findings of OM, but cannot rule it out, or (3) findings consistent with OM. There was complete agreement among all 4 pathologists with respect to the primary diagnosis in 13 (33.33%) of the 39 specimens, with a corresponding kappa ...

Mitigating Administrative Risks in Industry-sponsored Clinical Trials

Journal of Foot and Ankle Surgery — Mon, 12 Sep 2011 04:00:00 +0100

Industry sponsors often ask research directors to have their sites participate in clinical research trials: Phase I (first human trials and/or pharmacokinetic evaluation) through Phase IV (post-market evaluation). Industry sponsors need clinical trials in order to advance their drug or device through the FDA process to get it to market or for post-market analysis. Clinical trials are very expensive to industry sponsors ; therefore, they must identify potential clinical research trial sites that have a high probability of enrolling the necessary number of subjects . The sponsors mitigate their risks by selecting sites with proven track records for patient volume, by recruiting more sites than actually—statistically—are needed, and by creating milestones within the contract that act as i...

Journal of Foot and Ankle Surgery — Sat, 27 Aug 2011 19:43:39 +0100

(Source: Journal of Foot and Ankle Surgery)

Invitation to Authors to Submit Video Footage with Manuscripts

Journal of Foot and Ankle Surgery — Sat, 27 Aug 2011 19:43:39 +0100

(Source: Journal of Foot and Ankle Surgery)

Masthead

Journal of Foot and Ankle Surgery — Sat, 27 Aug 2011 19:43:39 +0100

(Source: Journal of Foot and Ankle Surgery)

Information for Subscribers

Journal of Foot and Ankle Surgery — Sat, 27 Aug 2011 19:43:39 +0100

(Source: Journal of Foot and Ankle Surgery)

Tubercular Osteomyelitis of the Second Metatarsal: A Case Report

Journal of Foot and Ankle Surgery — Sat, 27 Aug 2011 19:43:35 +0100

We describe a case of spina ventosa affecting the second metatarsal, with a review of the literature and description of the clinical manifestations, diagnostic images, and treatment of skeletal tuberculosis. (Source: Journal of Foot and Ankle Surgery)

Cigarette Smoking and Foot and Ankle Surgery

Journal of Foot and Ankle Surgery — Sat, 27 Aug 2011 19:43:30 +0100

It is generally known by foot and ankle surgeons that tobacco products are detrimental to wound healing and bone union, and numerous published reports have pointed this out . Smoking-induced oxidative stress alters inflammatory cell function and extracellular matrix turnover, which impair healing. Cigarette smoking not only delays healing but also increases the prevalence of wound infection and dehiscence . Interestingly, abstinence from smoking has been shown to restore inflammation, although it does not affect fibroblast proliferation, suggesting that cessation would reduce wound infection but not dehiscence . Another investigation showed that smoking cessation increased wound depth in a 5-mm experimental punch biopsy wound model and increased vitamin C and procollagen I N-propeptide whi...

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Journal of Foot and Ankle Surgery — Sat, 27 Aug 2011 19:43:30 +0100

(Source: Journal of Foot and Ankle Surgery)

The Taylor Spatial Frame™ for Correction of Neglected Fracture Dislocation of the Ankle

Journal of Foot and Ankle Surgery — Mon, 22 Aug 2011 04:00:00 +0100

We describe a case where a TSF was used to reduce and treat a 6-week-old fracture dislocation of the ankle. The TSF is a versatile device, which has a role in the management of both acute and neglected fractures. (Source: Journal of Foot and Ankle Surgery)

Proximal Phalangeal Osteotomy with Proximal Interphalangeal Joint Arthrodesis for Multiplanar Deformities of the Second Toe: Historical Perspectives and Review of a Case Series

Journal of Foot and Ankle Surgery — Mon, 22 Aug 2011 04:00:00 +0100

In this report, a review of previously described surgical techniques is presented, along with a retrospective analysis of 20 second toe surgical reconstructions, in 16 patients, performed between June 2003 and October 2010. Subjective outcomes were assessed by means of a mailed questionnaire, and a subset (15 second toes in 11 patients) returned for follow-up evaluation, including ascertainment of American Orthopaedic Foot & Ankle Society Clinical Rating System for Lesser Metatarsophalangeal-Interphalangeal Joint Surgery scores. Overall, the duration of follow-up was 38.25 ± 25.82 months, and the subset was followed up for 36.07 ± 27.95 months. The preoperative visual analog pain score was 4.9 ± 2.7, whereas the postoperative pain score was 1.6 ± 2.47 (p < .001). The preoperative Ameri...

Nonunion after Arthrodesis of the First Metatarsal-Phalangeal Joint: A Systematic Review

Journal of Foot and Ankle Surgery — Tue, 16 Aug 2011 04:00:00 +0100

Abstract: Arthrodesis of the first metatarsal-phalangeal joint (MTPJ) has been proposed for treatment of first MTPJ pathology because of the perceived safety and efficacy. Nonunion of the arthrodesis site has been purported as a common complication. The author undertook a systematic review of the electronic databases and other relevant sources to identify material relating to the incidence of nonunion and other complications after arthrodesis of the first MTPJ. In an effort to procure the highest quality studies available, the studies were eligible for inclusion only if they involved patients undergoing arthrodesis of the first MTPJ using modern osteosynthesis techniques (1980 onward time restriction), included a minimum of 30 feet in the publication, and evaluated patients at a mean follo...

Management of Valgus Extra-articular Calcaneus Fracture Malunions with a Lateral Opening Wedge Osteotomy

Journal of Foot and Ankle Surgery — Tue, 16 Aug 2011 04:00:00 +0100

Abstract: A total of 34 cases of symptomatic valgus deformity of the hindfoot secondary to a malunited extra-articular calcaneal fracture were corrected with laterally based open wedge calcaneal osteotomy. The pre- and postoperative radiographic parameters were compared, and a postoperative clinical evaluation was performed using the American Orthopedic Foot and Ankle Society ankle and hindfoot scoring system. The mean follow-up period was 56.2 (range 24.1 to 97) months. The most significant radiographic changes were improvement in the talonavicular coverage angle (mean 17.3°) on the anteroposterior view. The mean postoperative American Orthopedic Foot and Ankle Society hindfoot and ankle score was 90, with 23 excellent, 8 good, and 3 poor results. Laterally based opening wedge osteotomy ...

Early Clinical Results of the BOX Ankle Replacement Are Satisfactory: A Multicenter Feasibility Study of 158 Ankles

Journal of Foot and Ankle Surgery — Tue, 16 Aug 2011 04:00:00 +0100

Abstract: A new design for a 3-part ankle replacement was developed in an effort to achieve compatibility with the naturally occurring ligaments of the ankle by allowing certain fibers to remain isometric during passive motion. In order to test the design concept clinically, 158 prostheses were implanted in 156 patients within a 9-center trial and were followed up for a mean of 17 (range 6 to 48) months. The mean age at the time of surgery was 60.5 (range 29.7 to 82.5) years. Outcome measures included the American Orthopaedic Foot & Ankle Surgery hindfoot-ankle score and range of motion measured on lateral radiographs of the ankle. The preoperative American Orthopaedic Foot & Ankle Surgery score of 36.3 rose to 74.6, 78.6, 76.4, and 79.0, respectively, at 12, 24, 36, and 48 months. A signi...

Perforator-based Pacman Flap in the Plantar Region

Journal of Foot and Ankle Surgery — Mon, 08 Aug 2011 04:00:00 +0100

We describe a method of plantar soft tissue reconstruction using a perforator-based Pacman flap to cover the circular defects after wide excision in cases of plantar malignancy. Eight patients who underwent plantar reconstruction between September 2008 and February 2011 were reviewed in the present study. Of the 8 patients, 6 had malignant melanoma, 1 had basosquamous basal cell carcinoma, and 1 had squamous cell carcinoma. Medial (5 patients) and lateral (3 patients) plantar artery perforator-based Pacman flaps were used. All flaps provided satisfactory coverage of the soft tissue defects in the plantar region, and all patients achieved a good functional outcome after a mean follow-up of 13 (range 2 to 22) months. The median patient age was 54 (range 26 to 67) years. The median maximum di...

