Journal of Foot and Ankle Surgery

Cover 1

2010-03-01

Conducting Clinical Research and Getting the Report Published

D. Scot Malay — 2010-03-01

Providing satisfactory care and making a living are probably the two most common goals of the everyday practicing surgeon, whereas the goal implied by “publish or perish” is probably not very important to anyone who is not employed at an academic institution. Nonetheless, publication of the results of clinical research is a crucial part of the transfer of knowledge, and remains a worthwhile endeavor for foot and ankle surgeons everywhere. For this reason, clinicians should understand the way in which clinical questions become publishable research projects. For surgeons who want to publish their work, attention to a few important concepts will increase the likelihood that their work will get accepted for publication in a peer-reviewed biomedical journal. These key elements include reliable results, protocol development, prospective versus retrospective approaches, and attention to the particular journal's guide for authors.

An Invitation to Authors to Submit Video Footage with Manuscripts

D. Scot Malay — 2010-02-05

In an effort to further enhance the teaching value and interest in the manuscripts that we publish, authors are encouraged to include video clips along with their figures and tables. Video can be used to depict complicated surgical maneuvers and clinical examinations as a supplement to the text of an article. To view an example, visit our web site, http://www.jfas.org, where you can find the add-on that accompanies The Journal of Foot & Ankle Surgery Instructional Course entitled “Closed Reduction of the Supination-Eversion Stage IV (Weber Type B) Ankle Fracture,” by D'Angelantonio et al, Volume 48, Issue 3, pp. 283–418, May–June 2009 (http://www.jfas.org/article/S1067-2516%2809%2900055-6/addOns). This particular video clip shows a complex closed reduction maneuver that brings the words on the written page to life. Video imagery activates our sensory system and transcends language, and most readers simply enjoy watching an interesting or unusual diagnostic examination, fracture reduction, tendon transfer, arthroscopic manipulation, or other therapeutic intervention. Readers can also view the video as often as they desire, and even stop the action to study a particular aspect of the footage. At The Journal of Foot & Ankle Surgery, we accept the most commonly used audiovisual formats, such as .avi, .gif, and .mov; however, we prefer .mpg (MPEG-1 or MPEG-2) and .mp4. Each of these formats is capable of containing a number of data streams, and we prefer that they be limited to one stream each for video, audio, and titles to minimize the file size. Currently, we do not accept Flash video files, although we should have the capacity to handle the Flash format in the near future. Video is a powerful tool for teaching and learning and an asset to any publication, and we encourage our authors to take advantage of this medium to enhance their manuscripts.

Clarification

D. Scot Malay — 2010-03-01

Recently I was notified by Chris Powell, Product Manager Small Joint, Arthrex, Inc, Naples, FL, that we inaccurately referred to their product, namely the Ankle TightRope®, in connection with the term “Endobutton∗,” and that, in fact, the term “Endobutton∗” is trademarked by Smith & Nephew, Inc, London, UK (specifically, “Endobutton∗ CL BTB Fixation Device”). Mr Powell's concern was in reference to the following article: Cottom JM, Hyer CF, Philbin TM, Berlet GC. Transosseous fixation of the distal tibiofibular syndesmosis: comparison of an interosseous suture and endobutton versus traditional screw fixation in 50 cases. J Foot Ankle Surg 48(6):620–630, 2009. In that publication, the authors said: “To this end, traditional AO (Arbeitsgemeinschaft für Osteosynthesefragen, AO Foundation, Davos, Switzerland) screw fixation was compared with an endobutton and transosseous suture (Ankle TightRope®, Arthrex, Inc, Naples, FL), and radiographic and subjective and objective patient outcomes were compared between the treatment groups.” Because we make every effort to be as accurate as possible, and to avoid using proprietary terminology without the use of appropriate capitalization and trademark symbols, and noting the trademark owner's company name and address (city and state), I would like to make clear that the term “endobutton” was used in a generic sense to indicate a fixation device, much like a button, that is affixed to a suture, and this was not done in reference to Smith & Nephew's proprietary device. Moreover, we did not want to imply that Smith & Nephew's proprietary device, namely the EndoButton∗, was in any way a component of the Arthrex TightRope®. Along with taking steps to distinguish between generic and proprietary terminology, we also strive to avoid excessive commercial influence in the reports that we publish, and for this reason we encourage our authors to use generic terminology as much as possible after first identifying the product using the proprietary terminology. It is also interesting to note that as technical language changes over time, specific terms often evolve to convey a more general meaning. The term “endobutton” has, in fact, been used many times in the surgical literature over the past decade as a proprietary term, and also as a generic term, much like it was used in the aforementioned article that we published. With this in mind, the use of “endobutton” as a generic reference to a specific component of a fixation device is commensurate with the term's current use in the biomedical literature. Just the same, we understand and appreciate the concern that Mr Powell has pointed out, and in the future we will strive to be even clearer about our use of the term “endobutton” and, in fact, avoid mentioning the term in conjunction with the Ankle TightRope® and Mini-TightRope® devices, which are trademarked by Arthrex, Inc.

