Cheilectomy as a First-Line Surgical Treatment Option Yields Good Functional Results in Grade III Hallux Rigidus

2016 ◽  
Vol 106 (1) ◽  
pp. 22-26 ◽  
Author(s):  
Engin Cetinkaya ◽  
Merter Yalcinkaya ◽  
Sami Sokucu ◽  
Abdulkadir Polat ◽  
Ufuk Ozkaya ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Visual Analog Scale ◽  
Functional Results ◽  
Hallux Rigidus ◽  
Wilcoxon Test ◽  
Foot And Ankle ◽  
First Line ◽  
Analog Scale ◽  
American Orthopaedic ◽  
Grade Iii

Background: This study aimed to analyze the functional results of cheilectomy in the surgical treatment of grade III hallux rigidus and to evaluate whether cheilectomy is a preferable first-line treatment over other surgical methods. Methods: Of 29 patients with moderate daily physical activity who underwent cheilectomy between 2009 and 2012 on being diagnosed as having grade III hallux rigidus according to the Coughlin-Shurnas grading system, 21 patients (14 women and 7 men; mean age, 59.2 years; age range, 52–67 years) (22 feet) with regular follow-up and complete medical records were included in the study. The patients were evaluated in the preoperative and postoperative periods using a visual analog scale for pain and the American Orthopaedic Foot and Ankle Society metatarsophalangeal assessment forms. Results: The preoperative mean American Orthopaedic Foot and Ankle Society score of 53 (range, 29–67) improved to 78 (range, 57–92) postoperatively (Wilcoxon test P = .001). The preoperative mean visual analog scale score of 89 (range, 60–100) improved to 29 (range, 0–70) in the postoperative period (Wilcoxon test P = .001). Conclusions: As a simple and repeatable procedure that allows for further joint-sacrificing surgical procedures when required, cheilectomy is a preferable method to be applied as a first-line option for the surgical treatment of grade III hallux rigidus.

scholarly journals Hállux Rígidus: estudo prospectivo da substituição articular com hemiartroplastia

2013 ◽  
Vol 21 (2) ◽  
pp. 71-75 ◽  
Author(s):  
Alexandre Leme Godoy dos Santos ◽  
Fernando Aires Duarte ◽  
Carlos Augusto Itiu Seito ◽  
Rafael Trevisan Ortiz ◽  
Marcos Hideyo Sakaki ◽  
...  
Keyword(s):  
Visual Analog Scale ◽  
Hallux Rigidus ◽  
Foot And Ankle ◽  
Analog Scale ◽  
American Orthopaedic

OBJETIVO: Relatar os resultados com médio prazo de seguimento após a implantação de Arthrosurface-HemiCap® em pacientes com diagnóstico de hállux rígidus (HR). MÉTODO: Onze pacientes foram submetidos à artroplastia parcial da primeira metatarso-falangeana. Seis mulheres e cinco homens com idade média de 51,9 anos (46 a 58 anos) e média de seguimento pós-operatório de 3,73 anos (3-4 anos); foram classificados através do sistema de Kravitz e avaliados pelas escalas da american orthopaedic foot and ankle society (AOFAS) para hállux, visual analog scale (VAS) - analógico funcional de dor - e pela amplitude de movimento da primeira articulação metatarsofalangeana no periodo pré-operatório, pós-operatório de seis meses e pós-operatório atual. RESULTADOS: Os resultados revelam melhora significativa dos três parâmetros analisados no estudo, tanto para análise global como para comparações pré e pós-operatórias individuais. A análise comparativa de cada variável nos períodos pós-operatórios de seis meses e atual não mostram diferença estatística o que indica manutenção dos parâmetros durante esse intervalo. CONCLUSÃO: A hemiartroplastia da primeira metatarsofalangeana é opção reprodutível e segura para o tratamento cirúrgico do hállux rígidus II e III, com significativa melhora dos parâmetros avaliados para a população estudada. Nível de Evidência IV, Série de casos.

