Letter to the Editor| Volume 49, ISSUE 3, P316, May 2010

Letter to the Editor

Published:April 05, 2010DOI:
      Dear Editor:
      In a recent article, “An Anatomic and Autologous Lateral Ankle Stabilization,” Journal of Foot and Ankle Surgery 48(6):700–705, 2009, the author, Dr Jack Schuberth, discusses a new approach for the stabilization of lateral ankle sprains using the peroneus longus tendon. Although I found this a well-written article, I must take issue with the technique being presented as new and for not crediting the original source. Drs Schoenhaus and Jay originally published the anatomy, pathomechanics, diagnosis, rationale, purpose, and operative procedure using a portion of the peroneus longus tendon in the original article, which appeared in Current Therapy in Podiatric Surgery, pp 283–285, B.C. Decker, Philadelphia, 1989.
      The purpose of using the peroneus longus tendon is not limited to the available length or the preservation of the evertor effect of the peroneus brevis. Most importantly, ankle stabilization with the peroneus longus tendon weakens one of the major deforming forces in recurrent ankle instability (forefoot valgus) without jeopardizing the stabilizing effect of that muscle.
      The peroneus longus is a stance phase muscle that begins to fire in late contact phase and continues into late propulsion. It transfers weight to the medial side of the foot and stabilizes the first ray in late midstance and propulsion. The stabilization of the first ray follows the locking mechanism of the calcaneo-cuboid attained during midstance by the soleus muscle and resupination of the foot. When an imbalance from antagonist muscle exists, the biomechanical function of the peroneus longus can cause a pathomechanical deformity.
      In the normal foot, the lateral aspect of the forefoot contacts the ground in the beginning of stance phase. When the forefoot is fixed in valgus, the medial aspect is first to contact the ground, placing a retrograde force on the foot and causing supination of the subtalar and midtarsal joints. The force is transmitted to the leg segment, causing an abrupt cessation of the normal internal rotation, and forces external rotation of the limb. These abrupt changes in motion apply supinatory forces into the ankle, a “supinatory rock,” which may cause an acute inversion ankle injury with subsequent lateral ankle instability. A rearfoot varus is often associated with a forefoot valgus.
      Drs Schoenhaus and Jay's approach of the peroneus longus stabilization was also credited in McGlamry's Comprehensive Textbook of Foot and Ankle Surgery, Volumes 1 to 2, Chapter 35, Chronic ankle conditions, page 1120, Lippincott Williams and Wilkins, Philadelphia.
      Thank you.

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