Background: Supination-adduction (SAD) type injuries are pylon variant injuries and lie between partial intra-articular pylon fractures and rotational ankle fractures. We aimed to evaluate functional outcomes of SAD type 2 bimalleolar fractures in comparison to supination–external rotation (SER) type 4 fractures.
Methods: We retrospectively reviewed data of 42 cases with SER type 4 and 20 cases with SAD type 2 injuries. Patients with a history of rheumatic disease, open fractures, pathologic fractures, nonbimalleolar fractures, neuropathic disease, and talus osteochondral lesion, and those operated on after greater than 72 hours because of skin lesion or managed with a two-stage surgical protocol after external fixation, were not included in the study. We compared these two groups in terms of the mean age, follow-up time, visual analog scale pain and American Orthopedic Foot and Ankle Society scores, Kellgren-Lawrence arthrosis classification, union time, and complications.
Results: The groups did not differ in terms of mean age (P = .115) and sex (P = .573). There was no significant difference in terms of union time between the groups (P = .686). American Orthopedic Foot and Ankle Society score was significantly higher in the SER group (91.2 ± 9.9) than in the SAD group (86.1 ± 13.2; P = .034). Visual analog scale pain scores were similar in the SAD (0.3 ± 0.92) and the SER (0.26 ± 0.7) groups (P = .897).
Conclusions: Supination-adduction bimalleolar fractures may have worse functional outcomes in the intermediate term than do SER bimalleolar fractures, implying pylon variant fractures as a mechanism of injury. Supination-adduction bimalleolar fractures might be associated with a high rate of intra-articular cartilage impaction, resulting in varus deformity after surgery.
Background: Studies have shown that personal and economic reasons determine whether clinicians use diagnostic technology in their routine clinical biomechanical practice. This study aimed to identify the biomechanical management plan of local clinicians in relation to management of the diabetic high-risk foot and to investigate whether diagnostic technology is being used to determine the effectiveness of dispensed prescription orthoses in view of ulcer prevention.
Methods: A mixed-methodologic approach was adopted in this study. A retrospective quantitative study was also conducted to access records of patients attending the biomechanics clinic at a local health biomechanics clinic. Outcomes of interest included the number and percentage of patients attending the biomechanics clinic, source of referral to this clinic, age and gender of patients, clinical diagnosis, management plan, and referral pathway. Following a phenomenologic approach, four experienced clinicians working in the private, primary, and tertiary health sectors were interviewed. Thematic analysis was used to analyze and interpret data.
Results: Only low-risk patients living with diabetes mellitus were referred for a comprehensive biomechanical examination; the majority were referred by podiatrists. There was no record of diabetic high-risk patients being referred for a detailed biomechanical assessment within the health service. This study also confirmed that, because of the expenses and laborious work involved when using diagnostic technology to assess foot pressures, interviewed clinicians based their treatment plan and tested the efficiency of dispensed offloading devices on the basis of clinical experience and visual observation only.
Conclusions: Waiting for signs of ulceration can be too late for the high-risk foot. A change in clinical practice is recommended where the integration of diagnostic technology, together with standard care, in view of ulcer prevention is warranted.
Background: The aim of the study was to examine the effect of the position of the plate and syndesmotic screw on postoperative tibiofibular joint malreductions in cases where the syndesmotic screw is inserted through the hole of the anatomically locked lateral distal fibula plate.
Methods: Thirty patients (13 female and 17 male patients) with postoperative computed tomographic scans were examined retrospectively. Patient information (eg, tibiofibular congruence measured from postoperative computed tomographic scans, the anterior and posterior tibiofibular distance at axial sections, the presence and orientation of fibular rotation, the presence of tibiofibular intraarticular piece, the angle between the syndesmotic screw and incisural line, the placement of the plate, and the localization of the screw on the fibula in axial images) was recorded.
Results: Those with fibular internal rotation had a lower syndesmotic screw–incisural line angle (SIA) (P = .001).There was a very strong negative significant correlation between the tibiofibular angle and SIA (rho, −0.780; P = .001). The median tibiofibular angle was found to be higher in cases with the fibula plate placed anteriorly (P = .009).The median SIA was found to be lower in cases with the fibula plate placed anteriorly (P = .004).The rate of placement of syndesmotic screw in the anterior third of the fibula was found to be high in cases with the fibula plate placed anteriorly (P = .049).
Conclusions: In ankle fractures treated with insertion of a syndesmotic screw through the plate, the orientation of the syndesmotic screw in the axial plane and the position of the plate may be associated with the incidence of postoperative syndesmosis malreduction.
