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Tarsal Coalitions
Activity Levels With and Without Surgery
This study compares activity levels of patients with tarsal coalitions who did and did not have surgery and quantifies the return-to-activity time after tarsal coalition surgery. Thirty-one patients (mean ± SD age, 22.1 ± 11.6 years) with 39 coalitions (28 talocalcaneal, 1 complete talonavicular, and 10 calcaneonavicular) were included. The mean postoperative review time was 3 years. Fifteen patients (17 feet) who underwent resection had a mean ± SD return-to-activity time of 10.3 ± 5.8 weeks. There was no statistically significant difference in the return-to-activity time between talocalcaneal and calcaneonavicular coalitions. Thirteen patients (21 feet) quit sports; 11 (17 feet) were from the nonsurgical group. Three nonsurgical patients continued playing sports. The Fisher exact test was used to determine whether those forgoing surgery had a decreased ability to achieve desired activity levels. The correlation of surgery and failure to achieve the desired activity level was low (–0.69). Therefore, tarsal coalition excision is not correlated with failure of patients to reach desired activity levels. Patients forgoing surgery could not reach desired activity levels. Surgical excision of tarsal coalitions has a favorable outcome. (J Am Podiatr Med Assoc 93(4): 259-263, 2003)
In a retrospective review of 102 patients treated for chondromalacia pa-tellae and patellofemoral pain syndrome/retropatellar dysplasia (PFPS/RPD), the effectiveness of semiflexible foot orthoses was investigated. The combined disorders were diagnosed in 89.3% of the patients. Subjects were 46 women and 54 men, aged 12 to 87 years (mean, 37.9 years; SD, 15.9), who exhibited excessive forefoot varus or rearfoot varus. The initial screening and clinical diagnosis were based on an examination by an orthopedist. Particular attention was directed to patellar crepitation, patellofemoral malalignment, Q-angle measurements, limitation of range of motion, and knee effusion. Patients were evaluated for the onset and duration of patellofemoral pain and degree of knee joint disease. Semiflexible orthoses for each subject were fabricated, based on a clinical lower extremity biomechanical examination. At their follow-up visit, 76.5% were improved and 2% were asymptomatic, showing a significant decrease in the level of pain with orthoses intervention (chi-square P < .001). Although multiple treatment modalities are used for these patients, the results suggest that the use of semiflexible orthoses is significant in reducing symptoms of PFPS/RPD. (J Am Podiatr Med Assoc 93(4): 264-271, 2003)
Peroneal Tendon Abnormalities
A Review of 40 Surgical Cases
The authors reviewed data from 40 peroneal tendon surgeries performed on 39 patients (25 males and 14 females) between 1991 and 1999. Patients underwent tendon repair, subluxation repair, and/or accessory ossicle and muscle excisions. Some patients underwent more than one procedure, including eight undergoing ankle stabilizations. Preoperatively and postoperatively, the American Orthopaedic Foot and Ankle Society ankle–hindfoot score was assessed. Average preoperative and postoperative ankle–hindfoot scores were 61.6 (range, 19 to 72) and 91.4 (range, 63 to 100), respectively. Mean group return-to-activity time, defined as initiation of regular activity, including sports, was 3.2 months (range, 1 to 6 months). There were 17 athletes and 22 active patients; no patients were sedentary. Magnetic resonance imaging was used to evaluate peroneal tendon pathology in 29 patients. Sensitivity was 82.7%; specificity, 50%; and positive predictive value, 100%. Overall results were excellent in 25 cases, good in 12, fair in 1, and poor in 2. A paired t-test showed that patients with previous steroid injections had statistically poorer results. Patients with symptoms for more than 12 months also had poorer outcomes. (J Am Podiatr Med Assoc 93(4): 272-282, 2003)
Surgery for Chronic Achilles Tendinopathy
Review of 91 Procedures over 10 Years
