Calcaneonavicular Coalition Resection with Extensor Digitorum Brevis Interposition in Adults

2007 ◽  
Vol 28 (8) ◽  
pp. 890-895 ◽  
Author(s):  
Aaron T. Scott ◽  
H. Robert Tuten
Keyword(s):  
Extensor Digitorum ◽  
Foot And Ankle ◽  
Aofas Score ◽  
Radiographic Evidence ◽  
Degenerative Arthritis ◽  
Superficial Infection ◽  
Calcaneonavicular Coalition ◽  
Average Patient ◽  
American Orthopaedic ◽  
Extensor Digitorum Brevis

Background: Traditionally, pediatric patients with symptomatic calcaneonavicular coalitions have been treated with resection of the coalition and interposition of the origin of the extensor digitorum brevis muscle. Despite the success of calcaneonavicular coalition resection in children, many surgeons are reluctant to perform this procedure in adults or in patients with osseous coalitions, and joint sacrificing arthrodesis often is done instead. Methods: Seven adult patients (eight feet) had calcaneonavicular coalition resection with extensor digitorum brevis interposition. The average patient age was 41 years, and all patients displayed isolated, symptomatic calcaneonavicular coalitions without any radiographic evidence of degenerative arthritis. At followup, physical and radiographic evaluations were performed, and an American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score was recorded. Charts were reviewed for complications and patients were questioned with regards to their overall satisfaction with the surgery. Results: At a mean postoperative followup of 56.5 months, the average AOFAS score was 87. Review of most recent radiographs revealed no degenerative changes or recurrence of the coalition. All patients responded that they would have this surgery again and that they would recommend this procedure to a friend. Complications included one superficial infection and one dysesthesia involving the sural nerve. Conclusions: The results of the present study suggest that resection combined with muscular interposition can be successful in patients over the age of 18 in whom conservative management of their symptomatic coalitions has failed. This procedure offers an excellent alternative to arthrodesis and has a very low complication rate.

scholarly journals Effect of extensive tenosynovectomy on diffuse flexor hallucis longus tenosynovitis combined with effusion

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901986335 ◽  
Author(s):  
Wenqing Qu ◽  
Tong Liu ◽  
Wentao Chen ◽  
Zhenzhong Sun ◽  
Shengjie Dong ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Final Analysis ◽  
Flexor Hallucis Longus ◽  
Foot And Ankle ◽  
Aofas Score ◽  
Pain Scores ◽  
The Difference ◽  
Magnetic Resonance Imaging Mri ◽  
American Orthopaedic

Objective: The objective of this study was to examine the clinical and magnetic resonance imaging (MRI) outcomes of extensive tenosynovectomy on patients with diffuse flexor hallucis longus tenosynovitis combined with effusion (DFHLT-E). Methods: Consecutive patients undergoing extensive tenosynovectomy for DFHLT-E in the same foot and ankle center from January 2013 to December 2016 were selected; a total of 14 patients were included in the final analysis. Patients with a minimum 1-year follow-up were evaluated with physical examination, MRI, American Orthopaedic Foot and Ankle Society (AOFAS) clinical midfoot scale, and visual analog scale (VAS) pain scores. Results: The 14 patients were followed up for an average of 15.0 ± 2.3 months (12–18 months). There were no recurrences in all clinical examinations at the final follow-up. The AOFAS score was improved from 61.57 ± 10.70 before surgery to 90.28 ± 9.41 at the final follow-up. The difference was statistically significant ( p = 0.001). The VAS score was improved from 4.00 ± 0.82 before surgery to 0.43 ± 0.53 at the final follow-up ( p < 0.001). MRI examination revealed two patients with small residual and limited effusion with no clinical symptoms. Superficial pin infection was observed in one patient, and two patients had transient neurostimulation. Conclusions: Extensive tenosynovectomy is an effective alternative for the treatment of DFHLT-E with less complications or recurrence.