A Rare Case of Cryptococcal Infection of Talus with Pathological Fracture That Healed with Medical Management

Journal of Foot and Ankle Surgery — Mon, 08 Aug 2011 04:00:00 +0100

Abstract: Skeletal involvement occurs in 5% to 10% of reported cases of disseminated cryptococcal infection. We are reporting a very rare presentation of cryptococcal infection of the talus with pathological fracture, which healed with medical management. Our patient had pain and swelling around the ankle associated with fever. Radiologically, he had a lytic lesion of the talus with fracture of the talar neck. Biopsy and cultures revealed cryptococcal infection. He was treated with surgical debridement combined with antifungal therapy, and the fracture healed well by 5 months. At the end of the 1-year follow-up, he had painless ankle movement and there was no evidence of recurrence. He was able to walk without support or limp, and he could wear normal footwear. (Source: Journal of Foot and...

Metal-reinforced Cement Augmentation for Complex Talar Subsidence in Failed Total Ankle Arthroplasty

Journal of Foot and Ankle Surgery — Fri, 05 Aug 2011 04:00:00 +0100

In this report, we describe a unique method of restoring talar support and preserving ankle function after failed TAA with major talar bone loss and component subsidence. Talar reconstruction using metal-reinforced bone cement augmentation is combined with the Inbone (Wright Medical Technology, Inc., Arlington, TN) total ankle system to restore talar height and ligamentous support. This technique has been used successfully in the last 4 years for various patterns of talar bone loss and obviates the need for custom components. When successfully performed, the revision technique results in restoration of mechanical alignment, anatomic height, and component support, in addition to providing substantial symptomatic relief. (Source: Journal of Foot and Ankle Surgery)

Longitudinal Tears of Peroneus Longus and Brevis Tendons: A Gouty Infiltration

Journal of Foot and Ankle Surgery — Fri, 05 Aug 2011 04:00:00 +0100

Abstract: The natural history of recurrent uric acid deposition includes joint destruction, as well as tendon weakening and rupture. Simultaneous rupture of the peroneus longus and brevis tendons secondary to tophaceous gout is very rare. In the present report, we describe the case of a 37-year-old man who had a history of recurrent ankle pain and 4 previous episodes of acute gout localized to his ipsilateral first metatarsophalangeal joint. The physical examination revealed the ankle pain to actually be localized to the peroneal tendons immediately distal to the fibular malleolar groove. Magnetic resonance imaging showed longitudinal tears in the peroneus longus and brevis. Surgical exploration and repair of the ruptured tendons revealed the presence of monosodium urate deposition within ...

An Unusual Cause of Intractable Heel Pain

Journal of Foot and Ankle Surgery — Wed, 03 Aug 2011 04:00:00 +0100

We report a case of severe heel pain that did not respond to noninvasive measures. Magnetic resonance imaging scans revealed a soft tissue mass that after complete surgical excision was found to be an epidermal cyst. The patient experienced full resolution of the symptoms after excision of the epidermal cyst. To our knowledge, intractable heel pain due to an epidermal cyst is rare. We were unable to identify a previous publication describing the presence of an epidermal cyst localized to the heel without a history of previous trauma. From our experience with the present case, we believe that clinicians should consider the possibility of an epidermal inclusion cyst and should have a low threshold for obtaining magnetic resonance imaging scans, in particular, before the initiation of invasiv...

Mechanical Comparison of Two Types of Fixation for Ludloff Oblique First Metatarsal Osteotomy

Journal of Foot and Ankle Surgery — Wed, 03 Aug 2011 04:00:00 +0100

Abstract: The Ludloff oblique metatarsal osteotomy is an effective method to correct hallux valgus deformity, although a number of problems have been associated with it, including inherent instability, delayed union, dorsal malunion, and fixation failure. The purpose of the present study was to compare the mechanical characteristics of fixation of the Ludloff osteotomy in 20 identical synthetic bone models, 10 fixated using 2 screws (group I) and 10 fixated using 2 screws augmented with a mini locking plate (group II). Each specimen was loaded to failure, and the mean average load to failure, stiffness, and absorbed energy to failure were compared using unpaired Student’s t test. The mean average stiffness of the Ludloff osteotomy fixed with 2 screws (group I) and with the supplementary ...

Use of an Acrylic Mold for Mortise View Improvement in Ankle Fractures: A Feasibility Study

Journal of Foot and Ankle Surgery — Tue, 19 Jul 2011 23:00:00 +0100

Abstract: We investigated an acrylic mold for use in obtaining ankle radiographs in 31 consecutive patients with ankle fracture. The radiologic examination consisted of routine lateral and mortise views, with the same views procured with the use of the acrylic mold to position the ankle. Radiographic evidence of ankle displacement was ascertained using both sets of radiographs, and 3 radiographic spaces (lateral talofibular, central talotibial, and medial talotibial) were considered identifiable on the mortise view. The routine radiographs identified 58 joint spaces (62.37%) and the use of the acrylic mold showed 74 (79.57%; p (Source: Journal of Foot and Ankle Surgery)

Periosteal Osteosarcoma of the Fifth Metatarsal: A Rare Pedal Tumor

Journal of Foot and Ankle Surgery — Sun, 17 Jul 2011 23:00:00 +0100

Abstract: Periosteal osteosarcoma is a rare pedal chondroblastic osteosarcoma that rarely involves the medullary bone. In the present report, we describe the case of a woman who presented with a periosteal osteosarcoma localized to her left foot. (Source: Journal of Foot and Ankle Surgery)

Deep Vein Thrombosis after Bunionectomy: A Case Report of Two Genetic Mutations

Journal of Foot and Ankle Surgery — Mon, 11 Jul 2011 04:00:00 +0100

Abstract: Deep venous thrombosis after foot and ankle surgery is a serious complication that can have potentially life-threatening complications, such as pulmonary embolus. Genetic mutations have been reported in the published data to cause an increased risk of developing deep vein thrombosis. Two such genetic mutations are the methylenetetrahydrofolate reductase gene variant C677T and the 4G/5G polymorphism of the plasminogen activator inhibitor gene. This case report presents a female patient who developed a postoperative deep vein thrombosis after hallux valgus reconstruction. A hypercoagulable panel revealed the 2 mentioned genetic mutations. We hope this case study will highlight the importance of ascertaining all patient risk factors and the relation to perioperative deep vein thromb...

Double Calcaneal Osteotomy Using Single, Dual-function Screw Fixation Technique

Journal of Foot and Ankle Surgery — Fri, 08 Jul 2011 04:00:00 +0100

Abstract: Historically, a variety of fixation techniques for calcaneal osteotomies have been used. The prevention of postoperative sequelae, including delayed or nonunion of the osteotomy sites and minimization of soft tissue damage, is always a primary consideration for foot and ankle surgeons. The present report describes a fixation technique for a double calcaneal osteotomy that entails use of a single screw that functions as both a positional tool, as well as a compressive fixation device. This technique provides compressive and positional qualities and decreases the amount of soft tissue disruption to the surgical site. (Source: Journal of Foot and Ankle Surgery)

Posterior Approach Using Anterior Ankle Arthrodesis Locking Plate for Tibiotalocalcaneal Arthrodesis

Journal of Foot and Ankle Surgery — Thu, 07 Jul 2011 23:00:00 +0100

Abstract: Tibiotalocalcaneal arthrodesis is a successful treatment for patients with severe pain and functional disability in the ankle and subtalar joint. Patients with post-traumatic ankle and subtalar joint arthritis, and/or Charcot deformity, often present with compromised skin and soft tissue structures. In the present report, we describe a technique using an anterior ankle arthrodesis locking plate placed posteriorly to obtain hindfoot and ankle fusion. This technique, which uses the well vascularized, thick, posterior soft tissue envelope, provides very good exposure of the articular surfaces for resection and tibiotalocalcaneal fusion. The technique provides a valuable option for patients with compromised skin and soft tissue structures over aspects of the ankle that make other app...

