CORR Insights®: Loss of Mechanical Ankle Function Is Not Compensated by the Distal Foot Joints in Patients with Ankle Osteoarthritis

Abstract Background Although supramalleolar osteotomy is the main joint-preserving method for the treatment of varus ankle osteoarthritis, it tends to be ineffective when ankle osteoarthritis presents in combination with an excessive talar tilt angle. The purpose of this study was to present a new surgical technique, supramalleolar osteotomy combined with lateral ligament reconstruction and talofibular immobilization, for the treatment of varus ankle osteoarthritis with an excessive talus tilt angle and to evaluate the clinical and radiological results. Methods From January 2013 to October 2016, a total of 17 patients with 17 cases of varus ankle arthritis with excessive talar tilt angles (larger than 7.3°) underwent surgical treatment using our new technique. The American Orthopaedic Foot and Ankle Society (AOFAS) clinical ankle-hindfoot scale and a visual analogue scale (VAS) were used to evaluate ankle function and pain before surgery and at the last follow-up. The medial distal tibial angle (MDTA), anterior distal tibial angle (ADTA), talar tilt angle (TTA), and hindfoot moment arm values (HMAVs) were evaluated on weight-bearing radiographs acquired preoperatively and at the last follow-up. Results The AOFAS score improved significantly from 45.8 ± 2.1 before surgery to 84.8 ± 1.8 after surgery (p < 0.001), and the VAS score decreased from 4.9 ± 0.4 to 1.1 ± 0.2 (p < 0.001). The MDTA, TTA, and HMAV changed from 80.9° ± 0.4° to 90.1° ± 0.4°, 11.7° ± 0.6° to 1.4° ± 0.3°, and 12.6 mm ± 0.8 mm to 4.2 mm ± 0.6 mm, respectively (each p < 0.001). The ADTA showed no obvious change (p = 0.370). The staging of 11 cases (65%) improved. Intramuscular vein thrombosis of the lower limbs occurred in 1 patient 1 week after surgery, and superficial infection occurred in 1 patient. Conclusions Supramalleolar osteotomy combined with lateral ligament reconstruction and talofibular immobilization can correct the load of the weight-bearing ankle and effectively improve the ankle function. As the talar tilt angle can be significantly improved after surgery, this technique can be used for the treatment of varus ankle osteoarthritis with an excessive TTA.

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ANKLE OSTEOARTHRITIS

Journal of Minimally Invasive Orthopedics ◽

10.15383/jmio.4 ◽

2014 ◽

Author(s):

Baris Yilmaz ◽

◽

Baran Komur ◽

Serhat Mutlu ◽

Guzelali Ozdemir ◽

...

Keyword(s):

Ankle Osteoarthritis

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A case of cutaneous necrosis due to intra-articular hyaluronic acid and treated with hyaluronidase

SAGE Open Medical Case Reports ◽

10.1177/2050313x211025110 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110251

Author(s):

Michelle Aaron ◽

Yu Qing Huang ◽

Danielle Bouffard ◽

Jean-Pascal Costa ◽

Benoît Côté

Keyword(s):

Hyaluronic Acid ◽

Initial Treatment ◽

Treatment Approach ◽

Clinical State ◽

Dermal Fillers ◽

Ankle Osteoarthritis ◽

Cutaneous Necrosis ◽

Hyaluronic Acid Injection ◽

First Time ◽

Ankle And Foot

A 66-year-old woman presented to the hospital with cutaneous necrosis of her right ankle and foot. Her symptoms began immediately after an intra-articular injection of hyaluronic acid for ankle osteoarthritis, which was performed 6 days before. Histopathology showed an intra-vascular hyaluronic acid embolus. The initial treatment approach was conservative, but the patient’s clinical state degraded. She was thus treated with sub-cutaneous hyaluronidase, the enzyme that degrades hyaluronic acid, which yielded a moderate improvement even though it was administered 22 days after the initial hyaluronic acid injection. Although hyaluronic acid embolism and subsequent cutaneous necrosis are well-known complications of dermal fillers, there are few reported cases of embolism following intra-articular injection. To our knowledge, this is the first time hyaluronidase has been used in this setting.

