Congenital Brachymetatarsia: Three Cases

We report on three cases with congenital brachymetatarsia, one with bilateral affectation, together with the results of a lengthening of the short metatarsal bones by progressive axial distraction using an external minifixator. The method proved to be easy to implement, permitting immediate functionality of the ankle and early load bearing. The immediate results (cosmetic) and later findings (functional) were excellent in all three cases.

Intraosseous Ganglion Cyst of the Talus: Case Report

A case of an intraosseous ganglion cyst 1 , 6 of the talus is described. 1 , 9 Ganglion cysts within bone are not rare but are usually found within long bones located in metaphyseal areas. 7 , 10 This lesion of the talus produced significant pain and was successfully treated with curettage and iliac crest bone graft. 3

Tuberculosis of Bones and Joints of the Foot: An Analysis of 22 Cases

Skeletal tuberculosis constitutes 1% to 3% of extrapulmonary cases and involvement of foot bones is rare. Lack of awareness and a confusing clinical and radiological picture often lead to a delay in diagnosis. We reviewed 23 feet seen over a 3.5-year period. Most cases were children or young adults less than 40 years of age; isolated bony involvement was seen in 10 feet, with the calcaneus being involved in five cases. Articular involvement at presentation was seen in 13 cases and these cases had significantly higher delays in diagnosis. Twenty cases responded to antitubercular therapy alone while one case had to be operated (there was one fatal outcome). Complete resolution of sequestra was seen with antitubercular therapy alone. The results were better in cases with isolated bony involvement, while cases with joint involvement had residual sequelae in the form of stiffness or pain. Two patients were advised arthrodesis. Early diagnosis and antitubercular therapy is essential to prevent joint involvement from periarticular bony lesions; surgical intervention is rarely needed. A high index of suspicion has to be maintained in high risk groups like Asian immigrants. Concomitant extraskeletal lesions may not always be present.

Nonsurgical Treatment of Lateral Ligament Injury of the Ankle Joint

Between 1986 and 1989, 40 patients with acute lateral ligament injury of the ankle joint were treated by immobilizing their affected feet in a plaster cast with a heel for 4 weeks, followed by a brace for the next 2 months. The average follow-up time was 29 months. Ninety-eight percent of the patients were rated as having satisfactory functional results. Stress radiographs at the latest follow-up showed good stability even in ankles that were severely unstable at injury. Posttreatment stress radiographs taken periodically showed that stability was maintained 6 months after treatment.

Tarsal Coalition Presenting As A Pes Cavo-Varus Deformity: Report Of Three Cases and Review Of the Literature

The diagnosis of idiopathic pes cavo-varus is one of exclusion. Typically a neuropathic etiology is sought. Equally well known is the association of rigid flatfoot deformity with calcaneonavicular and subtalar coalition. Less well known is the association of pes cavo-varus with tarsal coalition. This is a report of three patients who presented with cavo-varus deformities without underlying neurologic abnormalities, one with a calcaneonavicular coalition and two with subtalar coalitions, the latter an entity not previously described in association with pes cavo-varus, to our knowledge.

Acute Compartment Syndrome of the Lower Extremity Secondary to Noncontact Injury

We retrospectively reviewed the cases of three patients with injuries similar to the mechanism of an ankle sprain which resulted in compartment syndrome of the lower extremity. All three patients presented with sharp, proximal, anterolateral pain in the leg after an indirect, twisting injury. None of the injuries involved direct contact. Two of the three athletes initially presented to local hospitals, where the injury was misdiagnosed as an ankle sprain. The mechanism appears to be a muscle strain or tear with resultant hemorrhage in the compartment. All three patients returned to high-level athletics after prolonged recovery periods.

Deformity Correction and Arthrodesis of the Midfoot with a Medial Plate*

Nine feet in eight patients undergoing tarsometatarsal (Lisfranc) or other midfoot arthrodeses for posttraumatic or degenerative arthritis were reviewed retrospectively. All patients were treated using a medial one-third tubular plate spanning the midfoot joints to be fused. Three feet underwent fusion in situ while six feet underwent correction of residual planus, planovalgus, or cavovarus deformity at the time of fusion. All patients achieved fusion within 12 weeks. A good or excellent result was achieved in seven of nine feet. There was no radiographic or clinical evidence of pseudarthrosis or medial hardware failure in any patient. No patient to date has required hardware removal for a painful or prominent implant. The talus first metatarsal angle was improved an average of 15.5° in the lateral plane and 10° in the AP plane in patients undergoing deformity correction. The technique of using a medial plate for midfoot arthrodesis allows for reliable fusion in patients who require salvage for midfoot arthritis. This technique also allows for correction of deformity in patients with residual midfoot deformity.

In-Shoe Plantar Pressure Measurement of the First Metatarsophalangeal Joint in Asymptomatic Patients

Using an in-shoe plantar pressure sensor, the pressure under the first metatarsophalangeal (MTP) joint was measured in 20 asymptomatic control subjects during their normal gait. A 7-micron in-shoe pressure sensor recorded the pressure under the first MTP joint in the 20 volunteers while they were wearing their normal footwear (athletic footwear), a wooden postoperative shoe, a fiberglass short leg walking cast, and a postoperative shoe with a first MTP joint cutout orthotic device. The results showed both casting, and the postoperative shoe with the first MTP joint cutout orthotic device significantly reduced pressure under the first MTP joint compared with normal footwear, with an average decrease of 31% and 43%, respectively. However, the standard postoperative shoe did not significantly reduce first MTP pressure compared with normal footwear. Certain surgeries performed on the distal first metatarsal may benefit from a diminution of loading forces encountered during normal gait. The results of this study indicate that a reduction in first MTP pressures can best be accomplished with either a postoperative shoe with a cutout orthotic device or a short leg walking cast. A standard postoperative shoe showed inconsistent results and had no statistically significant effect on decreasing the pressure under the first MTP joint.