Use of Expanded Reverse Sural Artery Flap in Lower Extremity Reconstruction

Journal of Foot and Ankle Surgery — Mon, 04 Jul 2011 04:00:00 +0100

Abstract: Coverage of defects of the distal third portion of the leg and foot remains a challenge for surgeons. The difficulty results from the limited mobility and availability of the overlying skin, the weight-bearing requirements, and the relatively poor circulation of the skin. From January 2008 to December 2009, 10 patients had defects of the foot and ankle covered using the 2-stage expanded reverse sural flap. Of these 10 patients, 6 had at least 1 risk factor for compromised wound healing, such as diabetes mellitus, peripheral arterial disease, venous insufficiency, tobacco smoking, or age older than 40 years. Flap necrosis was observed in only 1 patient (10%). Venous congestion was noted in 2 patients (20%) by the third postoperative day, 1 of whom responded to postural elevation o...

Effect of WF10 (Immunokine) on Diabetic Foot Ulcer Therapy: A Double-blind, Randomized, Placebo-controlled Trial

Journal of Foot and Ankle Surgery — Mon, 04 Jul 2011 04:00:00 +0100

Abstract: This randomized controlled trial was undertaken to evaluate the effect of WF10 (Immunokine) as an adjunct to the standard treatment of diabetic foot ulcer. A total of 40 participants were randomized into 2 groups of 20. One group underwent standard therapy combined with infusions of WF10, and 1 underwent standard therapy combined with placebo. The wound severity scores, which vary with the severity of infection and inflammation, necrotic and granulation tissues, and wound depth and area, were assessed weekly for 9 weeks. Before treatment, the wound severity scores were not significantly different statistically between the 2 groups (13.7 ± 2.8 and 12.9 ± 3.2). After 9 weeks, the WF10 group had a statistically significant decreased wound severity score compared with that of the p...

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Journal of Foot and Ankle Surgery — Sun, 03 Jul 2011 23:00:00 +0100

I also appreciated the letter from Drs. Barske and Baumhauer, as their concerns are well grounded and make clear the intuitive nature of assignment of a level of clinical evidence. I also appreciate Dr. DiDomenico's comments. (Source: Journal of Foot and Ankle Surgery)

Treadway’s Lasting Contribution to Surgical Residency Training

Journal of Foot and Ankle Surgery — Sun, 03 Jul 2011 23:00:00 +0100

Beginning this year, the Council on Podiatric Medical Education (CPME) will only accredit 3-year postgraduate programs. Next year will mark the 40th anniversary of the death of James C. Treadway, DPM, a man whose name is virtually unknown to most doctors of our era. Unfortunately, history has neglected to recognize a man who played a key role in the growth of our postgraduate education and whose contributions helped to change the face of the profession. In an era in which the 3-year postgraduate residency is standard, we are long overdue in recognizing the key person in the expansion of residency programs, who initiated his work at a time when some members of the profession questioned the need for hospital-based postgraduate training. (Source: Journal of Foot and Ankle Surgery)

Journal of Foot and Ankle Surgery — Tue, 28 Jun 2011 01:03:39 +0100

(Source: Journal of Foot and Ankle Surgery)

Invitation to Authors to Submit Video Footage with Manuscripts

Journal of Foot and Ankle Surgery — Tue, 28 Jun 2011 01:03:39 +0100

(Source: Journal of Foot and Ankle Surgery)

Masthead

Journal of Foot and Ankle Surgery — Tue, 28 Jun 2011 01:03:39 +0100

(Source: Journal of Foot and Ankle Surgery)

Information for Subscribers

Journal of Foot and Ankle Surgery — Tue, 28 Jun 2011 01:03:39 +0100

(Source: Journal of Foot and Ankle Surgery)

The Hematoma Block: A Simple, Effective Technique for Closed Reduction of Ankle Fracture Dislocations

Journal of Foot and Ankle Surgery — Tue, 28 Jun 2011 01:03:39 +0100

Abstract: Management of a dislocated ankle fracture can be challenging because of instability of the ankle mortise, a compromised soft tissue envelope, and the potential neurovascular compromise. Every effort should be made to quickly and efficiently relocate the disrupted ankle joint. Within the emergency department setting, narcotics and benzodiazepines can be used to sedate the patient before attempting closed reduction. The combination of narcotics and benzodiazepines provides relief of pain and muscle guarding; however, it conveys a risk of seizure as well as respiratory arrest. An alternative to conscious sedation is the hematoma block, or an intra-articular local anesthetic injection in the ankle joint and the associated fracture hematoma. The hematoma block offers a comparable amou...

Misdiagnosis of OTA Type B (Weber B) Ankle Fractures Leading to Nonunion

Journal of Foot and Ankle Surgery — Tue, 28 Jun 2011 01:03:35 +0100

Abstract: Little is known about the specific etiology of nonunion of stable Orthopaedic Trauma Association (OTA) type B fractures. In the present retrospective cohort study, we investigated all patients with a nonunion in a level 1 trauma center during an 8.5-year period. Patient history, clinical findings, radiographic features, and therapeutic aspects were critically evaluated to be able to predict the nonunion. In the predefined period, 388 patients were treated for a stable OTA type B fracture. Eight patients (2.1%) developed a nonunion. Retrospectively, the radiographic features in 6 of the 8 patients and clinical findings in 1 of the 8 patients could predict the nonunion. We conclude that in almost every nonunion occurring after a “stable” OTA type B fracture in the present study...

Displacement of the Anterior Process of the Calcaneus after Evans Calcaneal Osteotomy

Journal of Foot and Ankle Surgery — Tue, 28 Jun 2011 01:03:34 +0100

Abstract: The Evans calcaneal osteotomy is an invaluable tool in the correction of pediatric collapsing pes planovalgus. It has traditionally been performed without the use of fixation. Recently, however, fixation of the Evans osteotomy has been proposed to prevent displacement. A retrospective radiographic study was performed of 33 patients (50 feet) to examine the amount of displacement of the anterior process after performing the Evans osteotomy without fixation. The anterior process height was measured digitally from the radiographs on the lateral view preoperatively, at approximately 6 weeks postoperatively, and at the final follow-up visit. The patients were followed up to a mean of 30.57 (range, 6 to 107) weeks postoperatively. The anterior process showed a statistically significant...

Identifying Risk Factors in Subtalar Arthroereisis Explantation: A Propensity-matched Analysis

Journal of Foot and Ankle Surgery — Tue, 28 Jun 2011 01:03:34 +0100

This study helps identify key factors that may result in subtalar arthroereisis explantation. (Source: Journal of Foot and Ankle Surgery)

Arthroplasty or Arthrodesis

Journal of Foot and Ankle Surgery — Tue, 28 Jun 2011 01:03:33 +0100

Until recently, the gold standard intervention for advanced ankle arthrosis was arthrodesis. Advancements in total ankle replacement (TAR) techniques, however, have moved arthroplasty forward to become a legitimate alternative to fusion. On the one hand, the traditional advantages of fusion include the relative ease of the technique, the ready availability of implants and instruments, and a long track record of success, particularly for pain relief. On the other hand, TAR preserves or even improves motion while providing relief from pain. When one considers the basic goals of most reconstructive surgical procedures—namely, pain relief, improved function, and deformity correction—the fact that TAR is associated with improved ankle motion makes it easy to understand why successful arthro...

Trabecular Quality and Cellular Characteristics of Normal, Diabetic, and Charcot Bone

Journal of Foot and Ankle Surgery — Mon, 27 Jun 2011 04:00:00 +0100

Abstract: Charcot neuroarthropathy (CN) is a disabling and devastating condition that affects many neuropathic diabetic patients. It can lead to foot deformity, ulceration, and lower extremity amputation. The pathogenesis of CN is not clear, but 1 possible predisposing factor is increased bone turnover and increased osteoclastic activity. Although the affect of diabetes on bone is not entirely clear, studies have shown increased bone fragility in diabetics with neuropathy. The purpose of the present study was to compare the bone quality histologic findings and trabecular histomorphometry, including the cellular characteristics, between normal subjects (N = 7), diabetics without CN (N = 8), and diabetics with CN (N = 8). Histologically, the bone in diabetics with CN displayed an inflammato...