Background: Neurologic assessments using a monofilament and a tuning fork are routinely performed to screen for peripheral neuropathy and to identify foot ulceration and amputation risks. We investigated whether assessments commonly used to monitor sensation in the feet may illuminate a more holistic perspective of a person’s overall health status.
Methods: Recruitment of 50 participants for foot health screening was facilitated via a promotional event for Foot Health Week. Participants were aged 52 to 92 years (31 women and 19 men). Monofilament and tuning fork assessments were used to determine each participant’s neurologic status. Participants also completed a modified Foot Health Status Questionnaire. Data were analyzed to identify correlations between neurologic assessment results and questionnaire responses.
Results: For participants self-reporting an “excellent” health rating, a significant relationship was identified with adequate vibration sensation (P < .01). Significant correlations were also identified between a greater number of sites detected using a 10-g monofilament assessment and a person’s experience of having a lot of energy (P = .03), limited interference with social activities (P = .03), and greater confidence completing a variety of functional tasks.
Conclusions: Significant correlations were observed between basic neurologic assessments and a participant’s perception of their overall health. Although these findings reflect a correlational rather than a causational relationship, they may provide a stimulus for clinicians to reflect on the holistic value of peripheral neurologic assessment. Although the immediate focus for a practitioner is minimizing risk and preserving tissue viability, neurologic test results may be useful to stimulate further discussion about a patient’s health outcomes by exploring issues beyond the presenting condition.
Background: Excessive external eversion moments acting on the ankle derived from the ground reaction force (GRF) during the support phase of running are considered a risk factor for overuse lower-limb injuries. The external eversion moment is considered to be dominated by the moment derived from the vertical GRF. However, no studies have directly evaluated the accuracy with which external eversion moment can be estimated with this information. Thus, the objective of this study was to evaluate the extent to which external eversion moment can be estimated from external eversion moment derived from vertical GRF.
Methods: From three-dimensional foot coordinates and GRF data of 28 healthy participants, we computed external eversion moment (EMrun), center of the ankle coordinates (ANKrun), center of pressure coordinates (COPrun), and vertical GRF (VGRFrun) during the support phase of running. Moreover, we computed center of the ankle joint coordinates (ANKstand) and vertical GRF (VGRFstand) in the resting standing position.
Results: A highly significant correlation was observed between EMrun and external eversion moment derived from vertical GRF ([COPrun – ANKrun] × VGRFrun), with a contribution of 84.7%. Moreover, a highly significant correlation was observed between EMrun and (COPrun – ANKstand) × VGRFstand, with a contribution of 81.5%.
Conclusions: These results indicate that external eversion moment can be estimated from the external eversion moment derived from vertical GRF with high accuracy. Moreover, it was found that the accuracy did not decrease even if the data of center of ankle and vertical GRF were replaced with the data during standing.
Turf toe injuries are common, particularly in athletes competing on artificial turf. This debilitating injury and its associated sequelae can affect the long-term performance of athletes and others. In this case is presented an atypical cause for development of grade III turf toe. This case presents an acute injury with significant damage to the plantar first metatarsophalangeal joint, with plantar plate rupture and tibial sesamoid retraction secondary to injury involving working calves on a ranch. The anatomy, mechanism, and associated treatments are reviewed. The anatomical and functional interplay with this injury is discussed.
Background: Flat feet change lower extremity alignment, and it may change the load distribution on Achilles tendon during exercise. The purpose of the present study was to investigate the immediate effect of cumulative transverse strain via resistive ankle plantarflexion exercise on the Achilles tendon in individuals with flat feet.
Methods: Fourteen individuals with flat feet and 14 age-matched individuals with normal foot posture were enrolled in the present study. Achilles tendon thickness was measured by an ultrasonography device with a linear probe at 3 points: 1 cm (AT-1), 2 cm (AT-2), and 3 cm (AT-3) proximal to the superior aspect of the calcaneus. Ultrasonography measurements were performed before and after participants completed 90 repetitions of double-leg calf raise exercises which included moving the foot from full ankle dorsiflexion to full ankle plantarflexion.
Results: Achilles tendon thickness at all points measured was thinner in the flat feet group at both pre- and post-exercise conditions compared with that of the control group (p<0.05). Achilles tendon thickness at AT-1, AT-2, and AT-3 decreased after the exercise in both groups (p<0.001). The differences in Achilles tendon thickness at all points measured between pre- and post-exercise conditions were lower in individuals with flat feet than those of the control group (p<0.05).
Conclusion: There was a significant decrease in Achilles tendon thickness after exercise in both groups; however, the tendon thickness markedly diminished in individuals with normal foot posture. The results are thought to result from changes in tendon structure and in load distribution on the Achilles tendon.