scholarly journals No Progression to MTPJ Arthrodesis with Youngswick Osteotomy for Hallux Rigidus Stage II and III

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0039
Author(s):  
Gaston Slullitel ◽  
Juan Pablo Calvi ◽  
Victoria Alvarez ◽  
Laura Gaitan ◽  
Valeria Lopez
Keyword(s):  
Visual Analog Scale ◽  
Hallux Rigidus ◽  
Stage Ii ◽  
Metatarsal Osteotomy ◽  
Foot And Ankle ◽  
Analog Scale ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal ◽  
Secondary Procedures

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus treatment by the means of decompressive osteotomy would theoretically be able to alleviate pain and improve function. The Youngswick osteotomy is a procedure conceived for relatively long first metatarsals, a characteristic that has been associated with the pathogenesis of hallux rigidus. Nevertheless, studies of this procedure that assessed the overall results and further need of a first metatarsal arthrodesis over the years are lacking. After using the Youngswick first metatarsal decompressive osteotomy for many years, we decided to review a retrospective series of patients. The purpose of this study was to evaluate the need for first metatarsophalangeal joint arthrodesis or any other secondary procedures in the long term follow up in patients with stage II and III hallux rigidus. Methods: A retrospective review of 61 consecutive patients (61 feet) who had undergone decompressive osteotomy by the same surgical team during a period of 156 months was performed. The candidates for inclusion into the present study underwent a clinical evaluation preoperatively, and the clinical data recorded in the patients’ medical records were reviewed retrospectively. All clinical measurements were taken at the initial preoperative examination and at the final follow-up visit. Patients underwent Youngswick first metatarsal osteotomy as described in previous publication. The clinical examination included the the Foot and Ankle Outcome Score (FAOS), total range of motion of the first MTPJ. Radiographic examinations (AP and lateral weightbearing) were performed preoperatively, immediately postoperatively, and at each patient’s last follow-up visit by another member who was unaware of the clinical results. The need of any secondary procedure of the first metatarsal or subsequent need of first MTPJ arthrodesis was also recorded. Results: Decompressive osteotomy was performed in 61 patients, including 41 right feet and 20 left feet, with no bilateral procedures. The patient population consisted of 45 females (78%), with an average age of 53.8 years (range 29 to 72) years. The mean follow-up time was 54.8 months (range 12 to 150). 74% (45 patients) were classified as grade II and 16 patients (26%) as grade III. All patients who underwent this procedure had improvement their visual analog scale foot and ankle score, with all achieving postoperative scores >75 points. Evaluation at the last follow-up visit showed that 91% of patients would recommend the same procedure to a family member. In our group of patients there were no further needs of first MTPJ arthrodesis. Conclusion: We found significant visual analog scale foot and ankle score, providing evidence that good outcomes and high levels of patient satisfaction can be achieved, and that this results would maintain over time. Secondary procedures mainly hardware removal were somewhat usual, however no first MTPJ arthrodesis was needed in the medium term.

Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A Clinical and Radiological 2- to 8-Year Follow-up Study

2019 ◽  
Vol 47 (7) ◽  
pp. 1679-1686 ◽  
Author(s):  
Lizzy Weigelt ◽  
Rebecca Hartmann ◽  
Christian Pfirrmann ◽  
Norman Espinosa ◽  
Stephan H. Wirth
Keyword(s):  
Body Mass Index ◽  
Subchondral Bone ◽  
Visual Analog Scale ◽  
Osteochondral Lesions ◽  
Foot And Ankle ◽  
Analog Scale ◽  
American Orthopaedic ◽  
Ankle Function ◽  
Tegner Score