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Journal of Foot and Ankle Surgery — Sun, 26 Jun 2011 23:00:00 +0100

I am pleased to note the concerns that Drs. Barske and Baumhauer have raised in regard to our published report. We felt the most objective evidence was the radiographic “physical changes”—something definitive and measurable. We did not feel there was a need to compare, as there are many ways in which one could compare (what set of procedures to perform). Additionally, the other procedures such as a flexor digitorum longus transfer are well reported. Our intention was to demonstrate that the surgeon does not have to perform this additional surgery in such cases of posterior tibial tendon dysfunction II and III. When a patient has tendinosis/tendonitis, etc., that is not responsive to nonoperative care, this procedure works well. (Source: Journal of Foot and Ankle Surgery)

Necrosis of the Ungual Process of Great Toe as Cause for Long-standing Disabling Pain: A Case Report

Journal of Foot and Ankle Surgery — Sun, 26 Jun 2011 23:00:00 +0100

We report a case of necrosis of the ungual process of the great toe, which caused longstanding disabling pain in a 34-year-old woman. After a 3-year history of unsuccessful conservative treatment, surgical excision led to complete and persistent relief of the symptoms. Although rare, idiopathic osteonecrosis, even small in size, should be taken into consideration in patients who complain of pain of the foot and lacking conclusive etiologic evidence. (Source: Journal of Foot and Ankle Surgery)

Use of an Anti-gravity Treadmill in the Rehabilitation of the Operated Achilles Tendon: A Pilot Study

Journal of Foot and Ankle Surgery — Thu, 23 Jun 2011 23:00:00 +0100

Abstract: Achilles surgical patients were evaluated using an “anti-gravity” Alter-G (AG) treadmill that allows for reduction of weightbearing pressure on the lower extremity. We studied our hypothesis, which was based on our prior clinical findings, that being able to run on the AG treadmill at 85% of body weight is sufficient to clear patients to run with full body weight outside. Patients undergoing Achilles tendon rupture or insertional repair surgery were prospectively studied. They were compared with a control group that had similar surgeries and a similar rehabilitation program during the same time period: the variable was not using the AG treadmill. The criteria for the study group to be allowed to run outside was being able to run for at least 10 minutes on the AG at 85% of bod...

Treatment of Jones Fracture Nonunion with Isolated Intramedullary Screw Fixation

Journal of Foot and Ankle Surgery — Sun, 19 Jun 2011 23:00:00 +0100

Abstract: Although the treatment of acute Jones fractures is well described in published studies, the Jones fracture nonunion is more controversial with regard to treatment. Although nonoperative treatment is an option, surgery is the usual course. We conducted a retrospective case series of 7 patients (1 man and 6 women; age range 39 to 54 years), who were initially treated nonoperatively for acute Jones fractures. They went on to develop nonunions and were treated with intramedullary screw fixation. All patients had healed radiographically by 11 weeks postoperatively. One screw (14.29%) required removal because of irritation. None of the patients to date have experienced a new fracture. Our results indicate that intramedullary screw fixation alone without bone grafting is a viable option...

Structural and Functional Modulation of Early Healing of Full-thickness Superficial Digital Flexor Tendon Rupture in Rabbits by Repeated Subcutaneous Administration of Exogenous Human Recombinant Basic Fibroblast Growth Factor

Journal of Foot and Ankle Surgery — Fri, 17 Jun 2011 04:00:00 +0100

Abstract: The present study was designed to investigate the effects of basic fibroblast growth factor on the healing of the acute phase of complete superficial digital flexor tendon rupture in rabbits. A total of 40 skeletally mature female white New Zealand rabbits were randomly divided into 2 equal groups of injured treated and injured control. After tenotomy and surgical anastomosis, using a modified Kessler and running pattern, the injured legs were placed in casts for 14 days, and basic fibroblast growth factor was injected subcutaneously over the lesion on days 3, 7, and 10 after injury. The injured control rabbits received a normal saline injection in a similar protocol. The rabbits' weight, tendon diameter, clinical signs, radiographs, and ultrasound scans were evaluated weekly. Th...

Interval Changes in Postoperative Range of Motion of Salto-Talaris Total Ankle Replacement

Journal of Foot and Ankle Surgery — Thu, 16 Jun 2011 23:00:00 +0100

Abstract: The purpose of the present study was to identify changes in the range of motion during the first year after placement of the Salto-Talaris total ankle implant. The first 97 cases were assessed throughout the year at 6 weeks and 3, 6, and 12 months. Data were extracted through retrospective chart review, operative reports, and electronic goniometry of the implant in maximal dorsiflexion and plantarflexion. The range of motion incrementally improved through the treatment course, with the greatest increases occurring between 6 weeks and 6 months. The mean range of motion at 6 weeks was 11.85° ± 0.824° standard error, which had increased by 3.07° ± 0.862° to 14.92° (p < .0001) at 3 months postoperatively. From 3 to 6 months, it increased 3.96° ± 0.981° to 18.88° (p < .0001...

Radiographic Evaluation of Navicular Position in the Sagittal Plane—Correction Following an Extraosseous Talotarsal Stabilization Procedure

Journal of Foot and Ankle Surgery — Thu, 16 Jun 2011 23:00:00 +0100

Abstract: The navicular drop in the sagittal plane on weight-bearing is a valid indicator of foot pronation. Dislocation of the talus on the tarsal mechanism results in hyperpronation, which can lead to excessive navicular drop. The purpose of the present study was to radiographically determine the efficacy of HyProCure® in realigning the navicular bone in hyperpronating feet. We hypothesized that following the placement of HyProCure®, the navicular height would increase significantly compared to its preoperative value. Radiographs of 61 adult patients (86 feet) who received HyProCure® without adjunctive hindfoot or midfoot soft tissue or osseous procedures were analyzed. The distance of the navicular with respect to the cuboid was measured from the pre- and postoperative weight-bearing...

Outcomes after the Stainsby Procedure in the Lesser Toes: An Alternative Procedure for the Correction of Rigid Claw Toe Deformity

Journal of Foot and Ankle Surgery — Thu, 16 Jun 2011 23:00:00 +0100

This study demonstrates this simple technique is reproducible and effective in reducing morbidity. (Source: Journal of Foot and Ankle Surgery)

Comparison of Ponseti Versus Surgical Treatment in Congenital Talipes Equinovarus

Journal of Foot and Ankle Surgery — Wed, 15 Jun 2011 23:00:00 +0100

Abstract: In the present study we compared the rate of relapse after conservative Ponseti treatment method with that of a historical cohort who underwent conventional operative treatment. From June 2002 to December 2004, 70 patients presented with 107 clubfeet and started Ponseti treatment. Of these 70 patients, 9 (15 feet) were excluded because of a teratologic deformity. Thus, 50 patients with 75 clubfeet were studied (41 [82%] boys and 9 [18%] girls). Data were compiled from the clinic assessment forms and patient notes. All cases resulting in recasting or additional operative procedures were regarded as failure of conservative treatment. The minimum follow-up period was 2 years or failure of the Ponseti method within this period. These data were then compared with the published data fr...

Use of Remodeled Femoral Head Allograft for Tarsal Reconstruction in the Treatment of Müller-Weiss Disease

Journal of Foot and Ankle Surgery — Mon, 13 Jun 2011 04:00:00 +0100

Abstract: Müller-Weiss disease (MWD), spontaneous avascular necrosis of the navicular in adults, is rare. Without treatment, it can result in permanent disability. Operative treatment is often required. MWD was suspected in a 51-year-old woman with spontaneous pain in her right foot. The radiologic tests showed a comma shaped deformed navicular and severe talonavicular necrosis and sclerosis. After excision of the necrotic navicular, a 5 × 5 × 3-cm defect appeared. A femoral head bone allograft was remodeled to fit this defect precisely. Autologous cancellous bone was also used. The allograft interposition arthrodesis was stabilized with a low contact plate. The histopathologic results showed avascular osteonecrosis, supporting the diagnosis of MWD. After 12 weeks of non–weight-beari...