A Review of 51 Talonavicular Joint Arthrodeses for Flexible Pes Valgus Deformity

Craig A. Camasta, Christopher R.D. Menke, Patrick B. Hall — 2009-12-16

Abstract: The purpose of this study was to evaluate the radiographic and clinical outcomes of isolated talonavicular arthrodesis in the treatment of the flexible pes valgus foot type. Retrospectively, 51 consecutive isolated talonavicular arthrodeses in 41 patients were evaluated. The mean patient age was 47 (range 9 to 72) years, and the mean follow-up duration was 43.3 (range 11 to 113) months. The mean 10-cm categorical pain score before the surgery was 7.60 ± 2.37, and this improved to 1.90 ± 2.38 postoperatively, and this difference was statistically significant (P < .001). We also measured the preoperative and postoperative percent of talar uncovering, calcaneocuboid angle, Kite's angle, talar dome height, calcaneal inclination angle, and Meary's angle, and observed statistically significant (P < .001) improvements in all of these. Fifty-one (100%) of the cases progressed to radiographic osseous union, although 2 (3.92%) of the cases were considered delayed unions. Moreover, 4 (7.84%) of the cases displayed juxta-articular arthrosis postoperatively, and 2 (3.9%) cases developed transfer pain to the lateral column. The authors concluded that isolated talonavicular arthrodesis is a safe and effective procedure for the treatment of painful pes valgus deformity.

Functional Outcome and Patient Satisfaction after Flexor Tenotomy for Plantar Ulcers of the Toes

Tim Schepers, Heleen A. Berendsen, I. Hok Oei, Jan Koning — 2010-02-05

Abstract: Ulcers of the toes may cause a severe physical burden, especially in patients with diabetes, in whom they occur most frequently. Several treatments have been proposed for the underlying anatomical abnormalities, but they vary in effectiveness. We evaluated our results in using flexor tenotomy to treat ulcers with underlying flexible clawing of the toes. For 42 toes from 23 patients, 15 of whom were diabetic, all ulcers healed. The mean healing time was 4 weeks (range, 1-8 weeks), the mean follow-up was 11 months (range, 1-27 months), and one recurrence and one complication occurred. Postoperative American Orthopaedic Foot Ankle Society Midfoot scores were available for 15 patients: the mean was 77 (range, 43-100). The mean visual analogue scale (VAS) for patient satisfaction increased from 3.9 points (range, 0-10 points) preoperatively to 7.7 (range, 5-10 points) postoperatively. Flexor tenotomy is a simple treatment with low complications and recurrence rates and provides good-to-excellent functional outcomes in treating flexible clawing of the toes and the associated ulceration.

The Porcine Small Intestinal Submucosa (SIS) Patch in Foot and Ankle Reconstruction

Christopher Bibbo — 2009-12-21

Abstract: We undertook a retrospective cohort study of 54 patients who underwent foot and ankle soft tissue reconstructive surgery augmented with a porcine small intestinal submucosal (SIS) patch. The mean patient age was 44 (range 17 to 68) years, there were 21 (38.89%) males in the cohort, and the mean follow-up duration was 1080 (range 365 to 1943) days. Clinical outcomes were considered excellent in 46 (85.19%) patients, good/fair in 3 (5.56%) patients, and poor in 5 (9.26%) patients; and no adverse events attributable to the xenograft were observed. Direct SIS patch failure, resulting in stretching of the repair, re-tear, or tendon stenosis, occurred in 3 (5.56%) patients, and delayed incision healing occurred in 6 (11.11%) patients. Based on our observations, we concluded that the porcine SIS xenograft, when used to augment cellular and vascular in-growth, is a viable adjunct to musculoskeletal reconstructions of the foot and ankle.