Background: Autologous matrix-induced chondrogenesis (AMIC) has become an interesting treatment option for osteochondral lesions of the talus (OLTs) with promising clinical short- to midterm results. Purpose: To investigate the clinical and radiological outcome of the AMIC procedure for OLTs, extending the follow-up to 8 years. Study Design: Case series; Level of evidence, 4. Methods: Thirty-three patients (mean age, 35.1 years; body mass index, 26.8) with osteochondral lesions of the medial talar dome were retrospectively evaluated after open AMIC repair at a mean follow-up of 4.7 years (range, 2.3-8.0 years). Patients requiring additional surgical procedures were excluded. All OLTs (mean size, 0.9 cm2; range, 0.4-2.3 cm2) were approached through a medial malleolar osteotomy, and 28 patients received subchondral autologous bone grafting. Data analysis included the visual analog scale for pain, the American Orthopaedic Foot and Ankle Society score for ankle function, the Tegner score for sports activity, and the MOCART (magnetic resonance observation of cartilage repair tissue) scoring system for repair cartilage and subchondral bone evaluation. Results: Mean ± SD visual analog scale score improved significantly from 6.4 ± 1.9 preoperatively to 1.4 ± 2.0 at latest follow-up ( P < .001). The mean American Orthopaedic Foot and Ankle Society score was 93.0 ± 7.5 (range, 75-100). The Tegner score improved significantly from 3.5 ± 1.8 preoperatively to 5.2 ± 1.7 at latest follow-up ( P < .001), and 79% returned to their previous sports levels. The MOCART score averaged 60.6 ± 21.2 (range, 0-100). Complete filling of the defect was seen in 88% of cases, but 52% showed hypertrophy of the cartilage layer. All but 1 patient showed persistent subchondral bone edema. The patient’s age and body mass index, the size of the osteochondral lesion, and the MOCART score did not show significant correlation with the clinical outcome. There were no cases of revision surgery for failed AMIC. Fifty-eight percent underwent reoperation, mainly for symptomatic hardware after malleolar osteotomy. Conclusion: AMIC for osteochondral talar lesions led to significant pain reduction, recovery of ankle function, and successful return to sport. The MOCART score did not correlate with the good clinical results; the interpretation of postoperative imaging remains therefore challenging.

scholarly journals P094 DIASTASIS POST-PREGNANCY PROGRAM

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Osvaldo Santilli
Keyword(s):  
Surgical Treatment ◽  
Specific Treatment ◽  
Line Treatment ◽  
First Line ◽  
Linea Alba ◽  
Multidisciplinary Program ◽  
Grade Ii ◽  
Grade Iii ◽  
First Line Treatment ◽  
Prospective Database

Abstract Aim This study aims to summarize our knowledge in rectus abdominis diastasis based on the experience collected by the multidisciplinary program. Material and Methods Retrospective analysis of a prospective database. The diastasis post-pregnancy program is an interdisciplinary protocol that aims to restore the anatomical and functional structure of the abdominal wall after the degenerative process of pregnancy. Used a systematic multidisciplinary evaluation that included an abdominal walls surgeon, plastic surgeon, physiotherapist, and radiologist. Following the findings, we propose a classification, adapting the specific treatment according to the degree of the patient's condition. Grade I only performed physiotherapy; Grade II: started physiotherapy plan, with associated surgical treatment due to lack of response; Grade III underwent surgery as the first treatment in addition to physiotherapy protocol. Endoscopic-assisted linea alba reconstruction plus mesh have using to repair midline hernias in association with diastasis. Results From January 2017 and June 2019, 1085 patients completed the program. Clinical classification: Grade I: 760 patients (70 %) and Grade II: 248 patients (64%) performed physiotherapy as first-line treatment, with associated surgical treatment being necessary for 89 patients (36%); Grade III: 77 patients (7%) underwent surgery as first-line treatment, associated with physiotherapy postoperative protocol. Postoperative complications were: 31 seromas(14%) , 11 omphalitis (5%), 5 hematoma (2%) 1 (0.44%) required surgical dressing. Mc Gill and Us Check-up post-treatment test showed improvement in 77 % of patients. Please insert your text here. Conclusions Evaluation and treatment, in post-pregnant patients, using a multidisciplinary approach concept showed good initial results with important improvement anatomical, functional, clinical, and aesthetic.