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Satisfactory long-term clinical outcomes after bone marrow stimulation of osteochondral lesions of the talus

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-021-06630-8 ◽

2021 ◽

Author(s):

Quinten G. H. Rikken ◽

Jari Dahmen ◽

Sjoerd A. S. Stufkens ◽

Gino M. M. J. Kerkhoffs

Keyword(s):

Bone Marrow ◽

Clinical Outcomes ◽

Degenerative Changes ◽

Osteochondral Lesions ◽

Ankle Osteoarthritis ◽

Bone Marrow Stimulation ◽

Marrow Stimulation ◽

The Mean

Abstract Purpose The purpose of the present study was to evaluate the clinical and radiological outcomes of arthroscopic bone marrow stimulation (BMS) for the treatment of osteochondral lesions of the talus (OLTs) at long-term follow-up. Methods A literature search was conducted from the earliest record until March 2021 to identify studies published using the PubMed, EMBASE (Ovid), and Cochrane Library databases. Clinical studies reporting on arthroscopic BMS for OLTs at a minimum of 8-year follow-up were included. The review was performed according to the PRISMA guidelines. Two authors independently conducted the article selection and conducted the quality assessment using the Methodological index for Non-randomized Studies (MINORS). The primary outcome was defined as clinical outcomes consisting of pain scores and patient-reported outcome measures. Secondary outcomes concerned the return to sport rate, reoperation rate, complication rate, and the rate of progression of degenerative changes within the tibiotalar joint as a measure of ankle osteoarthritis. Associated 95% confidence intervals (95% CI) were calculated based on the primary and secondary outcome measures. Results Six studies with a total of 323 ankles (310 patients) were included at a mean pooled follow-up of 13.0 (9.5–13.9) years. The mean MINORS score of the included studies was 7.7 out of 16 points (range 6–9), indicating a low to moderate quality. The mean postoperative pooled American Orthopaedic Foot and Ankle Society (AOFAS) score was 83.8 (95% CI 83.6–84.1). 78% (95% CI 69.5–86.8) participated in sports (at any level) at final follow-up. Return to preinjury level of sports was not reported. Reoperations were performed in 6.9% (95% CI 4.1–9.7) of ankles and complications related to the BMS procedure were observed in 2% (95% CI 0.4–3.0) of ankles. Progression of degenerative changes was observed in 28% (95% CI 22.3–33.2) of ankles. Conclusion Long-term clinical outcomes following arthroscopic BMS can be considered satisfactory even though one in three patients show progression of degenerative changes from a radiological perspective. These findings indicate that OLTs treated with BMS may be at risk of progressing towards end-stage ankle osteoarthritis over time in light of the incremental cartilage damage cascade. The findings of this study can aid clinicians and patients with the shared decision-making process when considering the long-term outcomes of BMS. Level of evidence Level IV.

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Arthroscopic Ankle Arthrodesis for Treating Osteoarthritis in a Patient with Kashin-Beck Disease

Case Reports in Medicine ◽

10.1155/2014/931278 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Kenjiro Iwasa ◽

Noriyuki Kanzaki ◽

Takaaki Fujishiro ◽

Shinya Hayashi ◽

Shingo Hashimoto ◽

...

Keyword(s):

Humic Acid ◽

Growth Plate ◽

Preventive Treatment ◽

Ankle Arthrodesis ◽

Ankle Osteoarthritis ◽

Pathologic Feature ◽

Skeletal Deformity ◽

Degenerative Osteoarthritis ◽

Beck Disease

Kashin-Beck disease (KBD) is an endemic degenerative osteoarthritis. Death of cartilage and growth plate is the pathologic feature; therefore, KBD involves skeletal deformity and often results in osteoarthritis. Deficiency of selenium, high humic acid levels in water, and fungi on storage gains are considered the cause of KBD. The most frequently involved joints are ankles, knees, wrists, and elbows and symptoms are pain and limited motions of those joints. The main treatments for KBD are rehabilitation and osteotomy to correct the deformities because preventive treatment has not been established. In this report, we present a case of ankle osteoarthritis due to KBD and first describe arthroscopic ankle arthrodesis for treating osteoarthritis of KBD.

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Hiflex Foot Gear improves Quality of life in patients with osteoarthritis of the ankle

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00529 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0052

Author(s):

Akiyama Yui ◽

Takaaki Hirano ◽

Hisateru Niki

Keyword(s):