Interpositional Arthroplasty With Extensor Digitorum Brevis Tendon in Freiberg Disease

2020 ◽  
Vol 41 (11) ◽  
pp. 1398-1403
Author(s):  
Nazan Çevik ◽  
Yavuz Akalın ◽  
Özgür Avci ◽  
Ali Çınar ◽  
Alpaslan Öztürk ◽  
...  
Keyword(s):  
Joint Space ◽  
Extensor Digitorum ◽  
Long Term Results ◽  
X Rays ◽  
Aofas Score ◽  
Interpositional Arthroplasty ◽  
Freiberg Disease ◽  
The Mean ◽  
Extensor Digitorum Brevis

Background: No consensus has been reached in the treatment of Frieberg disease. Our aim was to evaluate medium- to long-term results of patients with advanced Freiberg disease managed with extensor digitorum brevis tendon interpositional arthroplasty. Methods: There were 24 patients (19 females, 5 males) managed with interpositional arthroplasty for advanced Freiberg disease between 2003 and 2015. The mean follow-up was 133.8 (range, 60-198) months. According to Smillie classification, there were 4 grade 3, 13 grade 4, and 7 grade 5 patients. Patients were evaluated preoperatively and at the final follow-up with the American Orthopaedic Foot & Ankle Society (AOFAS) score and metatarsophalangeal joint range of motion and postoperatively with visual analog scale (VAS) and subjective satisfaction evaluation. Joint space was evaluated on x-rays. Results: Mean AOFAS score increased (53.9 to 80.3, P = .001). Eight patients had excellent, 14 had good, and 2 had fair scores. A significant increase was found in dorsiflexion (38.1° [24°-52°] vs 55.3° [34°-65°]; P = .001) and plantarflexion (19.0° [10°-28°] vs 28.6° [19°-39°]; P = .001). Narrowing of the joint space was not seen in any patient, but expansion was determined in all patients (0.39 [0.35-0.47] vs 0.44 [0.41-0.47] cm; P = .002). Of the patients, 9 were very satisfied, 12 were satisfied, 2 were moderately satisfied, and 1 was dissatisfied. The mean postoperative VAS pain score was 1.7 ± 0.9 (0-4). Conclusion: After a minimum 5-year follow-up, most patients with Freiberg disease managed with interpositional arthroplasty using the extensor digitorum brevis tendon had excellent to good functional results with a widening of the joint space. Level of Evidence: Level IV, retrospective case series.

scholarly journals Management of mal-united Pilon fractures with joint-sparing osteotomy

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0052
Author(s):  
Guang-rong Yu
Keyword(s):  
Type Ii ◽  
Foot And Ankle ◽  
Aofas Score ◽  
Vas Score ◽  
Articular Surfaces ◽  
Significant Difference ◽  
The Mean ◽  
American Orthopaedic ◽  
Time From Injury ◽  
Pilon Fractures

Category: Ankle Introduction/Purpose: To explore the effectiveness and operative methods to treat various mal-united Pilon fractures with joint-sparing osteotomy. Methods: Between January 2011 and October 2016, 21 patients with mal-united Pilon fractures were treated with joint-sparing osteotomy. There were 13 males and 8 females with an average age of 38.4 years (range, 22-48 years). 14 were left feet and 7, right. The time from injury to reconstructive operation was 4 months to 10 years. 17 received operative treatment previously, and 4 were treated by plaster fixation. According to Rüedi-Allgöwer classification, 16 were rated as type II (including 6 medial Pilon fractures, 5 anterior, 5 posterior) and 5, type III. All patients received standardized postoperative managements. Results: All patients were followed up for more than 1 year. All the fractures were reunited in an average time of 13.8 weeks (range 9 to 18 weeks). The mean visual analogue scale (VAS) score was 2.42 (range 0 to 5) and the mean ankle and hindfoot scale of the American Orthopaedic Foot and Ankle Society (AOFAS) score was 78.81(range 65 to 92) 6 months after operation. The VAS score was 5.27 (range 2 to 7) and the AOFAS score was 57.26 (range 20 to 81) before. Comparing to preoperative data, statistically significant difference was found postoperatively (P<0.05). Conclusion: Results by joint-sparing osteotomy to realign and reconstruct articular surfaces of ankles are acceptable. Functions and symptoms are improved significantly after operation. Joint-sparing osteotomy can be a considerable option for treating mal-united Pilon fractures.

