Background
Ankle sprains are common, affecting especially the lateral ligament complex of the ankle, often leading to chronic symptoms and instability. Many procedures have been described for chronic ankle instability. This study analyzes clinical outcomes and return to sport in patients who underwent minimally invasive reconstruction of the lateral ligament complex of the ankle with a semitendinosus tendon autograft.
Methods
Twenty-three patients (mean age, 33.9 years) with grade 3 lesions of both the anterior talofibular and calcaneofibular ligaments underwent minimally invasive reconstruction of the anterior talofibular and calcaneofibular ligaments with an ipsilateral semitendinosus tendon autograft. They were retrospectively reviewed, and return to sport was evaluated with the Halasi ankle activity scale.
Results
Mean follow-up was 30 months (range, 26–53 months). The mean American Orthopaedic Foot and Ankle Society score increased from 68.6 to 95.3. The average visual analog scale score decreased from 3.6 to 1.3. The Halasi score changed from 5.0 to 5.1. Except for the Halasi score, the differences were significant (P < .001). Nineteen patients judged the received treatment as excellent, 2 as good. No revision procedures were performed. No major complications were reported.
Conclusions
This study confirms good clinical and sport outcomes after minimally invasive reconstruction of the lateral ligament complex of the ankle with a semitendinosus autograft.
Background
In the Ponseti technique, the residual equinus deformity is corrected with percutaneous tenotomy. This experimental study aimed to compare the safety and effectiveness of a large-gauge needle, a corneal knife, and a No. 11 blade in percutaneous achillotomy performed in rats.
Methods
Ninety Achilles tendons of 45 Sprague-Dawley rats were analyzed, following division into three study groups. In the study, group I (needle), group II (corneal knife), and group III (No. 11 blade) were compared on the basis of bleeding, incision length, requirement for primary suture, range of motion, and resulting neurovascular injury at day 0. Moreover, the groups were compared in terms of range of motion, macroscopic and microscopic adhesions, and tenocyte morphology at days 21 and 42 postoperatively.
Results
On day 0, one suture was required in group III, whereas in groups I and II, no sutures were required. Postoperative bleeding was greater in group III and similar in groups I and II. Neurovascular injury was not observed in any of the groups. Three incomplete tenotomies were observed in group III and one incomplete tenotomy was observed in group II. Importantly, all tenotomies were complete in group I. In all groups, the range of motion was similar. The macroscopic adhesion score revealed high adhesion in group III (P = .009). According to Tang's criteria, microscopic adhesion was significantly higher on day 21 in group III compared with the other groups (P <0.001). No significant differences were observed in tenocyte morphology based on the Bonar criteria (P = .850).
Conclusions
In the results obtained from this animal study, we observed less bleeding, less adhesion, and less incomplete tenotomy in the large-gauge needle and corneal knife groups compared with the No. 11 blade group during the percutaneous Achilles tenotomy performed in rats.
Background
Diabetic foot ulcers combined with ischemia and infection can be difficult to treat. Few studies have quantified the level of blood supply and infection control required to treat such complex diabetic foot ulcers. We aimed to propose an index for ischemia and infection control in diabetic chronic limb-threatening ischemia (CLTI) with forefoot osteomyelitis.
Methods
We retrospectively evaluated 30 patients with diabetic CLTI combined with forefoot osteomyelitis who were treated surgically from January 2009 to December 2016. After 44 surgeries, we compared patient background (age, sex, hemodialysis), infection status (preoperative and 1- and 2-week postoperative C-reactive protein [CRP] levels), surgical bone margin (with or without osteomyelitis), vascular supply (skin perfusion pressure), ulcer size (wound grade 0–3 using the Society for Vascular Surgery Wound, Ischemia, and foot Infection classification), and time to wound healing between patients with healing ulcers and those with nonhealing ulcers.
Results
Preoperative CRP levels and the ratio of ulcers classified as wound grade 3 were significantly lower and skin perfusion pressure was significantly higher in the healing group than in the nonhealing group (P < .05). No other significant differences were found between groups.
Conclusions
This study demonstrates that debridement should be performed first to control infection if the preoperative CRP level is greater than 40 mg/L. Skin perfusion pressure of 55 mm Hg is strongly associated with successful treatment. We believe that this research could improve the likelihood of salvaging limbs in patients with diabetes with CLTI.
Background
The measures used for the diagnosis of biomechanical pathologic disorders are variable. The aim of this study was to determine the concordance between the Clarke angle and the Chippaux-Smirak and Staheli indices in evaluation of the footprints of kidney transplant patients.