Extracorporeal Pulse-Activated Therapy versus Injection: Treatment of Recalcitrant Plantar Fasciitis

2019 ◽  
Vol 109 (2) ◽  
pp. 108-112
Author(s):  
John Grady ◽  
Yelena Boumendjel ◽  
Kathryn LaViolette ◽  
Trevor Smolinski
Keyword(s):  
Visual Analog Scale ◽  
Treatment Modality ◽  
Functional Outcomes ◽  
Plantar Fasciitis ◽  
Corticosteroid Injection ◽  
Inclusion Criteria ◽  
Analog Scale ◽  
Vas Score ◽  
Clinical Presentations ◽  
American Orthopaedic

Background: Plantar fasciitis is one of the most common clinical presentations seen by podiatric clinicians today. With corticosteroid injection being a classic treatment modality and extracorporeal pulse-activated therapy (EPAT) technology improving, the purpose of this study was to retrospectively compare pain and functional outcomes of patients with plantar fasciitis treated with either injection or EPAT. Methods: Between November 1, 2014, and April 30, 2016, 60 patients who met the inclusion criteria were treated with either corticosteroid injection or EPAT. Patients were evaluated with both the visual analog scale (VAS) and the American Orthopaedic Foot & Ankle Society Hindfoot Score at each visit. Results: The EPAT was found to reduce pain on the VAS by a mean of 1.98 points, whereas corticosteroid injection reduced pain by a mean of 0.94 points. This was a significant reduction in the VAS score for EPAT compared with corticosteroid injection (P = .035). Conclusions: Extracorporeal pulse-activated therapy is as effective as corticosteroid injection, if not more so, for the treatment of recalcitrant plantar fasciitis and should be considered earlier in the treatment course of plantar fasciitis.

scholarly journals Harmonic scalpel® hemorrhoidectomy: A painless procedure?

2007 ◽  
Vol 60 (9-10) ◽  
pp. 421-426 ◽  
Author(s):  
Dejan Ivanov ◽  
Sinisa Babovic ◽  
Dora Selesi ◽  
Mirjana Ivanov ◽  
Radovan Cvijanovic
Keyword(s):  
Surgical Treatment ◽  
Postoperative Pain ◽  
Visual Analog Scale ◽  
Surgical Approach ◽  
Surgical Procedure ◽  
Thermal Damage ◽  
Harmonic Scalpel ◽  
Hemorrhoidal Disease ◽  
Disease Stage ◽  
Analog Scale

Since the surgical treatment of hemorrhoidal disease has been characterized by intense postoperative pain, recent studies have tried to modify the standard Milligan-Morgans technique. The up-to-date literature, in the experience of authors, has confirmed that the new method of Harmonic Scalpel? hemorrhoidectomy reduces postoperative pain. The aim of our study was to statistically evaluate, based on our experience, the efficacy of this surgical approach in terms of reducing postoperative pain and establishing a stable hemostasis. Seventy-seven (77) patients suffering from hemorrhoid disease, stage III and IV, underwent surgery in our clinic during the last five years. The postoperative pain was determined using the visual analog scale on the 1st, 2nd and 7th postoperative days. Patients were divided into two groups in regard to the surgical procedure applied. The data were statistically processed using the Statistica 7.0 software. We concluded that Harmonic Scalpel? hemorrhoidectomy, due to less thermal damage, statistically significantly reduced postoperative pain with better hemostasis, compared with Milligan-Morgan's method of treating hemorrhoidal disease. .