The Deep Peroneal Nerve in the Foot and Ankle: An Anatomic Study

1995 ◽  
Vol 16 (11) ◽  
pp. 724-728 ◽  
Author(s):  
Steven J. Lawrence ◽  
Michael J. Botte
Keyword(s):  
Peroneal Nerve ◽  
Average Distance ◽  
Extensor Digitorum ◽  
Anterior Tibial Artery ◽  
Terminal Branch ◽  
Foot And Ankle ◽  
Deep Peroneal Nerve ◽  
Extensor Hallucis Longus ◽  
Anterior Tibial ◽  
Extensor Digitorum Brevis

Injury to the deep peroneal nerve in the foot and ankle may result from trauma, repetitive mechanical irritation, or iatrogenic harm. The nerve is most susceptible to injury along its more distal anatomic course. Dissection of 17 cadaver specimens was undertaken to describe the course of the deep peroneal nerve and quantify its branch patterns. In the distal one third of the leg, the nerve was located superficial to the anterior tibial artery between the tibialis anterior and extensor hallucis longus muscles. Typically, the nerve crossed deep to the extensor hallucis longus tendon to enter the interval between the extensor hallucis longus and extensor digitorum longus at an average distance of 12.5 mm proximal to the ankle. A proximal bifurcation was usually present at an average distance of 12.4 mm distal to the mortise. The lateral terminal branch penetrated the deep surface of the extensor digitorum brevis to provide motor innervation. The medial terminal branch passed over the talonavicular joint capsule, and coursed an average of 2.9 mm lateral to the first tarsometatarsal joint. Within the forefoot, it passed deep to the extensor hallucis brevis tendon, bifurcated in the midmetatarsal region, and then arborized, supplying sensibility to the first toe interspace and the adjacent sides of the first and second toes.

scholarly journals RELATIONSHIP BETWEEN THE KNEE AND HINDFOOT AXES IN PATIENTS WITH SEVERE KNEE OSTEOARTHRITIS

2020 ◽  
Vol 28 (5) ◽  
pp. 229-232 ◽  
Author(s):  
HENRIQUE MANSUR ◽  
FELIPE ALMEIDA ROCHA ◽  
PEDRO GUILME TEIXEIRA DE SOUSA FILHO ◽  
ISNAR MOREIRA DE CASTRO JUNIOR
Keyword(s):  
Mean Value ◽  
Foot And Ankle ◽  
Moderate Correlation ◽  
Varus Knee ◽  
Aofas Score ◽  
Level Of Evidence ◽  
The Mean ◽  
American Orthopaedic ◽  
Ankle Function ◽  
Angular Deformities

ABSTRACT Objective: To evaluate the correlation between knee axis and hindfoot axis in patients with advanced gonarthrosis, and the association between ankle function and angular deformities. Methods: 72 patients were enrolled in the study: 66% were women, and mean age was 58.7 years. The anatomical axis of the knee and hindfoot were measured by short knee radiographs and long axial view of the hindfoot. Results: Among the study group, 79.2% presented varus knee (mean 15º ± 7.69º) and 20.8% valgus (mean 15.9º ± 7.7º). 63.9% had hindfoot varus (mean 8.5º ± 6.07º) and 36.1% valgus (mean 3.9º ± 3.92º) (p < 0.05). The mean value for the American Orthopaedic Foot and Ankle Society (AOFAS) score was 74.26 points, and values were significantly higher among patients with hindfoot varus (p < 0.05). We found no correlation between gender or AOFAS score and knee and hindfoot axes, nor between deformities in the knee and hindfoot axes (p > 0.05). The subgroup genu valgum - hindfoot varus presented a moderate correlation (r = 0.564; p < 0.05). Conclusion: We found no association between the anatomical axes of the knee and hindfoot. Patients with gonarthrosis and hindfoot varus presented a better ankle function. Level of Evidence II, Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease.