Methods
An observational prevalence study was performed in kidney transplant patients in the University Hospital Complex A Coruña from 1981 through 2014. After obtaining patient informed consent and ethics committee approval, sociodemographic (age and sex) and anthropometric (body mass index) variables and comorbidity (Charlson Comorbidity Index score) were assessed for each patient, and a podiatric medical examination was performed of the footprint through a pedigree (Chippaux-Smirak index, Staheli index, and Clarke angle). A descriptive analysis of all of the variables was performed; for agreement, the kappa index and the Bland-Altman method were used.
Results
We found a predominance of male sex (65.6%) and a high level of overweight (43.3%) in the sample. The highest concordance between the indices studied is presented by the Chippaux-Smirak index, with a kappa index of 0.86 for the left foot and 0.76 for the right foot.
Conclusions
High agreement was attained among observers in measurements of the footprints of kidney transplant patients.
Background
It is well established and accepted that fungi are a major contributing factor in nail dystrophy. It has also been recognized that bacteria play a crucial role in onycholysis. However, the bacteria and fungi that can be grown on culture media in the laboratory are only a small fraction of the total diversity that exists in nature. Contemporary studies have revealed that fungi and bacteria often form physically and metabolically interdependent consortia that harbor properties and pathogenicity distinct from those of their individual components. Metagenomic DNA “shotgun” sequencing has proved useful in determining microbial etiology in clinical samples, effective for not only bacteria but also fungi, archaea, and viruses.
Methods
Thirty-nine consecutive nail and subungual debris samples with suspected onychomycosis were sent for laboratory analysis using three examination techniques: DNA sequencing, polymerase chain reaction analysis, and standard fungal culture. The nail plate and surrounding areas were disinfected with an ethyl alcohol swab before nail sampling. Samples from 16 patients were analyzed for suspected onychomycosis with DNA sequencing, searching a database of 25,000 known pathogens. These results were compared with 15 real-time polymerase chain reaction screening assays and eight fungal cultures sampled with the same methods.
Results
The DNA sequencing detected 32 species of bacteria and 28 species of fungi: 50% were solely bacterial, 6.3% were solely fungal, and 43.7% were mixed communities of bacteria and fungi.
Conclusions
Toenails tested with DNA sequencing demonstrated the presence of both bacteria and fungi in many samples. Further work is required to fully investigate its relevance to nail pathology and treatment.
Background
Sports have a strong influence on current society. Foot posture has been postulated to be a risk factor for overuse injuries; however, the link between foot posture and injuries is unclear. This study aimed to determine whether children with pronated feet become more fatigued after participating in sports tests than those with normal feet.
Methods
One hundred five children aged 10 to 12 years (mean ± SD age, 10.46 ± 0.78 years) participated in the sports tests, which were aerobic-type resistance exercises with six stations at which each child remained for 30 sec. The posture of the foot was evaluated via the Foot Posture Index and the plantar footprint via the arch index and the Clarke angle before and after aerobic-type resistance exercises. Perceived tiredness was evaluated with the Pictorial Children's Effort Rating Table (PCERT) and whether there was pain during or after physical activity.
Results
The variables used to measure foot posture and the plantar arch changed more in the pronated feet, suggesting that the feet undergo more pronation after physical exercise. The neutral feet obtained a mean ± SD PCERT score of 5.46 ± 1.89 and the pronated feet a score of 7.60 ± 1.92.
Conclusions
Children with pronated feet showed more fatigue and foot pain during and/or after physical exercise than those with neutral feet. Foot type could be responsible for the lack of enthusiasm of children toward undertaking healthy activities, and this problem might be solved via appropriate orthopedic treatment.
Background
We aimed to evaluate radiologic and clinical outcomes of ankle fractures involving posterior fragments that were fixed with a posterior plate by the posterolateral approach.
Methods
Sixty-five patients who were followed for at least 12 months and were older than 18 years were included. The posterior malleolus fractures were classified according to the Haraguchi classification system with computed tomography (CT). The posterior malleolus fragments were fixed with a plate through a posterolateral approach. Intra-articular step-off, reduction of the posterior malleolar fragment, and fibular position in the incisura were evaluated by early postoperative CT. American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analog scale pain score were used for clinical assessment.
Results
The posterior malleolus fractures were classified as Haraguchi type 1 in 45 patients (69.2%), Haraguchi type 2 in 12 patients (18.5%), and Haraguchi type 3 in eight patients (12.3%). No patients showed signs of instability or loss of reduction on direct radiographs during follow-up. Postoperative CT showed no loss of reduction in the posterior malleolus and tibiofibular alignment. On evaluation, there was no intra-articular step-off (<1) in any of the patients. The mean AOFAS score was calculated to be 91.6. The mean visual analog scale score was 1.2.