Treatment of Bone Marrow Edema of the Talus with Pulsed Electromagnetic Fields

2015 ◽  
Vol 105 (1) ◽  
pp. 27-32 ◽  
Author(s):  
Nicolò Martinelli ◽  
Alberto Bianchi ◽  
Elena Sartorelli ◽  
Alessandra Dondi ◽  
Carlo Bonifacini ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Bone Marrow Edema ◽  
Foot And Ankle ◽  
Resonance Imaging ◽  
Analog Scale ◽  
Pulsed Electromagnetic ◽  
American Orthopaedic ◽  
Marrow Edema

Background Bone marrow edema (BME) of the talus is a rare, mostly self-limiting cause of foot and ankle pain. We sought to investigate in patients with idiopathic BME of the talus the effectiveness of pulsed electromagnetic fields and to determine the effect of this therapy on magnetic resonance imaging findings. Methods Six patients with BME of the talus confirmed by magnetic resonance imaging were enrolled. Pain was quantified with a visual analog scale from 0 (no pain) to 10 (the worst pain imaginable). The clinical outcome was assessed using the American Orthopaedic Foot and Ankle Society scoring system. Treatment consisted of pulsed electromagnetic field stimulation 8 h/d for 30 days. The device used generated pulses 1.3 milliseconds in duration, with a frequency of 75 Hz and a mean ± SD induced electric field of 3.5 ± 0.5 mV. Results The mean American Orthopaedic Foot and Ankle Society score improved from 59.4 (range, 40–66) before treatment to 94 (range, 80–100) at the last follow-up. The visual analog scale score decreased significantly from 5.6 (range, 4–7) before treatment to 1 (range, 0–2) at the last follow-up. Magnetic resonance imaging showed that BME improved after 1 month of treatment and resolved completely within 3 months in 5 patients, with normal signal intensity and no signs of progression to avascular necrosis. Conclusions A significant reduction in BME area was associated with a significant decrease in pain within 3 months of beginning treatment.

Long-term evaluation of functional results after 3D laparoscopic prostatectomy using visual analog scale

2021 ◽  
Vol 79 ◽  
pp. S1645-S1646
Author(s):  
H. Haapiainen ◽  
T.J. Murtola ◽  
H. Huhtala ◽  
A.J. Kaipia ◽  
M. Raitanen
Keyword(s):  
Visual Analog Scale ◽  
Functional Results ◽  
Analog Scale ◽  
Laparoscopic Prostatectomy ◽  
Term Evaluation

Arthroscopic Treatment of Osteochondral Lesions of the Talus in a Pediatric Population: A Minimum 2-Year Follow-up

2020 ◽  
Vol 48 (8) ◽  
pp. 1989-1998
Author(s):  
Michael J. Carlson ◽  
Tomasz T. Antkowiak ◽  
Nicholas J. Larsen ◽  
Gregory R. Applegate ◽  
Richard D. Ferkel
Keyword(s):  
Patient Satisfaction ◽  
Short Form ◽  
Arthroscopic Treatment ◽  
Osteochondral Lesions ◽  
Study Group ◽  
Foot And Ankle ◽  
Analog Scale ◽  
Foot Function ◽  
American Orthopaedic