Correction of Longitudinal Epiphyseal Bracket Disease with External Fixation: A Case Report with 6-year Follow-up Period

Journal of Foot and Ankle Surgery — Mon, 13 Jun 2011 04:00:00 +0100

We present the case of a 9-year-old patient with longitudinal epiphyseal bracket disease of the first metatarsal. The abnormality was surgically treated by bracket osteotomy with callus distraction before physeal closure. At 6 years of follow-up, the patient displayed a relatively normal looking cosmetic foot compared with the contralateral foot. A mild residual hallux varus was noted, with maintenance of the forefoot parabola. Surgical correction resulted in alteration of the first intermetatarsal angle and the first metatarsophalangeal angle. The first intermetatarsal angle decreased from a preoperative value of −30° to a postoperative value of 10°. The first metatarsophalangeal angle decreased from a preoperative value of 36° of hallux varus to a postoperative value of 4°. The len...

Septic Arthritis of the Adult Ankle Joint Secondary to Salmonella enteritidis: A Case Report

Journal of Foot and Ankle Surgery — Sun, 12 Jun 2011 23:00:00 +0100

Abstract: Salmonella septic arthritis in healthy individuals is a rare phenomenon. However, septic arthritis of the native adult ankle joint in healthy patients has not been previously described in the published data. This is a case report of a 70-year-old farmer who presented with a 2-week history of a painful, swollen right ankle and an inability to bear weight. He had no history of ankle injury or any predisposing conditions. Joint aspirations were positive for Salmonella enteritidis that was successfully treated with right ankle arthrotomy and washout, along with a 6-week course of intravenous antibiotic therapy. (Source: Journal of Foot and Ankle Surgery)

Pathologic Fracture of a Calcaneal Aneurysmal Bone Cyst

Journal of Foot and Ankle Surgery — Thu, 09 Jun 2011 04:00:00 +0100

Abstract: A 21-year-old man presented with a pathologic fracture through the posterior aspect of the calcaneus into an aneurysmal bone cyst. The patient was treated using curettage, phenol, alcohol, and burr with open reduction and internal fixation. This is the first reported case of a pathologic fracture of an aneurysmal bone cyst of the calcaneus, highlighting the fracture potential of these lesions and the need for early management. (Source: Journal of Foot and Ankle Surgery)

Quantification and Perception of On-call Podiatric Surgical Resident Workload

Journal of Foot and Ankle Surgery — Wed, 08 Jun 2011 23:00:00 +0100

Abstract: The general assumption inherent to the design of podiatric surgical residency programs is that all residents will have comparable experiences in terms of patient care interactions and workload throughout their training. Despite this, there is usually the perception that certain residents consistently have greater or smaller workloads when on-call and are considered “black clouds” or “white clouds,” respectively. During a prospective investigational period of 1 year, on-call podiatric residents at a level 1 trauma center recorded their workload on a nightly basis in terms of three variables: pages/telephone calls, consultations, and hospital admissions. The results of these data suggest that all residents shared a similar workload during the study period without a clinical...

Posterolateral Approach for Treatment of Posterior Malleolus Fracture of the Ankle

Journal of Foot and Ankle Surgery — Sun, 05 Jun 2011 23:00:00 +0100

Abstract: Treatment of the posterior malleolus has been debated among orthopedic surgeons. Most orthopedic surgeons will fix the posterior malleolus if it is larger than 25% to 30% of the distal articular surface. The most common method of fixation of the posterior malleolus is by indirect reduction and anteroposterior screws. In the present study, we describe the technique and results of treatment of the posterior malleolus by direct reduction through the posterolateral approach to the ankle. The decision to fix the posterior malleolus was determined by its size and displacement. A total of 12 consecutive patients underwent the posterolateral approach to reduce the posterior malleolus, and these were fixed by posterior plate. Two patients were lost to follow-up in the early postoperative ...

Arthroscopic Tibiotalocalcaneal Arthrodesis with Intramedullary Nail with Fins: A Case Series

Journal of Foot and Ankle Surgery — Sun, 05 Jun 2011 23:00:00 +0100

Abstract: Arthroscopic arthrodesis of the ankle has several advantages compared with open arthrodesis, including a smaller skin incision, less damage to the soft tissue around the joint, a lower risk of skin necrosis and infection, a lower incidence of postoperative infection and swelling, and better preservation of the contour of the surface of the joint, which maintains a larger contact area between the talus and tibia. We successfully performed arthroscopic arthrodesis of the tibiotalocalcaneal joints with intramedullary nails with fins in 9 ankles of 8 patients. Solid fusion was attained in all cases, except for 1 case of nonunion at the subtalar joint. We also corrected the alignment in 1 patient with a varus deformity. The fixation was strong, even in the case of poor bone quality, s...

Hallux Varus as Complication of Foot Compartment Syndrome

Journal of Foot and Ankle Surgery — Sun, 05 Jun 2011 23:00:00 +0100

Abstract: Hallux varus can present as a congenital deformity or it can be acquired secondary to trauma, surgery, or neuromuscular disease. In the present report, we describe the presence of hallux varus as a sequela of calcaneal fracture with entrapment of the medial plantar nerve in the calcaneal tunnel and recommend that clinicians be wary of this when they clinically, and radiographically, evaluate patients after calcaneal fracture. (Source: Journal of Foot and Ankle Surgery)

Osteochondritis Dissecans of the First Metatarsophalangeal Joint: Arthroscopy and Microfracture Technique

Journal of Foot and Ankle Surgery — Wed, 01 Jun 2011 23:00:00 +0100

Abstract: Osteochondritis dissecans (OCD) is a localized disorder of the joint surface by which a segment of subchondral bone and its overlying cartilage become fragmented. Arthroscopic treatment of OCD of the first metatarsophalangeal joint consisted mainly of debridement and loose body removal. The microfracture technique for the treatment of OCD of the first metatarsophalangeal joint is presented for the first time. The technique has been shown to be a safe and technically uncomplicated first-line treatment. (Source: Journal of Foot and Ankle Surgery)

Functional Outcomes after Fibula Locking Nail for Fragility Fractures of the Ankle

Journal of Foot and Ankle Surgery — Wed, 01 Jun 2011 23:00:00 +0100

Abstract: The aim of the present study was to assess the functional outcome of fragility fractures of the ankle treated with a fibular locking nail. A retrospective review of 24 patients with fragility fractures treated with a fibular locking nail from January 2005 to December 2007 was performed. The fibular nail used in our study was Biomet SST (stainless steel taper) small bone locking nail for the fibula. The Olerud and Molander scale was used to assess the functional outcome at the end of 1 year. The domains of the Olerud and Molander scale are pain, stiffness, swelling, stair climbing, running, jumping, squatting, support, and the activities of daily living. The patients were interviewed by telephone or the questionnaire was send by mail. Of the 24 patients, 2 were men and 22 were wom...

Lateral Subtalar Dislocation Associated with Bimalleolar Fracture: Case Report and Literature Review

Journal of Foot and Ankle Surgery — Sun, 29 May 2011 23:00:00 +0100

We report the case of a 62-year-old woman diagnosed with lateral subtalar dislocation accompanied by an ipsilateral bimalleolar fracture after a fall downstairs. She underwent emergency reduction of the dislocation under sedation. Surgical treatment of the bimalleolar fracture was delayed 9 days to avoid cutaneous complications. This is the first report of a subtalar dislocation accompanied by a bimalleolar fracture. (Source: Journal of Foot and Ankle Surgery)

Nodular Excision for Painful Localized Achilles Tendon Xanthomas in Type II Hyperlipoproteinemia: A Case Report

Journal of Foot and Ankle Surgery — Sun, 29 May 2011 23:00:00 +0100

We describe the case of bilateral painful Achilles tendon xanthomas in a heterozygous type II hyperlipoproteinemia family. Her symptoms were not alleviated despite anti-inflammatory medication and eccentric exercise for 6 months. She was treated with nodular excision of the xanthomas bilaterally and then with postoperative statins to avoid recurrence. (Source: Journal of Foot and Ankle Surgery)

Interphalangeal Dislocation of Toes: A Retrospective Case Series and Review of the Literature

Journal of Foot and Ankle Surgery — Sun, 29 May 2011 23:00:00 +0100

Abstract: Although not uncommon, dislocation of the toes, including that of the great toe, is not commonly reported in published studies. In the present report, we describe a series of 18 patients with toe dislocations managed by our department from January 2001 to December 2007. We considered the radiographic pattern of injury in our series of patients. Of the 18 patients, 10 (55.56%) had their toe dislocations treated by closed reduction with or without internal fixation. Seven patients (38.89%) with complex dislocation, defined as open dislocation or dislocation not amenable to (failed attempt) closed reduction, that required open reduction and internal fixation. One patient (5.56%) with a dislocated toe declined to undergo any form of treatment. (Source: Journal of Foot and Ankle Surge...

