Foot and Ankle Injections in Athletes

2021 ◽  
pp. 194173812110036
Author(s):  
Jonathan K. Ochoa ◽  
Christopher E. Gross ◽  
Robert B. Anderson ◽  
Andrew R. Hsu
Keyword(s):  
English Language ◽  
Platelet Rich Plasma ◽  
Empirical Studies ◽  
Autologous Blood ◽  
Case Series ◽  
Placental Tissue ◽  
Ankle Injuries ◽  
Extensive Literature ◽  
Foot And Ankle ◽  
Level Of Evidence

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

scholarly journals Lateral open wedge calcaneus osteotomy with bony allograft augmentation in adult acquired flatfoot deformity. Clinical and radiological results

2021 ◽  
Author(s):  
Gabriele Colo’ ◽  
Mattia Alessio Mazzola ◽  
Giulio Pilone ◽  
Giacomo Dagnino ◽  
Lamberto Felli
Keyword(s):  
Range Of Motion ◽  
Case Series ◽  
Deformity Correction ◽  
Tibialis Posterior ◽  
Open Wedge ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Adult Acquired Flatfoot Deformity

Abstract The aim of this study is to evaluate the results of patients underwent lateral open wedge calcaneus osteotomy with bony allograft augmentation combined with tibialis posterior and tibialis anterior tenodesis. Twenty-two patients underwent adult-acquired flatfoot deformity were retrospectively evaluated with a minimum 2-year follow-up. Radiographic preoperative and final comparison of tibio-calcaneal angle, talo–first metatarsal and calcaneal pitch angles have been performed. The Visual Analog Scale, American Orthopedic Foot and Ankle Score, the Foot and Ankle Disability Index and the Foot and Ankle Ability Measure were used for subjective and functional assessment. The instrumental range of motion has been also assessed at latest follow-up evaluation and compared with preoperative value. There was a significant improvement of final mean values of clinical scores (p < 0.001). Nineteen out of 22 (86.4%) patients resulted very satisfied or satisfied for the clinical result. There was a significant improvement of the radiographic parameters (p < 0.001). There were no differences between preoperative and final values of range of motion. One failure occurred 7 years after surgery. Adult-acquired flatfoot deformity correction demonstrated good mid-term results and low recurrence and complications rate. Level of evidence Level 4, retrospective case series.

scholarly journals Incidence and Risk Factors of Symptomatic Venous Thromboembolism Following Foot and Ankle Surgery

2018 ◽  
Vol 40 (1) ◽  
pp. 98-104 ◽  
Author(s):  
Johanna Marie Richey ◽  
Miranda Lucia Ritterman Weintraub ◽  
John M. Schuberth
Keyword(s):  
Risk Factors ◽  
Hormone Replacement ◽  
Case Series ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Ankle Surgery ◽  
History Of ◽  
Low Incidence ◽  
Predictive Risk

Background: The incidence rate of venous thrombotic events (VTEs) following foot and ankle surgery is low. Currently, there is no consensus regarding postoperative prophylaxis or evidence to support risk stratification. Methods: A 2-part study assessing the incidence and factors for the development of VTE was conducted: (1) a retrospective observational cohort study of 22 486 adults to calculate the overall incidence following foot and/or ankle surgery from January 2008 to May 2011 and (2) a retrospective matched case-control study to identify risk factors for development of VTE postsurgery. One control per VTE case matched on age and sex was randomly selected from the remaining patients. Results: The overall incidence of VTE was 0.9%. Predictive risk factors in bivariate analyses included obesity, history of VTE, history of trauma, use of hormonal replacement or oral contraception therapy, anatomic location of surgery, procedure duration 60 minutes or more, general anesthesia, postoperative nonweightbearing immobilization greater than 2 weeks, and use of anticoagulation. When significant variables from bivariate analyses were placed into the multivariable regression model, 4 remained statistically significant: adjusted odds ratio (aOR) for obesity, 6.1; history of VTE, 15.7; use of hormone replacement therapy, 8.9; and postoperative nonweightbearing immobilization greater than 2 weeks, 9.0. The risk of VTE increased significantly with 3 or more risk factors ( P = .001). Conclusion: The overall low incidence of VTE following foot and ankle surgery does not support routine prophylaxis for all patients. Among patients with 3 or more risk factors, the use of chemoprophylaxis may be warranted. Level of Evidence: Level III, retrospective case series.

scholarly journals Functional assessment of foot and ankle tendinopathies treated with tendoscopy