Comparison of Achilles Tendon Repair Techniques in a Sheep Model Using a Cross-linked Acellular Porcine Dermal Patch and Platelet-rich Plasma Fibrin Matrix for Augmentation

2010-02-05

Abstract: The primary goal of this study was to evaluate a cross-linked acellular porcine dermal patch (APD), as well as platelet-rich plasma fibrin matrix (PRPFM), for repair of acute Achilles tendon rupture in a sheep model. The 2 surgically transected tendon ends were reapproximated in groups 1 and 2, whereas a gap was left between the tendon ends in group 3. APD was used to reinforce the repair in group 2, and autologous PRPFM was used to fill the gap, which was also reinforced with APD, in group 3. All sheep were humanely euthanized at 24 weeks after the repair, and biomechanical and histological testing were performed. Tensile strength testing showed a statistically significant difference in elongation between the operated limb and the unoperated contralateral limb in groups 1 and 3, but not in group 2. All operated tendons appeared healed with no apparent fibrosis under light and polarized microscopy. In group 1, all surgical separation sites were identifiable, and healing occurred via increasing tendon thickness. In group 2, healing occurred with new tendon fibers across the separation, without increasing tendon thickness in 2 out of 6 animals. Group 3 showed complete bridging of the gap, with no change in tendon thickness in 2 out of 6 animals. In groups 2 and 3, peripheral integration of the APD to tendon fibers was observed. These findings support the use of APD, alone or with PRPFM, to augment Achilles tendon repair in a sheep model.

Efficacy of Power-pulsed Lavage in Lower Extremity Wound Infections: A Prospective Observational Study

Gregory A. Mote, D. Scot Malay — 2010-01-13

Abstract: Power-pulsed lavage is a common adjunct to surgical wound debridement, although few studies have examined the effect of this technique in lower extremity wounds. Fifty-five consecutively enrolled patients underwent 73 surgical debridements with power-pulsed lavage, and specimens were obtained for Gram stain and culture and sensitivity analyses before and after lavage. A number of risk factors were analyzed in regard to a successful outcome, which was defined as the absence of any organisms observed on the immediate postlavage culture. The incidence of a successful outcome was 69.86%, and debridement plus power-pulsed lavage statistically significantly decreased bacteria between the immediate prelavage and immediate postlavage specimens, for Gram stain (P = .0004) and culture (P = .005) analyses. Generalized estimation equations provided fully adjusted effect estimates that revealed a decreased likelihood of observing success if the patient's age was 85 years or older, or if rare or many organisms, or gram-negative rods, were present on the immediate prelavage Gram stain; whereas an increased likelihood of success was observed if the patient's body mass index was indicative of normal weight, and if few bacteria were noted on the immediate prelavage culture specimen. Based on these results, we concluded that power-pulsed lavage can be effective in decreasing the presence of bacteria in lower extremity wounds, and an awareness of the patient characteristics and microbiological factors associated with the persistence of bacteria may be helpful to surgeons treating such wounds.

A Randomized Controlled Trial to Compare Two Techniques for Partial Digital Local Anesthetic Blocks

Bruce Whiteley, Sharon Rees — 2010-03-01

Abstract: The administration of local anesthetic before surgery to the great toe is often associated with significant difficulties, delaying surgery and increasing risk. Anxious patients can faint, refuse injection, or withdraw the foot while an anesthetic is being delivered. Such events led us to consider whether delivering a small amount of anesthetic throughout the injection site, before the main injection, may reduce pain intensity and duration. This study was designed to test this possibility. A randomized controlled, single-blinded, parallel-grouped clinical trial was carried out with a sample of 50 patients. All study participants received each injection method (1 or 2 stage) to either the medial or lateral side of the great toe. The primary end points were pain intensity, measured by scores on a visual analogue scale and duration, recorded by the patient with a stopwatch. The 2-stage method was associated with less intense pain (reduced from moderate to mild visual analogue scale level) of a shorter duration. The differences were highly statistically significant. In the 2-stage method, it is believed that they were due to the initial infiltration of a small quantity of the anesthetic solution throughout the injection site, with the remainder being administered, after a 2-minute interval, into tissue that was predominantly anesthetized. This differs from raising a traditional bleb where a small amount of anesthetic is infiltrated into superficial tissue. The 2-stage technique is therefore recommended as the method of choice for adults.