Post-treatment Leukocytosis Predicts an Unfavorable Clinical Response in Patients with Moderate to Severe Diabetic Foot Infections

Journal of Foot and Ankle Surgery — Sun, 29 May 2011 23:00:00 +0100

Abstract: Our aim was to determine whether post-treatment laboratory values could help to predict the clinical response in patients with advanced diabetic foot infections. One hundred and three consecutive patients hospitalized for moderate or severe diabetic foot infections at a large, university-affiliated hospital were identified and their records retrospectively reviewed. Definitive therapy during each patient’s hospital course was defined as any foot surgery when additional major surgery was not anticipated or when a course of deep soft tissue and/or bone culture-specific antibiotics had been initiated. The clinical response was assessed at 90 days after the start of definitive therapy. A poor response was recognized as persistent infection at the initial or a contiguous site or whe...

Axial Loading Cross Screw Fixation for the Austin Bunionectomy

Journal of Foot and Ankle Surgery — Sun, 29 May 2011 23:00:00 +0100

We present the use of an axial loading screw in conjunction with a dorsally placed compression screw. The benefit to this technique lies in the orientation of the axial loading screw, because it is directed to resist the ground reactive forces while also providing a second point of fixation in a crossing screw design. In a head-to-head biomechanical comparison, we tested single dorsal screw fixation versus double screw fixation, including both the dorsal and the axial loading screws in 10 metatarsal Sawbones® (Pacific Research Laboratories Inc, Vashon, WA). Five metatarsals received single dorsal screw fixation and five received the dorsal screw and the additional axial loading screw. The metatarsals were analyzed on an Instron compression device for comparison; 100% of the single screw f...

Medial Fracture Line Significance in Calcaneus Fracture

Journal of Foot and Ankle Surgery — Sun, 29 May 2011 23:00:00 +0100

Abstract: In Sanders’ classification of calcaneus fractures, the medial fracture line (subtype C) is close to the tarsal canal, which contains an artery for the talus and calcaneus. We hypothesized that because of this brittle vascular localization, patients with C line fracture patterns might describe radiologic subtalar arthritis more often and have more complaints. The purpose of the present study was to compare the results of C line fracture patterns with other types of calcaneus fractures. A total of 25 surgically treated feet were involved. Regarding Sanders’ classification, group 1 included fractures involving the C line (11 feet), and group 2 included fractures not involving the C line (14 feet). Patient age at admission, trauma date, and interval until surgery were obtained fr...

Combined Total Ankle Replacement and Modified Bridle Tendon Transfer for End-stage Ankle Joint Arthrosis with Paralytic Dropfoot: Report of an Unusual Case

Journal of Foot and Ankle Surgery — Sun, 29 May 2011 23:00:00 +0100

In this report, we describe the unconventional combination of total ankle replacement in an adult patient with concomitant paralysis that was addressed by means of tendon transfer. (Source: Journal of Foot and Ankle Surgery)

Bilateral Clubfoot in Three Homozygous Preterm Triplets

Journal of Foot and Ankle Surgery — Fri, 27 May 2011 04:00:00 +0100

We present the case of monochorionic triplets with bilateral congenital idiopathic talipes equinovarus deformities. To the best of our knowledge, such a presentation has not been previously described and supports a genetic etiology of congenital idiopathic talipes equinovarus deformity. (Source: Journal of Foot and Ankle Surgery)

Lateral Leg Compartment Syndrome Caused by Ill-fitting Compression Stocking Placed for Deep Vein Thrombosis Prophylaxis During Surgery: A Case Report

Journal of Foot and Ankle Surgery — Thu, 26 May 2011 23:00:00 +0100

We present a case of a 44-year-old man with isolated lateral leg compartment syndrome caused by a compression stocking used for deep vein thrombosis prophylaxis during surgery. It was found to be excessively tight around the patient’s proximal calf postoperatively. He underwent lateral leg compartment fasciotomy and delayed wound closure with a split-thickness skin graft. At the 7-month follow-up visit, he had returned to full activity, had no muscle deficits, and had numbness in the distribution of the intermediate dorsal cutaneous nerve. (Source: Journal of Foot and Ankle Surgery)

Giant Cell Tumor of the Distal Phalanx of the Biphalangeal Fifth Toe: A Case Report and Review of the Literature

Journal of Foot and Ankle Surgery — Thu, 26 May 2011 23:00:00 +0100

We report an unusual case of giant cell tumor arising at the distal phalanx of the left biphalangeal fifth toe in a 13-year-old boy. This was treated successfully with curettage and packing with bone substitution. (Source: Journal of Foot and Ankle Surgery)

Subextensor Digitorum Brevis Abscess after Blunt Trauma

Journal of Foot and Ankle Surgery — Thu, 26 May 2011 23:00:00 +0100

We present an interesting case of a patient who presented after a fairly benign, low energy injury to the foot. The patient was found to have a submuscular abscess that was successfully managed with a surgical incision and drainage. (Source: Journal of Foot and Ankle Surgery)

Mycetoma or Synovial Sarcoma? A Case Report with Review of the Literature

Journal of Foot and Ankle Surgery — Thu, 26 May 2011 23:00:00 +0100

We present a case of a soft tissue mass diagnosed in the United States. The patient had several clinical and radiographic features of synovial sarcoma but the histologic outcome was mycetoma. The case is followed by a review of the published data. (Source: Journal of Foot and Ankle Surgery)

Reconstructive Options for Defects after Melanoma Excision in the Foot and Ankle Region

Journal of Foot and Ankle Surgery — Thu, 26 May 2011 23:00:00 +0100

Abstract: Cutaneous wounds created by excision of primary cutaneous melanoma localized to the foot and ankle can be challenging to reconstruct. A wide range of coverage techniques are available for wound coverage. The techniques we have found useful in this regard include skin grafts and flaps, as well as specialized wound dressings. In this techniques report, we describe the specialized anatomic surface subunits of the foot and ankle and the reconstructive coverage methods we have found useful for each site. (Source: Journal of Foot and Ankle Surgery)

Foot and Shoe Size Mismatch in Three Different New York City Populations

Journal of Foot and Ankle Surgery — Thu, 26 May 2011 23:00:00 +0100

In conclusion, our findings suggest that proper footwear sizing is lacking among a large proportion of our patients and that an adequate shoe size can be achieved with proper counseling. (Source: Journal of Foot and Ankle Surgery)

Outcome of Subtalar Fusion Using Bovine Cancellous Bone Graft: A Retrospective Case Series

Journal of Foot and Ankle Surgery — Thu, 26 May 2011 23:00:00 +0100

Abstract: Solvent preserved bovine cancellous bone graft (Tutobone®) has been promoted as an alternative to autologous bone graft. The aim of our study was to compare the outcomes of subtalar fusion in patients in whom Tutobone® was used with the outcomes in patients in whom it was not used. This was a retrospective comparative study. Tutobone® was used in 9 patients in the test group. Of these repairs, 6 were isolated subtalar fusions, and 3 were performed as a part of triple arthrodesis. A total of 17 patients were included in the control group; 4 underwent autologous iliac crest grafting and 13 received a local bone graft from excised joint surfaces. At 12 months after surgery, 8 of the 9 in the Tutobone® group had persistent pain and radiologic signs of nonunion confirmed on comput...