Clinical and Radiographic Outcome of Revision Surgery for Failed Triple Arthrodesis

1997 ◽  
Vol 18 (8) ◽  
pp. 489-499 ◽  
Author(s):  
Steven L. Haddad ◽  
Mark S. Myerson ◽  
Richard F. Pell ◽  
Lew C. Schon
Keyword(s):  
Iliac Crest ◽  
Deep Infection ◽  
Iliac Crest Bone Graft ◽  
Bone Block ◽  
Foot And Ankle ◽  
Radiographic Outcome ◽  
Triple Arthrodesis ◽  
Revision Procedure ◽  
Average Patient ◽  
American Orthopaedic

Between 1987 and 1994, we treated 33 patients with surgical revision for failed triple arthrodesis, 28 (29 feet) of whom returned for final examination (mean, 4.4 years; range, 2–7 years). The average age of these 16 women and 12 men was 46 years (range, 14–69 years). Before the revision procedure, patients had undergone nonoperative therapies for an average of 3.7 years (range, 0.5–12 years) and an average of three foot operations (range, 1–6 operations) after the primary triple arthrodesis. All patients were managed with rigid internal fixation via cannulated screws and power staples. Calcaneal osteotomy and/or revision of the transverse tarsal arthrodesis via appropriate saw cuts and bone wedges were used. Iliac crest bone graft was added, when a bone block arthrodesis was required, for those patients with nonunion or ankle impingement. Arthrodesis was achieved in all 29 feet, although 4 patients (4 feet) (14%) required additional procedures for malunion (2 patients), deformity recurrence (1 patient), deep infection (1 patient), and skin graft (1 patient). Comparison of the average pre- (retrospective) and postoperative American Orthopaedic Foot and Ankle Society 94-point hindfoot and ankle scores showed a significant improvement: 31 points (range, 13–61 points) versus 59 points (range, 24–91 points), respectively ( P < 0.05). On a scale of 0 to 10 points, average patient satisfaction was 7.8 points (range, 2–10 points). This study demonstrated a satisfactory improvement in patient outcome after surgical correction of failed triple arthrodesis. We conclude that such a revision, although complex, may be attempted to establish a plantigrade foot free of infection and able to wear shoes without an orthosis or brace.

Success of Calcaneonavicular Coalition Resection in the Adult Population

1996 ◽  
Vol 17 (9) ◽  
pp. 569-572 ◽  
Author(s):  
Bruce E. Cohen ◽  
W. Hodges Davis ◽  
Robert B. Anderson
Keyword(s):  
Conservative Treatment ◽  
Adult Population ◽  
Adult Patients ◽  
Radiographic Evidence ◽  
Degenerative Arthritis ◽  
Calcaneonavicular Coalition ◽  
Hindfoot Arthrodesis

Twelve adult patients (13 feet), average age 33 years (range, 19–48 years), with calcaneonavicular coalitions remained symptomatic after a trial of conservative treatment. Surgical resections were performed. Before surgery, there was <5° of inversion/eversion in 11 patients, radiographic evidence of degenerative arthritis in 10 feet (77%), and talar beaking in 7 feet. At an average postoperative follow-up of 36 months, subjective relief of preoperative symptoms was achieved in all but two patients. Two patients required subsequent hindfoot arthrodesis. Resection of calcaneonavicular coalition in the adult can be successful and provides an option to arthrodesis after nonoperative methods have failed.

scholarly journals Lateral Subtalar Dislocation with Tarsometatarsal Dislocation: A Case Report of a Rare Injury

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Samik Banerjee ◽  
Mostafa M. Abousayed ◽  
Douglas J. Vanderbrook ◽  
Kaushik Bagchi
Keyword(s):  
Posttraumatic Arthritis ◽  
Foot And Ankle ◽  
Radiographic Evidence ◽  
Rare Injury ◽  
Subtalar Dislocation ◽  
Appropriate Treatment ◽  
Tarsometatarsal Dislocation ◽  
American Orthopaedic ◽  
One Year

Dislocation of the fourth and fifth tarsometatarsal joints in conjunction with lateral subtalar dislocation is a rare occurrence. Little is known about the mechanism of injury, the appropriate treatment for this condition, and its ultimate prognosis. In this report, we describe this atypical presentation in a middle aged, otherwise healthy male who sustained a trivial twisting injury to the ankle when he slipped and fell on ice. Open reduction and K-wire fixation were necessary to affix the lateral tarsometatarsal and talonavicular joints. At one year postoperatively, he was able to return to his preinjury occupation with mild to moderate pain with prolonged walking. His Foot and Ankle Disability Index and American Orthopaedic Foot and Ankle Society scores were 64 and 65 points, respectively. Surgical intervention resulted in a stable plantigrade foot; however, the patient had early radiographic evidence of posttraumatic arthritis in the midfoot joints at one-year follow-up.

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