Analysis of Ankle Range of Motion and Functional Outcome Following Total Ankle Arthoplasty

Pieter M. Lagaay, John M. Schuberth — 2010-03-01

Abstract: The success of ankle joint replacement has primarily been reviewed with respect to patient morbidity and survivorship rather than patient satisfaction. A retrospective review was performed of 95 patients who had undergone a total ankle replacement and who had completed both postoperative range of motion fluoroscopy and a subjective patient score sheet. Collected data included age, body mass index, length of follow-up, presence of complications, performance of adjunctive procedures, range of motion, and the etiology of the end-stage arthritis. These variables were then compared with patient satisfaction to see if there were any predictive conditions of successful outcomes. Patients older than 60 years and those with a body mass index (BMI) less than 30 demonstrated a significant positive association with subjective satisfaction scores (P = .0023 and .0008, respectively). The amount of postoperative range of motion did not appear to correlate with patient satisfaction. Furthermore, there were no significant associations of patient satisfaction with a patient age younger than 60 years, a BMI greater than 30, additional procedures, perioperative complications, the length of time after surgery, and the presenting etiology.

Safety of Local Anesthesia Combined with Monitored Intravenous Sedation for American Society of Anesthesiologists 3 and 4 Patients Undergoing Lower Limb–preservation Procedures

2010-02-05

Abstract: The aim of this retrospective study is to evaluate the prognostic value of American Society of Anesthesiologists (ASA) classification with regard to perioperative variables of cardiac complications, pulmonary complications, and mortality in patients undergoing limb salvage procedures with monitored intravenous sedation and foot and ankle blocks. None of the ASA 3 or 4 patients experienced any pulmonary or cardiac complication; no patient required invasive monitoring or postoperative cardiac care unit admission. We suggest that the performance of peripheral foot and ankle blocks with monitored intravenous sedation appears to be a safe and useful option for ASA 3 and 4 patients undergoing limb-preservation surgery.

Inflammatory Reaction to Implanted Equine Pericardium Xenograft

William T. DeCarbo, Bryan M. Feldner, Christopher F. Hyer — 2009-12-21

Abstract: Equine pericardium xenograft is now widely used to augment Achilles tendon repair. In this article, we describe the case of a postoperative complication in a healthy 37-year-old male who underwent primary repair, augmented with equine pericardium, of his acutely ruptured Achilles tendon. At 4 months postoperative, an indurated and fluctuant subcutaneous soft tissue reaction was noted at the repair site. Further questioning led the patient to recall having an allergy to horses, although it had been a very long time since he had experienced any symptoms related to the allergy and, as such, he failed to mention this important fact at the time of his initial examination. At 11 months postoperative, the xenograft was removed and, thereafter, the wound healed uneventfully. At 6 months following removal of the xenograft, the patient displayed no evidence of allergy or Achilles tendon dysfunction.

Clostridium septicum Necrotizing Fasciitis of the Forefoot Secondary to Adenocarcinoma of the Colon: Case Report and Review of the Literature

Valerie L. Schade, Thomas S. Roukis, Mohamad Haque — 2009-11-30

Abstract: Clostridium septicum accounts for 1% of all reported clostridial infections. C septicum infections are most often nontraumatic in nature and associated with either an occult colonic or hematologic malignancy. The initial presentation of a C septicum infection can be relatively benign with rapid progression to fatality without emergent treatment. Presented is a case of necrotizing fasciitis of the forefoot caused by C septicum associated with an occult adenocarcinoma of the colon in a patient with uncontrolled diabetes. The process we used to achieve successful functional limb preservation based on rapid surgical intervention and use of a multidisciplinary approach to medical and surgical management of this patient is discussed in detail, as well as a through review of the literature regarding the association between malignancies and C septicum infections.