Tuberculosis of and around the Ankle

Journal of Foot and Ankle Surgery — Tue, 24 May 2011 23:00:00 +0100

We present a retrospective review of 16 patients with tuberculosis in and around the ankle joint who were surgically treated during a 6-year period. The incidence of ankle joint involvement in extraspinal osteoarticular tuberculosis was 15.7% in our unit. The most common presentation in our series was chronic septic arthritis, followed by periarticular osseous lytic lesion. Tuberculous synovitis, tenosynovits, and retrocalcaneal bursitis were also seen. Osteopenia, the hallmark of osteoarticular tuberculosis, might not be seen in all forms of tuberculosis affecting this joint. Chemotherapy remains the mainstay of treatment. Adjuvant surgery is often required to establish the diagnosis and in the treatment of patients with deformity and widespread destruction of articular cartilage owing to...

Endoscopic Excision of Symptomatic Nonunion of Anterior Calcaneal Process

Journal of Foot and Ankle Surgery — Sun, 22 May 2011 23:00:00 +0100

We present a case of symptomatic nonunion of the anterior calcaneal process that was successfully treated by endoscopic resection of the fragment. The adjacent structures can be examined arthroscopically for concomitant lesions and treated accordingly. (Source: Journal of Foot and Ankle Surgery)

Synovial Osteochondromatosis of the Second Metatarsophalangeal Joint: A Case Report

Journal of Foot and Ankle Surgery — Sun, 22 May 2011 23:00:00 +0100

In this report, we presented a case of synovial osteochondromatosis in the second metatarsophalangeal joint and reviewed the literature. (Source: Journal of Foot and Ankle Surgery)

Nonunion in Proximal Phalanx of Great Toe Treated by Grafting with Precisely Processed Autologous Bone Peg

Journal of Foot and Ankle Surgery — Sun, 22 May 2011 23:00:00 +0100

We report a rare case of nonunion in the proximal phalanx of the great toe treated by grafting with a precisely processed autologous bone peg. The concept of this surgical method was to fix the nonunion of the proximal phalanx of the great toe using press-fit fixation and a bone peg precisely formed to fit the medullary cavity similar to an intramedullary nail. We believe that our new technique is a viable alternative for the treatment of phalanx fractures or nonunions requiring bone grafts. (Source: Journal of Foot and Ankle Surgery)

Osteonecrosis of the Distal Tibia after a Pronation External Rotation Ankle Fracture: Literature Review and Management

Journal of Foot and Ankle Surgery — Sun, 22 May 2011 23:00:00 +0100

Abstract: Posttraumatic osteonecrosis of the distal tibia is a rare but recognized complication of Weber C ankle fractures. To our knowledge, we report the first documented case managed with early percutaneous drilling of the defect. The patient noticed an improvement in symptoms, and magnetic resonance imaging confirmed resolution of the avascular area. The previously reported complication of secondary periarticular collapse and subsequent osteoarthritis was avoided. We advocate that a high index of suspicion, early detection, and drilling can encourage neovascularisation and prevent secondary joint destruction. (Source: Journal of Foot and Ankle Surgery)

Ray Reduction of the Foot in the Treatment of Macrodactyly and Review of the Literature

Journal of Foot and Ankle Surgery — Sun, 22 May 2011 23:00:00 +0100

Abstract: Macrodactyly of the foot is a rare disorder characterized by enlargement of the soft tissue and osseous elements of the foot that impedes the development of normal function and gait. Despite the morbidity associated with this condition, many surgeons are reluctant to perform surgical reduction. In the present report, we describe 3 pediatric patients with pedal macrodactyly, who underwent surgical correction consisting of amputation of the most enlarged ray, reduction of the adjacent rays, and ray transposition, combined with debulking of soft tissues. All 3 patients subsequently developed a normal gait and were able to wear normal, or minimally adjusted, shoes. We advocate early surgical treatment of macrodactyly of the foot to enhance the development of normal function and gait....

The Radiographic Fate of the Syndesmosis after Trans-syndesmotic Screw Removal in Displaced Ankle Fractures

Journal of Foot and Ankle Surgery — Wed, 18 May 2011 23:00:00 +0100

Abstract: The purpose of this study was to evaluate the radiographic changes of the tibiofibular position and the ankle mortise after removal of trans-syndesmotic fixation to determine if there is loss or maintenance of correction. In addition, the effect of the type of rotational injury, early weight bearing, and the number of trans-syndesmotic screws used on the integrity of the inferior tibiofibular articulation or ankle mortise after screw removal were evaluated. An analysis was conducted of 86 patients, with an unstable rotational ankle fracture requiring open reduction with syndesmosis screw stabilization. Routine radiographic parameters were measured just after open reduction and just before syndesmotic screw removal. There was a high correlation of loss of the integrity of the synd...

Lapidus Arthrodesis with a Single Lag Screw and a Locking H-Plate

Journal of Foot and Ankle Surgery — Wed, 18 May 2011 23:00:00 +0100

Abstract: The aim of this pilot study was to assess if using an interfragmental lag screw and a Darco® locking H-plate for the modified Lapidus arthrodesis in the treatment of hallux abducto valgus deformity (1) would allow for earlier weight bearing than previously described and (2) would indicate whether any changes would occur radiographically with the earlier weight bearing. Twenty-one metatarsocuneiform arthrodeses, in 18 patients, were retrospectively evaluated through chart review and postoperative radiographs. Original diagnoses included painful hallux abducto valgus and osteoarthritis of the first metatarsocuneiform joint. The mean age of the patients was 48 (range, 16 to 70) years. The mean follow-up duration was 38.5 (range, 29 to 60) months. The overall radiographic osseous un...

Timing of Antibiotic Prophylaxis in Tourniquet Surgery

Journal of Foot and Ankle Surgery — Wed, 18 May 2011 23:00:00 +0100

Abstract: It is customary to administer prophylactic antibiotics before exsanguination of the limb and inflation of a tourniquet in extremity surgery. To compare the clinical outcome in lower limb operations when prophylactic antibiotics were administered before versus after limb exsanguination and tourniquet inflation, we randomized patients to the administration of prophylactic antibiotics 5 minutes before exsanguination and inflation of the tourniquet (ABT) and administration of prophylactic antibiotics 1 minute after inflation of the tourniquet (AAT). A total of 106 patients completed the study, including 76 males (71.7%) and 30 females (28.3%). Of the 106 patients, 54 (50.9%) received antibiotics before tourniquet inflation (ABT) and 52 (49.1%) after tourniquet inflation (AAT). Most o...

Reinsertion of an Inverted Osteochondral Lesion of the Talus: A Case Report

Journal of Foot and Ankle Surgery — Sun, 15 May 2011 23:00:00 +0100

We present the case of a young female patient with an inverted OLT that was treated with open reduction and internal fixation using bioabsorbable pins. Follow-up radiographs and computed tomography showed a congruent joint and complete healing of the osteochondral fragment. At the short-term follow-up visit, the functional outcome was promising. (Source: Journal of Foot and Ankle Surgery)

Bilateral Os Subtibiale and Talocalcaneal Coalitions in a College Soccer Player: A Case Report

Journal of Foot and Ankle Surgery — Sun, 15 May 2011 23:00:00 +0100

This report will hopefully alert clinicians about these 2 rare anatomic findings and encourage them to use caution when evaluating suspected fractures of the medial malleolus that could be functional os subtibiale ossicles. In addition, we hope to shed some light on the complicated coupling of motion between the ankle and subtalar joint. These may have developed together to allow more normal coupled motion between the ankle and subtalar joint in this high-level college soccer player, and may be relevant to future reports or research in this area. (Source: Journal of Foot and Ankle Surgery)

A Modified Transmetatarsal Amputation

Journal of Foot and Ankle Surgery — Sun, 15 May 2011 23:00:00 +0100

Abstract: The incidence of the diabetic foot is increasing worldwide. Because evidence has shown that transmetatarsal amputation is associated with fewer failures in amputations of the diabetic foot with or without peripheral arterial disease, improving its management and surgical technique is a mission for the surgeon. Conventional transmetatarsal amputation has held firm, however, for more than 150 years. With a new concept for the transmetatarsal amputation method aimed at a better outcome, we propose a modified procedure for preserving the soft tissue between the metatarsal bones (the vasculature complex with the muscles, periostea, and vessels) and applying it to the distal bone stumps. The purpose of this method is to secure a functional foot by preserving the longitudinal arch. The ...