Conclusions
We conclude that direct posterior fixation with the posterolateral approach can be a good option for ankle fractures involving posterior malleolar fragments.
Background
Hallux abducto valgus is a triplane deformity with recent attention given to the significance of correcting the coronal plane component. This study explored the accuracy of the forefoot axial (FFA) study as a standard radiographic assessment method compared with weightbearing computed tomography (CT).
Methods
Twelve feet with hallux abducto valgus from 12 individuals were included in this study. Three images of the affected foot were taken: FFA radiograph and weightbearing CT with the foot in maximum pronation (pronated CT) and maximum supination (supinated CT). Five investigators determined the sesamoid rotation angles (SRAs) from each of the images. The measurements from a single investigator were used to compare the SRA means from each of the image types, and those from all five investigators were used to determine reliability.
Results
The mean ± SD SRA was 22.1° ± 7.6° for pronated CT, 10.5° ± 5.0° for supinated CT, and 12.2° ± 9.4° for FFA images. The mean SRA from the pronated CT was significantly greater than the supinated CT (P < .001) and FFA (P < .005) SRAs. There were no significant differences in mean SRA between the FFA and supinated CT images (P > .99). Results indicated high reliability in measurements among investigators.
Conclusions
Using weightbearing CT, these findings indicate that the sesamoids significantly alter their position in the coronal plane, as determined by the SRA, with changes in weightbearing subtalar joint position. Moreover, the affected foot positioning required for determining the SRA from the FFA radiograph seems to significantly underestimate the true SRA. Thus, use of this image in surgical hallux abducto valgus planning is called into question.
Background
First metatarsophalangeal joint fusion is a commonly used procedure for treating many pathologic disorders of the first ray. Historically, hallux valgus deformity with severely increased intermetatarsal angle or metatarsus primus adductus indicated need for a proximal metatarsal procedure. However, the effectiveness and reliability of first metatarsophalangeal joint arthrodesis in reducing the intermetatarsal angle has been increasingly described in the literature. We compared findings at our institution with current literature for further validation of this well-accepted procedure in correcting hallux valgus deformity with high intermetatarsal angle.
Methods
Weightbearing preoperative and postoperative radiographs of 43 patients, 31 women and 12 men, meeting the inclusion and exclusion criteria were identified. Two independent investigators measured the hallux abductus and intermetatarsal angles. Preoperative and postoperative measurements for each angle were compared and average reduction calculated. The data were further analyzed by grouping deformities as mild, moderate, and severe. Mean follow-up was 10 months.
Results
The overall mean preoperative intermetatarsal and hallux abductus angles decreased significantly (from 13.09° to 9.33° and from 23.72° to 12.19°, respectively; both P < .01). When grouping deformities as mild, moderate, and severe, all of the categories maintained reduction of intermetatarsal and hallux abductus angles (P < .01). Furthermore, the mean reduction of the intermetatarsal and hallux abductus angles seemed to correlate with preoperative deformity severity.
Conclusions
In patients undergoing correction of hallux valgus deformity, first metatarsophalangeal joint arthrodesis produced consistent reductions in the intermetatarsal and hallux abductus angles. Furthermore, these findings are consistent with those reported by other institutions.
Background
The definition of equinus varies from less than 0° to less than 25° of dorsiflexion with the foot at 90° to the leg. Despite its pervasive nature and broad association with many lower-extremity conditions, the prevalence of ankle equinus is unclear. Furthermore, there are few data to suggest whether equinus is predominantly a bilateral finding or isolated to the affected limb only.
Methods
We conducted a prospective cohort study examining consecutive patients attending a single foot and ankle specialty practice. Participation involved an assessment of ankle joint range of motion by a single rater with more than 25 years of clinical experience. We defined ankle equinus as ankle joint dorsiflexion range of motion less than or equal to 0° and severe equinus as less than or equal to –5°. Patients who had previously experienced an Achilles tendon rupture, undergone posterior group lengthening (ie, Achilles tendon or gastrocnemius muscle lengthening), or had conservative or surgical treatment of equinus previously were excluded.
Results
Of 249 included patients, 61% were female and 79% nondiabetic. The prevalence of ankle equinus was 73% [183 of 249], and nearly all of these patients had bilateral restriction of ankle joint range of motion (prevalence of bilateral ankle equinus was 98.4% [180 of 183] among those with equinus). We also found that ankle equinus was more common in patients with diabetes, higher body mass indexes (BMIs), or overuse symptoms.
Conclusions
The prevalence of ankle equinus in this sample was higher than previously reported, and nearly all of these patients had bilateral involvement. These data suggest that many people attending foot/ankle specialty clinics will have ankle equinus, and select groups (diabetes, increased BMI, overuse symptoms) are increasingly likely.