Gastrocnemius Recession as an Alternative to TendoAchillis Lengthening for Relief of Forefoot Pressure in a Patient with Peripheral Neuropathy: A Case Report and Description of a Technical Modification

2010-02-05

Abstract: The gastrocnemius recession is a popular surgical procedure for the treatment of equinus contracture. Lengthening the gastrocnemius tendon has been show to be an effective means of reducing pressure to the plantar forefoot by weakening the triceps surae complex. The more traditional method of weakening the triceps surae is a modification of Hoke's triple hemisection through the tendoAchillis. This technique unfortunately carries a serious risk of the development of a calcaneal gait. The purpose of this case report is to demonstrate that the gastrocnemius recession is an effective and safe alternative to the traditional tendoAchillis lengthening. The authors also describe a minimally invasive technique that uses a pediatric speculum for a self-retrained retractor and portal for instrumentation and visualization.

Treatment of Metastatic Prostate Adenocarcinoma to the Calcaneus

Christopher Bibbo, Shawn P. Hatfield, Justin T. Albright — 2009-12-16

Abstract: Metastatic skeletal adenocarcinoma is an all too common and unfortunate complication of advanced oncologic states. Mortality rates are usually elevated when bony metastasis are evident, as this signifies advanced disease. The foot and ankle are uncommon sites for metastatic deposits, but may occur. As such, the foot and ankle surgeon must be aware of the potential for such disease, and be able to proceed with an imaging and medical work-up of the patient with foot and ankle skeletal metastasis. The goal of treatment is pain relief and the preservation of functional ambulation, which may greatly enhance the quality of remaining life for patients. A team approach is mandatory to manage the patients with metastatic disease. We present a case of an elderly male with a known history of prostate cancer, who presented with unrelenting heel pain, which upon diagnostic work-up, proved to be progressive calcaneal as well as axial metastasis after a brief period of clinical remission. Operative management coupled with palliative radiation and bisphosphonate therapy provided symptomatic pain relief and maintenance of functional ambulation.

Application of an Interosseous Suture and Button Device for Hallux Valgus Correction: A Review of Outcomes in a Small Series

Priya Ponnapula, Richard Wittock — 2009-11-11

Abstract: A relatively new method to treat a bunion deformity by means of positional correction rather than structural realignment via osteotomy has been used in a series of 5 patients. This approach to first ray correction entails the use of an interosseous suture and button device that is positioned under tension between the first and second metatarsals, thereby reducing the first intermetatarsal angle. The median age of the group of patients was 51 years (range, 16-71 years), and the median follow-up duration was 20 months (range, 8-64 months). Statistically significant reductions in the first intermetatarsal and hallux abductus angles were observed between the preoperative and immediate postoperative measurements (P = .0006 and P = .0044, respectively) and between the preoperative and long-term postoperative measurements (P = .0189 and P = .0305, respectively), and, although loss of correction was observed between the immediate and long-term postoperative first intermetatarsal and hallux abductus angles, these changes were not statistically significant (P = .1369 and P = .1193, respectively). In 3 (60%) of the cases, complications developed that required revisional surgery and removal of the device. In the other 2 (40%) cases, the surgical procedure was modified and satisfactory outcomes were obtained, although minor complications occurred in both. Based on our experience with these patients, the modified surgical procedure shows some effectiveness in treating hallux abductovalgus, although further evaluation of the technique is warranted.

Retained Hawthorn Fragment in a Child's Foot Complicated by Infection: Diagnosis and Excision Aided by Localization with Ultrasound

Edwin J. Harris — 2009-12-04

Abstract: Puncture wounds in children are very common and often result in foreign body retention. Organic materials in the form of plant thorns present problems in identification and localization because they are not visualized with plain radiographs. A case of a 10-year-old girl with a small piece of retained hawthorn is presented. Correct diagnosis and treatment were delayed because of misinterpretation of magnetic resonance image studies. Ultrasound ultimately located the foreign body, and assisted in its excision. Plant thorns may be toxic and produce an intense local inflammatory response. In the case described in this article, deep infection caused by Enterobacter cloacae and Pantoea agglomerans was associated with the retained thorn. The small size of the foreign body, misinterpretation of diagnostic images, and the deep infection highlight the challenges that can be encountered by physicians managing puncture wounds in children.