Squamous Cell Carcinoma of the Foot Mimicking Osteomyelitis: A Case Report

Journal of Foot and Ankle Surgery — Thu, 12 May 2011 23:00:00 +0100

Abstract: Bone invasion by squamous cell carcinoma (SCC), other than the regions of the head and neck, is very rare. To our knowledge, and following a search of the National Library of Medicine's Medline database via PubMed, such invasion involving the foot in the absence of osteomyelitis has not been reported. In this case report, we present a rare case of a patient with an ulcerative lesion overlying a SCC in the plantar foot that clinically and radiographically mimicked osteomyelitis of the third digit and third metatarsal. This type of tumor, often referred to as verrucous carcinoma, is characterized by its locally aggressive nature, low potential for metastasis, and well-differentiated nature of SCC. The initial surgical approach consisted of wide excision of the malignant neoplasm, a...

Bilateral Symptomatic Os Vesalianum Pedis: A Case Report

Journal of Foot and Ankle Surgery — Thu, 12 May 2011 23:00:00 +0100

We present a very rare case of a bilateral symptomatic os vesalianum pedis. The clinical presentation and course are described, as well as its treatment. This case showed that both conservative and operative treatment can be effective for pain reduction. Operative treatment of course has the risk of complications, a lesion of a branch of the sural nerve occurring in this case. On the other hand, conservative treatment can take a long time to reduce pain, and there is always the risk of recurrence. (Source: Journal of Foot and Ankle Surgery)

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Table of Contents

Editorial Board

Thanks to Our Peer Reviewers

Lateral Supramalleolar Flap for Coverage of Ankle and Foot Defects in Children

Surgical Intervention for Congenital Nail Fold Hypertrophy

Incidence of Acute Deep Vein Thrombosis and Pulmonary Embolism in Foot and Ankle Trauma: Analysis of the National Trauma Data Bank

Publication Rates of Poster Presentations at the American College of Foot and Ankle Surgeons Annual Scientific Conference Between 1999 and 2008

Bicortical Fixation of Medial Malleolar Fractures: A Review of 23 Cases at Risk for Complicated Bone Healing

Prognostic Difference Between Soft Tissue Abscess and Osteomyelitis of the Foot in Patients with Diabetes: Data from a Consecutive Series of 452 Hospitalized Patients

Extraosseous Talotarsal Stabilization Using HyProCure® in Adults: A 5-year Retrospective Follow-up

Infected Internal Fixation after Ankle Fractures—A Treatment Path

An Analysis of Outcomes after Use of the Maxwell-Brancheau Arthroereisis Implant

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Transverse Incision for Calcaneal Tuberosity Avulsion Fractures

The Surgical Treatment of Peroneal Tendinopathy (Excluding Subluxations): A Series of 17 Patients

Matrix-associated Autologous Chondrocyte Transplantation Combined with Iliac Crest Bone Graft for Reconstruction of Talus Necrosis due to Villonodular Synovitis

Management of Combined Soft Tissue and Osseous Defect of the Midfoot with a Free Osteocutaneous Radial Forearm Flap: A Case Report

Function after Total Calcanectomy for Malignant Tumor in a Child: Is Complex Reconstruction Necessary?

Deep Soft Tissue Leiomyoma Mimicking Fibromatosis in a 5-year-old Male

Removal of Osteoid Osteoma of the Tibia Using Two-portal Posterior Ankle Arthroscopy

Surgical Technique for Combined Dwyer Calcaneal Osteotomy and Peroneal Tendon Repair for Correction of Peroneal Tendon Pathology Associated with Cavus Foot Deformity

Double Row Anchor Fixation: A Novel Technique for a Diabetic Calanceal Insufficiency Avulsion Fracture

A Case of “Fresh Rupture” after Open Repair of a Ruptured Achilles Tendon

A Retrospective Analysis of Lesser Metatarsophalangeal Joint Fusion as a Treatment Option for Hammertoe Pathology Associated with Metatarsophalangeal Joint Instability

Radiofrequency Thermoneurolysis for the Treatment of Morton’s Neuroma

Statement of Ownership

Table of Contents

Invitation to Authors to Submit Video Footage with Manuscripts

Editorial Board

Information for Subscribers

Subject Index

Author Index

Reply

Sinus Tarsi Artery

Editor's Comments

Reply

Lapidus Arthrodesis

Reply

Pulsed-activated Therapy

Erratum

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Incorporation of Bovine-based Structural Bone Grafts Used in Reconstructive Foot Surgery

Adolescent Hallux Valgus Deformity with Bilateral Absence of the Hallucal Sesamoids: A Case Report

Myxoid Liposarcoma of the Ankle: A Case Report

Use of Allograft Cellular Bone Matrix in Multistage Talectomy with Tibiocalcaneal Arthrodesis: A Case Report

Letter to the Editor

Reply

Stand Up and Start Counting

A Multicenter Retrospective Review of Outcomes for Arthrodesis, Hemi-Metallic Joint Implant, and Resectional Arthroplasty in the Surgical Treatment of End-Stage Hallux Rigidus

An Anatomical Way of Treating Ankle Syndesmotic Injuries

Fracture of the Talus as a Complication of Subtalar Arthroereisis

Arthroereisis of the Subtalar Joint: An Uncommon Complication and Literature Review

Tibiotalocalcaneal Arthrodesis Using a Femoral Locking Plate

Painless Giant Angioleiomyoma in the Subfascia of the Lower Leg

Talar Neck Fracture Associated with Talonavicular Dislocation and Fracture of Posteromedial Process of Talus

Evaluating Plantar Fascia Strain in Hyperpronating Cadaveric Feet Following an Extra-osseous Talotarsal Stabilization Procedure

Argon Beam Coagulation in Foot and Ankle Surgery

Three-wire Fixation Technique for Displaced Fifth Metatarsal Base Fractures

Rate of Nonunion after First Metatarsal-Cuneiform Arthrodesis Using Joint Curettage and Two Crossed Compression Screw Fixation: A Systematic Review

Effect of Extra-osseous Talotarsal Stabilization on Posterior Tibial Tendon Strain in Hyperpronating Feet

Effect of Extra-osseous Talotarsal Stabilization on Posterior Tibial Nerve Strain in Hyperpronating Feet: A Cadaveric Evaluation

Assessment of Medial and Lateral Neurovascular Structures after Percutaneous Posterior Calcaneal Displacement Osteotomy: A Cadaver Study

Statistical Reliability of Bone Biopsy for the Diagnosis of Diabetic Foot Osteomyelitis

Mitigating Administrative Risks in Industry-sponsored Clinical Trials

Table of Contents

Invitation to Authors to Submit Video Footage with Manuscripts

Masthead

Information for Subscribers

Tubercular Osteomyelitis of the Second Metatarsal: A Case Report

Cigarette Smoking and Foot and Ankle Surgery

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The Taylor Spatial Frame™ for Correction of Neglected Fracture Dislocation of the Ankle

Proximal Phalangeal Osteotomy with Proximal Interphalangeal Joint Arthrodesis for Multiplanar Deformities of the Second Toe: Historical Perspectives and Review of a Case Series

Nonunion after Arthrodesis of the First Metatarsal-Phalangeal Joint: A Systematic Review

Management of Valgus Extra-articular Calcaneus Fracture Malunions with a Lateral Opening Wedge Osteotomy

Early Clinical Results of the BOX Ankle Replacement Are Satisfactory: A Multicenter Feasibility Study of 158 Ankles

Perforator-based Pacman Flap in the Plantar Region

A Rare Case of Cryptococcal Infection of Talus with Pathological Fracture That Healed with Medical Management

Metal-reinforced Cement Augmentation for Complex Talar Subsidence in Failed Total Ankle Arthroplasty