2021 ◽  
Vol 15 (2) ◽  
pp. 128-132
Author(s):  
Rodrigo Guimarães Huyer ◽  
Mário Sérgio Paulillo Cillo ◽  
Carlos Daniel Cândido Castro Filho ◽  
Hallan Douglas Bertelli ◽  
Renato Morelli Berg
Keyword(s):  
Functional Assessment ◽  
Descriptive Analysis ◽  
Case Series ◽  
P Value ◽  
Peroneal Tendon ◽  
Foot And Ankle ◽  
Treatment Results ◽  
Duration Of Treatment ◽  
Aofas Score ◽  
Level Of Evidence

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

Application of Computerized Adaptive Testing to the Foot and Ankle Ability Measure

2020 ◽  
pp. 107110072097266
Author(s):  
Joseph T. O’Neil ◽  
Otho R. Plummer ◽  
Steven M. Raikin
Keyword(s):  
Computerized Adaptive Testing ◽  
Case Series ◽  
Adaptive Testing ◽  
Mean Difference ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Patient Reported ◽  
The Mean ◽  
Ability Measure ◽  
The Impact

Background: Patient-reported outcome measures are an increasingly important tool for assessing the impact of treatments orthopedic surgeons render. Despite their importance, they can present a burden. We examined the validity and utility of a computerized adaptive testing (CAT) method to reduce the number of questions on the Foot and Ankle Ability Measure (FAAM), a validated anatomy-specific outcome measure. Methods: A previously developed FAAM CAT system was applied to the responses of patients undergoing foot and ankle evaluation and treatment over a 3-year period (2017-2019). A total of 15 902 responses for the Activities of Daily Living (ADL) subscale and a total of 14 344 responses for the Sports subscale were analyzed. The accuracy of the CAT to replicate the full-form score was assessed. Results: The CAT system required 11 questions to be answered for the ADL subscale in 85.1% of cases (range, 11-12). The number of questions answered on the Sports subscale was 6 (range, 5-6) in 66.4% of cases. The mean difference between the full FAAM ADL subscale and CAT was 0.63 of a point. The mean difference between the FAAM Sports subscale and CAT was 0.65 of a point. Conclusion: The FAAM CAT was able to reduce the number of responses a patient would need to answer by nearly 50%, while still providing a valid outcome score. This measure can therefore be directly correlated with previously obtained full FAAM scores in addition to providing a foot/ankle-specific measure, which previously reported CAT systems are not able to do. Level of Evidence: Level IV, case series.

Effect of Postoperative Ketorolac Administration on Bone Healing in Ankle Fracture Surgery

2018 ◽  
Vol 39 (10) ◽  
pp. 1135-1140 ◽  
Author(s):  
Elizabeth McDonald ◽  
Brian Winters ◽  
Kristen Nicholson ◽  
Rachel Shakked ◽  
Steven Raikin ◽  
...  
Keyword(s):  
Bone Healing ◽  
Case Series ◽  
Ankle Fractures ◽  
High Rate ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Radiographic Outcomes ◽  
Significant Difference ◽  
Clinical Healing ◽  
Mean Time

Background: In an effort to minimize narcotic analgesia and its potential side effects, anti-inflammatory agents offer great potential provided they do not interfere with bone healing. The safety of ketorolac administration after foot and ankle surgery has not been well defined in the current literature. The purpose of this study was to report clinical healing and radiographic outcomes for patients treated with a perioperative ketorolac regimen after open reduction and internal fixation (ORIF) of ankle fractures. Methods: A retrospective review was performed on all patients that received perioperative ketorolac at the time of lateral malleolar, bimalleolar, and trimalleolar ankle ORIF by a single surgeon between 2010 and 2016 with minimum 4 months follow-up. Patients received 20 tablets of 10 mg ketorolac Q6 hours. Radiographs were evaluated independently by 2 blinded fellowship-trained orthopedic foot and ankle surgeons to assess for radiographic healing. A total of 281 patients were included, with a median age of 51 years and 138 males (47%). Statistical analysis consisted of a linear mixed-effects regression. Results: In all, 265/281 (94%) were clinically healed within 12 weeks and 261/281 (92%) were radiographically healed within 12 weeks. Within the group of patients that did not heal within 12 weeks, mean time to clinical healing was 16.9 weeks (range = 14-25 weeks), and mean time to radiographic healing was 17.1 weeks (range = 14-25 weeks). In patients taking ketorolac, there were no cases of nonunion in our series (n = 281) and no significant difference found between fracture patterns and healing or complications ( P = .500). Conclusions: Perioperative ketorolac use was associated with a high rate of fracture union by 12 weeks. This is the first study to examine the effect of ketorolac on radiographic time to union of ankle fractures. Additional studies are necessary to determine whether ketorolac helps reduce opioid consumption and improve pain following ORIF of ankle fractures. Level of Evidence: Level IV, case series.