Irreducible Fracture Dislocation of the Ankle Caused by Tibialis Posterior Tendon Interposition

2009-12-21

Abstract: A patient with severe irreducible open fracture dislocation of the ankle was admitted to our emergency department. After wound irrigation and debridement, skeletal traction was applied to the calcaneus to minimize soft tissue injury and swelling. The patient was followed in traction for 1 week, after which reduction and fixation of the fibula was attempted but not achieved. We extended the incision distally, visualized the ankle, and located the tibialis posterior tendon between the distal tibia and fibula, thereby inhibiting the reduction. The tendon coursed into the tibiotalar joint anteriorly and pushed the talus anterolaterally. After manipulation of the tendon to its anatomically correct location, the ankle was easily reduced. The wound at the medial side was closed with a fasciocutaneous rotational flap. The ankle was then immobilized for 6 weeks postoperatively. The patient regained her full range of motion, and there were no problems with the tibialis posterior tendon, such as rupture or insufficiency. Isolated tibialis posterior tendon interposition between the distal tibiofibular and tibiotalar joints has rarely been reported, and can inhibit anatomical reduction of the fractured ankle.

Reimplantation of a Totally Extruded Talus: A Case Report

2009-12-16

Abstract: Total extrusion of the talus is an unusual injury, and the obvious risks of reimplantation of the extruded bone include infection and avascular necrosis. In this article, the authors present the case of a 34-year-old man who sustained an open ankle injury with complete extrusion of the talus. The talus was recovered at the scene of the accident, and subsequently reimplanted along with ankle stabilization with pins and an external fixator. At 6 weeks following the osseous surgery, final soft tissue reconstruction with a suralis flap was performed. At 3 years after the injury, radiographs revealed spontaneous fusion of the tibiotalar and subtalar joints, and the clinical examination and history indicated satisfactory weight-bearing function of the involved foot and ankle. The definitive treatment of this serious lower extremity injury remains controversial, and the use of large allogeneic bone grafts, vascularized bone grafts, and tibiocalcaneal fusion, as well as reimplantation of the extruded talus have been recommended.

Concomitant Rupture of Achilles Tendon and Superior Peroneal Retinaculum: A Case Report

Jake Lee, John M. Schuberth — 2009-11-11

Abstract: A case of a concomitant rupture of the Achilles tendon and superior peroneal retinaculum is presented. This combination of injuries has only been reported once in the available literature. The intraoperative findings revealed a mid-substance failure of the superficial peroneal retinaculum, which is also a rare finding. It is suggested that mid-substance failure of this structure be included within the existing classification scheme for superficial peroneal retinacular tears. The authors also discuss the probable pathoanatomical features of these combined injuries and a proposed mechanism of injury.

Digital Fracture After a Flexor Tendon Transfer for Hammertoe Repair: A Case Report

William D. Fishco, Bryan J. Roth — 2009-12-04

Abstract: The authors present a case report of a complication of a complete phalangeal fracture after flexor digitorum longus tendon transfer used for the surgical correction of a hammertoe deformity.

Use of the Taylor Spatial Frame in Compression Arthrodesis of the Ankle: A Study of 10 Cases

Wasiq A. Thiryayi, Zafar Naqui, Sohail A. Khan — 2009-12-04

Abstract: Ankle fusion is a well established way of managing a variety of recalcitrant ankle pathologies including severe osteoarthritis and infected malunion of ankle fractures. Compression arthrodesis has been a widely accepted surgical means of achieving ankle fusion. The authors describe compression arthrodesis of the tibiotalar joint in 10 cases using the Taylor-Spatial Frame (TSF). From 2003 to 2005, 10 patients (9 male and 1 female) aged between 48 and 71 years (median age 61 years) underwent application of the TSF to achieve compression arthrodesis of 10 ankle joints. The TSF is an external fixator system supported by a computer program. After input of the radiological deformities referenced to one of the rings, the computer provides the detailed strut adjustments necessary to bring about gradual correction. The underlying pathology was severe posttraumatic arthritis (2 cases), malunion (1 case), nonunion of pilon fracture (1 case), and infected ankle (1 case). Five cases presented with previous failed surgical arthrodesis. Clinical, subjective, objective, and radiological analyses were performed regularly and at the end of an average follow-up of 16.7 months (range 12–26 months). Solid fusion in anatomical alignment with return to a fully functional status was obtained in 10 out of 10 ankles. The TSF has shown encouraging results as a simple, effective and versatile means of achieving compression arthrodesis of the ankle joint.