Background: Treatment of osteochondral lesions of the talus (OLTs) in children presents a difficult clinical challenge, with few large series reported. Purpose: To evaluate functional and radiographic outcomes for children and adolescents undergoing arthroscopic treatment of symptomatic OLT with a minimum follow-up of 2 years. Study Design: Case series; Level of evidence, 4. Methods: Patients were identified who had symptomatic OLT treated arthroscopically with marrow stimulation techniques. Inclusion criteria were age ≤18 years, symptomatic chronic OLT as the surgical indication, failure of nonoperative treatment, and minimum follow-up of 24 months. Outcome measures included Foot Function Index, American Orthopaedic Foot and Ankle Society Hindfoot Score, Tegner Activity Scale, 36-Item Short Form Health Survey (Short Form-36, v 2), visual analog scale, ankle range of motion, and patient satisfaction survey. Weightbearing radiographs were compared with preoperative radiographs via an ankle arthritis classification system. Magnetic resonance imaging (MRI) was used to evaluate postoperative lesion characteristics per the MOCART scale (magnetic resonance observation of cartilage repair tissue). The size, location, lesion stability, traumatic etiology, skeletal maturity, and length of follow-up were recorded and analyzed through univariate logistic regression. Results: The study group consisted of 22 patients (11 male, 11 female) with a mean age of 14.4 years (range, 8-18 years) and a mean follow-up of 8.3 years (range, 2-27 years). Of 22 patients, 20 were satisfied with the results from surgery and would recommend it to others. Mean follow-up visual analog scale for pain was reported as 2.2 on a 10-point scale, and mean American Orthopaedic Foot and Ankle Society score at follow-up was 86.6. Mean postoperative Foot Function Index scores for the study group were as follows: pain, 17.1; disability, 16.5; activity, 4.7; and overall, 38.7. Mean Short Form-36 physical component score was 50.7. Postoperative radiographs indicated a van Dijk osteoarthritis grade of 0 in 56%, I in 38%, II in 6%, and III in 0%. Postoperative MRI MOCART scores showed complete filling of the cartilage in 27% of cases, complete graft integration in 22%, and intact repair surface in 22%, with a mean MOCART score of 48.0. No correlation was found between radiographic and MRI findings and clinical outcomes. None of the prognostic factors were significantly associated with patient satisfaction, progression of arthritis, or MOCART scores. Conclusion: Arthroscopic treatment of symptomatic OLT in adolescent patients (≤18 years) demonstrated high functional outcomes, high clinical satisfaction rates, and minimal radiographic osteoarthritic progression despite low MOCART scores.

Comparison of Clinical Efficacy Among Endoscopy-Assisted Radio-Frequency Ablation, Extracorporeal Shockwaves, and Eccentric Exercises in Treatment of Insertional Achilles Tendinosis

2017 ◽  
Vol 107 (1) ◽  
pp. 11-16 ◽  
Author(s):  
Min Wei ◽  
Yujie Liu ◽  
Zhongli Li ◽  
Zhigang Wang
Keyword(s):  
Retrospective Study ◽  
Radio Frequency ◽  
Clinical Efficacy ◽  
Radio Frequency Ablation ◽  
Foot And Ankle ◽  
Analog Scale ◽  
Achilles Tendinosis ◽  
Scale Scores ◽  
Before And After ◽  
American Orthopaedic

Background: We sought to compare clinical efficacy among endoscopy-assisted radio-frequency ablation under local anesthesia, extracorporeal shockwaves (ESWs), and eccentric exercises in treating insertional Achilles tendinosis. Methods: In this retrospective study, 78 patients diagnosed as having unilateral insertional Achilles tendinosis were enrolled. These participants underwent endoscopy-assisted radio-frequency ablation, ESWs, and eccentric calf muscle exercises between March 1, 2006, and February 28, 2011. Clinical efficacy was evaluated by the visual analog scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) ankle/hindfoot scale, and the Victorian Institute of Sport Assessment–Achilles (VISA-A) scale before and after treatment. Results: Before treatment, there were no statistically significant differences in VAS, AOFAS ankle/hindfoot scale, and VISA-A scale scores among the different groups (all P &gt; .05). For the endoscopy and ESW groups, VAS, AOFAS ankle/hindfoot scale, and VISA-A scale scores were significantly improved after 18 months of treatment (all P &lt; .05). The VAS, AOFAS ankle/hindfoot scale, and VISA-A scale scores in the endoscopy group were significantly higher than those in the ESW and eccentric exercise groups after 18 months of therapy (all P &lt; .05). Conclusions: Combined with synovectomy and tendon debridement, endoscopy-assisted radio-frequency ablation yields better clinical efficacy compared with ESWs in treating insertional Achilles tendinosis.

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