The authors reviewed 91 surgical procedures in 87 patients with chronic Achilles tendinopathy. There were 62 males and 25 females (mean age, 44.9 years). The average interval between surgery and review for the group was 4.2 years (range, 1 to 10 years). Twenty patients underwent peritenolysis, with a mean return-to-activity time of 7.7 weeks. Four patients with concomitant bony procedures had significantly longer return-to-activity times than 16 patients who underwent peritenolysis only. The mean return-to-activity time was 13.2 weeks in 15 patients who had Achilles debridement for mucoid degeneration, 14.4 weeks in 32 Achilles tendocalcinosis repair patients, 18.6 weeks in 24 patients who had retrocalcaneal exostectomy procedures, and 34.0 weeks in 5 patients who had chronic Achilles rupture repair. Athletic patients (n = 47) had significantly shorter return-to-activity times than active (n = 38) and sedentary (n = 6) patients. Males returned to activity faster than females. Runners returned to activity faster than other patients. (J Am Podiatr Med Assoc 93(4): 283-291, 2003)
Ankle equinus has been proposed to be associated with lower-extremity pathology. Physiologically normal measurements have been quantified in various populations. Forty high-school athletes (16 girls and 24 boys) without a history of ankle injury had ankle dorsiflexion measured with the knee extended and flexed by an experienced evaluator using a goniometer with the subjects supine. The group mean ± SD dorsiflexion for the right ankle was 0.35° ± 2.2° with the knee extended and 4.88° ± 3.23° with the knee flexed. The values for the left ankle were –0.6° ± 2.09° and 4.68° ± 3.33°, respectively. There were no statistically significant differences between limbs using the Student t-test. In girls, values for right and left ankle dorsiflexion were 0.19° ± 2.1° and –0.7° ± 2.3°, respectively, with the knee extended and 4.88° ± 3.59° and 4.88° ± 3.07°, respectively, with the knee flexed. In boys, these values were 0.46° ± 2.3° and –0.5° ± 1.98° with the knee extended and 4.88° ± 3.04° and 4.54° ± 3.55° with the knee flexed. There were no statistically significant differences between boys and girls. Ankle dorsiflexion in asymptomatic adolescent athletes is approximately 0° with the knee extended and just less than 5° with the knee flexed. (J Am Podiatr Med Assoc 93(4): 312-314, 2003)
Fluoroquinolones have been associated with tendinopathies. The authors present three cases of Achilles tendinopathy in which the patients’ symptoms were preceded by treatment for unrelated bacterial infections with ciprofloxacin. Although the exact mechanism of the relationship is not understood, those who engage in sports or exercise should be advised of the risk of quinolone-induced tendinopathy. (J Am Podiatr Med Assoc 93(4): 333-335, 2003)
Wound Complications from Surgeries Pertaining to the Achilles Tendon
An Analysis of 219 Surgeries
Background: A retrospective review of one surgeon’s practice was conducted to assess the prevalence of wound complications associated with acute and chronic rupture repair, peritenolysis, tenodesis, debridement, retrocalcaneal exostectomy/bursectomy, and management of calcific tendinopathy of the Achilles tendon.
Methods: We evaluated the incidence of infection and other wound complications, such as suture reactions, scar revision, hematoma, incisional neuromas, and granuloma formation.
Results: A total of 219 surgical cases were available for review (140 males and 70 females; mean ± SD age at the time of surgery, 46.5 ± 12.6 years; age range, 16–75 years). Seven patients experienced a wound infection, three had keloid formation, six had suture granulomas, and six had suture abscesses, for a total complication rate of 10.0%. Six patients had more than one complication; therefore, the percentage of patients with complications was 7.3%. There were no hematomas. Seven patients had additional surgery after their wound complications; some had simple granuloma excision, and one necessitated a flap. Patients with risk factors such as diabetes mellitus, smoking, and rheumatoid arthritis necessitating corticosteroid therapy were more likely to have a wound complication (Fisher exact test, P = .03).
Conclusions: Complications with Achilles tendon surgery may be unavoidable. Suture granulomas may appear in a delayed manner. Absorbable and nonabsorbable sutures can be implicated. (J Am Podiatr Med Assoc 98(2): 95–101, 2008)
Injuries involving the first metatarsophalangeal joint and its associated structures are common, especially in athletes. However, injuries to the hallucal sesamoid complex constituted only 3% of all podiatric sports medicine injuries reported by Agosta. This case study reports a female ballet dancer with an isolated fibular sesamoid retraction injury that presented with a history of chronic microtrauma secondary to overuse. When consulting epidemiologic studies of forefoot injuries involving the hallucal sesamoid complex, we were unable to find a single instance of an isolated retraction of the fibular sesamoid resulting from chronic use, demonstrating the unusual nature of this case.