Stenosing Tenosynovitis of the Peroneus Brevis Tendon Associated with Hypertrophy of the Peroneal Tubercle

Hakan Boya, Halit Pinar — 2009-05-11

Abstract: Stenosing peroneal tenosynovitis is not an uncommon ailment. It has a number of different causes, one of which is hypertrophy of the peroneal tubercle. In this report, we present a case of stenosing tenosynovitis of the peroneus brevis tendon associated with hypertrophy of the peroneal tubercle without involvement of the peroneus longus tendon. The condition was fully resolved by means of operative treatment.

Precise Intraoperative 60° Skin Z-plasty

Samantha E. Bark, L. Marie Keplinger, Andrew J. Meyr — 2010-02-01

Abstract: The primary objective of this tip is to assist foot and ankle surgeons in performing a precise 60° lengthening Z-plasty in the operating room without the use of a template or protractor. A ruler and basic trigonometric principles are applied to the line of contracture to obtain consistent and reliable results.

Chevron Arthrodesis of the Interphalangeal Joint for Hammertoe Correction

J. Michael Miller, Douglas K. Blacklidge, Vafa Ferdowsian, David R. Collman — 2010-03-01

Abstract: Interphalangeal joint arthrodesis is a common procedure to correct fixed or semifixed lesser toe contracture. The authors present a simple modification to end-to-end interphalangeal joint arthrodesis that increases surface area and enhances construct stability. The technique is most commonly used for the proximal interphalangeal joint and may be combined with any number of fixation techniques.

Percutaneous Distraction Osteogenesis for Treatment of Brachymetatarsia

Bradley M. Lamm — 2009-12-21

Abstract: Brachymetatarsia is not an unusual deformity and is often associated with functional and cosmetic issues that warrant surgical reconstruction. Lengthening of the affected metatarsal can be undertaken on an acute basis in a single operative procedure that involves the use of a bone graft or by means of gradual callus distraction. Because of the risk of metatarsophalangeal joint malalignment, it is important for the surgeon to take steps to stabilize the joint during the lengthening process. In this report, a percutaneous method of callus distraction for repair of brachymetatarsia and maintenance of metatarsophalangeal joint alignment is presented.

The Use of a Femoral Distractor to Aid Distal Tibial Resection During Total Ankle Arthroplasty

Michael Whitehouse, Simon Thompson, Paul Halliwell, Matthew Solan — 2009-07-03

Abstract: Distal tibial resection during total ankle arthroplasty can be time consuming and presents a technical challenge. We recommend the use of a femoral distractor to assist with this specific part of the operation. We describe the technique below and have now adopted it as a commonplace stage in our ankle replacements.

An Uncomplicated Method for Minimally Invasive Achilles Tendon Repair

William Y.H. Ngai, Samson C.F. Chan — 2010-03-01

Abstract: The Achilles tendon is the largest palpable tendon in the human body, and rupture of this tendon is not an uncommon injury encountered by foot and ankle surgeons. A number of different minimally invasive methods have been described for repair of the ruptured Achilles tendon. In this article, we describe a relatively simple, minimally invasive technique of Achilles tendon repair that does not require special instrumentation, the key requirement being that of a sponge forceps.

An Unusual Injury to the First Metatarsophalangeal Joint

Niall P. Breen, Alistair Wilson — 2010-03-01

Abstract: Subtle but significant peripheral injuries can be overlooked in the multiply injured patient. We present one such case in relation to the first metatarsophalangeal joint, where failure to diagnose and treat early would have produced greater long-term morbidity.