scholarly journals The effects of regenerative injection therapy compared to corticosteroids for the treatment of lateral Epicondylitis: a systematic review and meta-analysis

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Julie Barnett ◽  
Madison N. Bernacki ◽  
Jessica L. Kainer ◽  
Hannah N. Smith ◽  
Annette M. Zaharoff ◽  
...  
Keyword(s):  
English Language ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Functional Limitations ◽  
Autologous Blood ◽  
Lateral Epicondylitis ◽  
Risk Of Bias ◽  
Injection Therapy ◽  
Lateral Epicondyle

Abstract Background The lateral epicondyle is a common site for chronic tendinosis (i.e. lateral epicondylitis), a condition characterized by overuse and degeneration of a tendon due to repeated microtrauma. This leads to pain and functional limitations. There is a growing interest in non-surgical forms of treatment for this condition including provision of corticosteroid injections and regenerative injection therapy (provision of autologous blood and platelet rich plasma injections). Objective We compared the effectiveness of corticosteroids with regenerative injection therapy for the treatment of lateral epicondylitis. Methods We systematically reviewed randomized controlled trials published in English language from 2008 to 2018. Databases used included PEDro, Scopus, PubMed, and CINAHL. Nine articles met our selection criteria. The PEDRo scale scores helped assess study quality. Cochrane risk of bias criteria helped assess bias. We analyzed results focusing on pain and function using meta-analyses. Results Six out of 9 studies had low risk of bias. There were no short-term (1 and 2 month) differences in pain scores between the corticosteroid and regenerative injection groups. Participants receiving regenerative injections demonstrated greater long-term improvements lasting for a period of ≈2 years. Conclusion Regenerative injections provision results in greater long–term pain relief and improved function for people with lateral epicondylitis.

scholarly journals Three-Stage Masquelet Technique and One-Stage Reconstruction to Treat Foot and Ankle Tuberculosis

2019 ◽  
Vol 41 (3) ◽  
pp. 331-341 ◽  
Author(s):  
Wenqiang Qu ◽  
Chi Wei ◽  
Li Yu ◽  
Yu Deng ◽  
Panfeng Fu ◽  
...  
Keyword(s):  
Pain Score ◽  
Early Stage ◽  
Distal Tibia ◽  
Case Series ◽  
Cement Spacer ◽  
Foot And Ankle ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Masquelet Technique

Background: The purpose of this article was to report the feasibility and effectiveness of 3-stage Masquelet technique and 1-stage operation for different stages of foot and ankle tuberculosis (TB). Methods: Ten consecutive patients with foot and ankle TB were retrospectively analyzed between January 2014 and December 2018. Five patients were treated with the 3-stage Masquelet technique, including thorough debridement with vacuum sealing drainage, implantation of antibiotic cement spacer, and subsequent reconstruction. Five patients were treated with a 1-stage reconstruction. The American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS) pain scores were recorded at the last follow-up. The follow-up was 30.3 ± 17.8 months. Results: No reactivation of TB was observed in any patients. For the 3-stage operation group, 1 patient developed a distal tibia fracture. The duration of anti-TB therapy was 12.0 ± 0.8 months. The AOFAS score increased from 39.5 ± 9.9 preoperatively to 75.3 ± 7.0 postoperatively ( P < .05). The VAS pain score decreased from 6.3 ± 1.9 to 1.5 ± 1.3 ( P < .05). For the 1-stage operation, 1 patient had wound necrosis. The duration of anti-TB therapy was 13.8 ± 1.1 months. The AOFAS score increased from 51.8 ± 15.0 to 81.8 ± 6.3 ( P < .05). The VAS pain score decreased from 5.4 ± 1.1 to 1.0 ± 0.7 ( P < .05). Conclusion: Three-stage operation was effective for foot and ankle TB with stage IV, sinus tracts or other infections, and 1-stage reconstruction was effective for early-stage TBs. Level of Evidence: Level IV, case series.