Quality Of Life ◽

Physical Function ◽

Conservative Therapy ◽

Japanese Society ◽

Daily Life ◽

Social Functions ◽

Ankle Osteoarthritis ◽

Custom Made ◽

Perception Of Health

Category: Ankle Arthritis Introduction/Purpose: There are few reports describing conservative therapy for ankle osteoarthritis. Hiflex Foot Gear (HFG) is a custom-made polyethylene ankle–foot orthosis developed to permit slight mobility of the ankle while providing adequate ankle support. The purpose of this study was to validate the hypothesis that HFG improves the quality of life (QOL) in patients with ankle osteoarthritis.Subjects and methods. Methods: Ten ankles from eight patients (one man, seven women) diagnosed with ankle osteoarthritis at this hospital, prescribed an HFG, and observed for follow-up for at least 3 months were included in this study. The patients’ mean age was 69.9 (range: 46?85) years. Patients were classified as Takakura–Tanaka stage IIIa (2 ankles), stage IIIb (2 ankles), stage IV (6 ankles), with a mean observation period of 8.9 (range: 3?13) months. Clinical evaluations were made before and 3 months after wearing the orthosis. The ankle/hindfoot scale of the Japanese Society for Surgery of the Foot (JSSF) Standard Rating System and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) subscale of the Japanese Orthopaedic Association/Japanese Society for Surgery of the Foot, respectively, were used for making evaluations. Scores were compared using a paired t-test. Results: JSSF scores improved from 55.1 points at baseline to 71.4 points after wearing the HFG (p < 0.001). According to the SAFE-Q subscales, changes after wearing the HFG were as follows: 28.9 to 61.9 points for items related to pain (p < 0.001), 36.9 to 53.7 points for those related to physical function and daily life (p = 0.001), 31.3 to 58.9 points for those related to social functions (p = 0.002), and from 31.3 to 65.0 points for those related to overall perception of health (p < 0.001); items related to shoes showed no substantial change (from 52.1 to 53.6 points). Conclusion: Our results revealed that wearing the HFG improved pain in patients with severe ankle osteoarthritis. Retained flexibility in the ankle range of motion was believed to be the factor underlying improvements in physical function and daily life, social functions, and overall perception of health. HFG is a potential option for conservative therapy in patients who cannot obtain sufficient pain control during the preoperative waiting period or in those who do not wish to undergo surgery.

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AB1435-HPR The contribution of assessing foot joints in early rheumatoid arthritis patients: Insights from item response theory

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2012-eular.1427 ◽

2013 ◽

Vol 71 (Suppl 3) ◽

pp. 757.2-757

Author(s):

L. Siemons ◽

P.M. ten Klooster ◽

E. Taal ◽

I.H. Kuper ◽

P.L.C.M. van Riel ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Item Response Theory ◽

Item Response ◽

Early Rheumatoid Arthritis ◽

Response Theory ◽

Foot Joints

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Clinical Radiographical Outcomes and Complications after a Brand-New Total Ankle Replacement Design through an Anterior Approach: A Retrospective at a Short-Term Follow Up

Journal of Clinical Medicine ◽

10.3390/jcm10112258 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2258

Author(s):

Massimiliano Mosca ◽

Silvio Caravelli ◽

Emanuele Vocale ◽

Simone Massimi ◽

Davide Censoni ◽

...

Keyword(s):

Mean Value ◽

Total Ankle Replacement ◽

P Value ◽

Ankle Osteoarthritis ◽

Ankle Replacement ◽

Patient Reported ◽

End Stage ◽

Term Performance ◽

Replacement Design

Recently, the progress in techniques and in projecting new prosthetic designs has allowed increasing indications for total ankle replacement (TAR) as treatment for ankle osteoarthritis. This retrospective work comprehended 39 subjects aged between 47 and 79 years old. The patients, observed for at least 12 months (mean follow up of 18.2 ± 4.1 months), have been evaluated according to clinical and radiological parameters, both pre- and post-operatively. The AOFAS and VAS score significantly improved, respectively, from 46.2 ± 4.8 to 93.9 ± 4.1 and from 7.1 ± 1.1 to 0.7 ± 0.5 (p value < 0.05). At the final evaluation, the mean plantarflexion passed from 12.2° ± 2.3° to 18.1° ± 2.4° (p value < 0.05) and dorsiflexion from a pre-operative mean value of 8.7° ± 4.1° to 21.7° ± 5.4° post-operatively (p value < 0.05). This study found that this new total ankle replacement design is a safe and effective procedure for patients effected by end-stage ankle osteoarthritis. Improvements have been demonstrated in terms of range of motion, radiographic parameters and patient-reported outcomes. However, further studies are needed to assess the long-term performance of these prostheses.

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Approximation of the Kinematics of Foot Joints by Using Passive Elastic Characteristics of Joint

Key Engineering Materials ◽

10.4028/www.scientific.net/kem.342-343.621 ◽

2007 ◽

Vol 342-343 ◽

pp. 621-624

Author(s):

Hyeon Ki Choi ◽

Si Yeol Kim ◽

Won Hak Cho

Keyword(s):

Joint Angle ◽

Reaction Force ◽

Force Plate ◽

Least Square Method ◽

Least Square ◽

Biomechanical Analysis ◽

Clinical Evaluations ◽

Foot Joints ◽

The Relationship ◽

Elastic Characteristics

We investigated the relationship between kinematic and kinetic characteristics of foot joints resisting ground reaction force (GRF). Passive elastic characteristics of joint were obtained from the experiment using three cameras and one force plate. The relationship between joint angle and moment was mathematically modeled by using least square method. The calculated ranges of motion were 7o for TM joint, 4o for TT joint and 20o for MP joint. With the model that relates joint angle and plantar pressure, we could get the kinematic data of the joints which are not available from conventional motion analysis. The model can be used not only for biomechanical analysis which simulates gait but also for the clinical evaluations.

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