The Extended Knee Hemilithotomy Position for Gastrocnemius Recession

Paul Dayton, Jeffrey Wienke — 2010-02-01

Abstract: The focus of this communication is to share an alternative positioning method that we have used over the past 3 years for gastrocnemius recession with the patient supine on the operating table. The technique uses a candy-cane leg holding system to situate the patient in the extended knee hemilithotomy position. We have found that this position provides excellent visualization of the surgical site, furnishes the anesthesiologist with optimal access to the patient, negates the need to turn the patient from prone to supine when adjunct procedures are to be undertaken, and allows the involved extremity to remain sterile throughout the operation, without an increase in complications or cost.

REMOVED: Retraction notice to The Use of a Femoral Distractor to Aid Distal Tibial Resection During Total Ankle Arthroplasty

Michael Whitehouse, Simon Thompson, Paul Halliwell, Matthew Solan — 2010-03-01

Available online This article has been removed consistent with Elsevier Policy on Article Withdrawal. The Publisher apologises for any inconvenience this may cause.

Masthead

2010-03-01

Editorial Board

2010-03-01

Journal of Foot and Ankle Surgery

Cover 1

Conducting Clinical Research and Getting the Report Published

An Invitation to Authors to Submit Video Footage with Manuscripts

Clarification

A Review of 51 Talonavicular Joint Arthrodeses for Flexible Pes Valgus Deformity

Functional Outcome and Patient Satisfaction after Flexor Tenotomy for Plantar Ulcers of the Toes

The Porcine Small Intestinal Submucosa (SIS) Patch in Foot and Ankle Reconstruction

Comparison of Achilles Tendon Repair Techniques in a Sheep Model Using a Cross-linked Acellular Porcine Dermal Patch and Platelet-rich Plasma Fibrin Matrix for Augmentation

Efficacy of Power-pulsed Lavage in Lower Extremity Wound Infections: A Prospective Observational Study

A Randomized Controlled Trial to Compare Two Techniques for Partial Digital Local Anesthetic Blocks

Analysis of Ankle Range of Motion and Functional Outcome Following Total Ankle Arthoplasty

Safety of Local Anesthesia Combined with Monitored Intravenous Sedation for American Society of Anesthesiologists 3 and 4 Patients Undergoing Lower Limb–preservation Procedures

Inflammatory Reaction to Implanted Equine Pericardium Xenograft

Clostridium septicum Necrotizing Fasciitis of the Forefoot Secondary to Adenocarcinoma of the Colon: Case Report and Review of the Literature

Gastrocnemius Recession as an Alternative to TendoAchillis Lengthening for Relief of Forefoot Pressure in a Patient with Peripheral Neuropathy: A Case Report and Description of a Technical Modification

Treatment of Metastatic Prostate Adenocarcinoma to the Calcaneus

Application of an Interosseous Suture and Button Device for Hallux Valgus Correction: A Review of Outcomes in a Small Series

Retained Hawthorn Fragment in a Child's Foot Complicated by Infection: Diagnosis and Excision Aided by Localization with Ultrasound

Irreducible Fracture Dislocation of the Ankle Caused by Tibialis Posterior Tendon Interposition

Reimplantation of a Totally Extruded Talus: A Case Report

Concomitant Rupture of Achilles Tendon and Superior Peroneal Retinaculum: A Case Report

Digital Fracture After a Flexor Tendon Transfer for Hammertoe Repair: A Case Report

Use of the Taylor Spatial Frame in Compression Arthrodesis of the Ankle: A Study of 10 Cases

Stenosing Tenosynovitis of the Peroneus Brevis Tendon Associated with Hypertrophy of the Peroneal Tubercle

Precise Intraoperative 60° Skin Z-plasty

Chevron Arthrodesis of the Interphalangeal Joint for Hammertoe Correction

Percutaneous Distraction Osteogenesis for Treatment of Brachymetatarsia

The Use of a Femoral Distractor to Aid Distal Tibial Resection During Total Ankle Arthroplasty

An Uncomplicated Method for Minimally Invasive Achilles Tendon Repair

An Unusual Injury to the First Metatarsophalangeal Joint

The Extended Knee Hemilithotomy Position for Gastrocnemius Recession

REMOVED: Retraction notice to The Use of a Femoral Distractor to Aid Distal Tibial Resection During Total Ankle Arthroplasty

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