Tumors of the Foot and Ankle: Experience with 153 Cases

2009 ◽  
Vol 30 (9) ◽  
pp. 836-841 ◽  
Author(s):  
Loretta B. Chou ◽  
Yvette Y. Ho ◽  
Martin M. Malawer
Keyword(s):  
Soft Tissue ◽  
Giant Cell Tumor ◽  
Giant Cell ◽  
Case Series ◽  
Soft Tissue Tumors ◽  
Cell Tumor ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Referral Center ◽  
Common Diagnosis

Background: Both primary and metastatic tumors in the foot and ankle have been reported as rare. The purpose of this study was to describe 153 cases of foot and ankle tumors from a 20-year experience in a tertiary referral center specializing in orthopaedic oncology. It is the largest reported series of both bone and soft tissue tumors in the foot and ankle. Materials and Methods: Between 1986 and 2006, a retrospective chart review was performed of a total of 2,660 tumors surgically treated in all anatomic sites by a single surgeon at a musculoskeletal tumor referral center. Results: One hundred fifty-three patients (5.75%) with bone and/or soft tissue tumors of the foot and ankle were treated. There were 84 women and 69 men. The patients' ages ranged from 1 to 84, with a median age of 30 and mean of 33.2. The tissue types included 80 soft tissue and 73 bone tumors. Overall, 60 (39.2%) were malignant, and 93 (60.8%) were benign. The most common diagnosis was giant cell tumor. In addition, giant cell tumor was the most common bone tumor, while pigmented villonodular synovitis and giant cell tumor of the tendon sheath were the most common soft tissue tumors. Conclusion: The incidence of tumors of the foot and ankle in this series of a single surgeon over a 20-year practice was 5.75%. The results of this study reaffirm that awareness, correctly diagnosing, and appropriately treating or referring to an orthopaedic oncologist may help with an improved outcome for patients. Level of Evidence: IV, Retrospective Case Series

scholarly journals Application of platelet-rich plasma for canine osteoarthritis treatment - a clinical series

2021 ◽  
Vol 24 (4) ◽  
pp. 601-607
Author(s):  
K. B Aminkov ◽  
N. H. Mehandzhiyski ◽  
B. Y. Aminkov ◽  
N. Z. Zlateva-Panayotova
Keyword(s):  
Platelet Rich Plasma ◽  
Autologous Blood ◽  
Case Series ◽  
Brief Pain Inventory ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Knee Joints ◽  
Radiographic Findings ◽  
Clinical Series ◽  
Osteoarthritis Treatment

Osteoarthritis, also known as degenerative joint disease (DJD), is defined as a progressive and permanent long-term deterioration of the cartilage surrounding the joints. There is no known cause for primary DJD. However, there are a wide variety of causes for secondary DJD, such as trauma, abnormal wear of joints and cartilage, or a congenital defect present at birth such as an improperly formed hip. One of the most popular methods used to biologically enhance healing in the fields of orthopaedic surgery and medicine includes the use of autologous blood products, namely, platelet rich plasma (PRP). Reports suggest that PRP, presumably containing high levels of platelet growth factors, may promote the recovery of the affected cartilage. This case series presents clinical and radiographic findings of three dogs with osteoarthritis of the elbow and knee joints. Pain score were assessed by CBPI (Canine Brief Pain Inventory). Treatment with three-fold intra-articular application of PRP, obtained by double centrifugation method, resulted in significant improvement in the function of the affected joint. Therefore, it could be concluded that PRP was clinically effective in the treatment of osteoarthritis in these three cases.

scholarly journals Comparative study of the FAOS and FAAM questionnaires as functional assessment instruments for patients with hallux valgus

2020 ◽  
Vol 14 (2) ◽  
pp. 144-147
Author(s):  
Alesson Filipi Bernini ◽  
Silvia Iovine Kobata ◽  
Alexandre Cassini de Oliveira ◽  
Rubens Trabbold Aguiar ◽  
Antônio César Mezêncio da Silveira
Keyword(s):  
Hallux Valgus ◽  
Functional Assessment ◽  
Case Series ◽  
Assessment Instruments ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Functional Scores ◽  
The Right ◽  
Relationship Of

Objective: To compare the Portuguese translations of the Foot and Ankle Activity Measure (FAAM) and the Foot and Ankle Outcome Score (FAOS) questionnaires as functional assessment instruments for patients with hallux valgus and assess correlations between scores and severity of deformity. Methods: A total of 28 patients were assessed and the functional scores provided by the FAAM and FAOS questionnaires were compared and their correlations with clinical and radiological severity were analyzed. Results: Mean age was 46.88 years (range: 18 to 64). Laterality was distributed as follows: 57.1% had the deformity on the right foot (16 cases) and 42.9% on the left (12 cases). The deformities identified were graded as follows: 26.1% of patients had mild deformity (6 cases), 45.3% had moderate deformity (14 cases), and 28.6% had severe deformity (8 cases). It was observed that the distribution of scores for the different grades of deformity was the same for both questionnaires. Conclusion: There was no significant difference between the results obtained using the FAAM or the FAOS questionnaire or in the relationship of proportionality between radiological deformity grade and the functional scores obtained using the two tests. Level of Evidence IV; Therapeutic Studies; Case Series.

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