Foot scan assessment of metatarsus adductus: A useful adjunct to Bleck's classification.

To determine the severity of metatarsus adductus (MA) comparing with Bleck's classification as a commonly acceptable method for assessing MA, static foot scan has been used. In this cross-sectional descriptive research study, 100 subjects were equally divided into four groups according to Bleck's classification. The feet were scanned and MA severity (MAS) index was measured on the obtained foot scan images. The MAS index was the ratio of the transverse deviation of the forefoot from the lateral border heel line to the width of the ball of the foot. The mean of the MAS index in normal, mild, moderate, and severe MA was 0.02±0.02, 0.1±0.01, 0.159±0.03, and 0.216±0.025, respectively. The difference of MAS index between each group was significant (p<0.001). The mean of MAS index in 4 groups was consistent with Bleck's classification, with a significant increase from normal to severe MA (p<0.05). Since the results of this method are consistent with Bleck's classification and this novel foot scan assessment appears to be more objective than Bleck's classification, the authors recommend this method to be used in examination of patients with MA. However, further studies should be conducted to define interobserver and intraobserver reliability. LEVEL OF EVIDENCE: III.

The Use of the MyoDK for Mechanical Pressure in the Treatment of Chronic Lateral Epicondylalgia: A Pilot Study.

INTRODUCTION: Chronic Lateral Epicondylalgia (CLE) is potentially associated with a significant reduction of the patient's quality of life; its treatment by manual Deep Transverse Friction (DTF), although widely accepted, lacks standardization. The purpose of our study was to evaluate the efficacy of the MyoDK device, which allows deep transverse pressure (DTP) monitoring, for treatment of CLE. MATERIALS AND METHODS: This is a single centre observational study for treatment of CLE by the MyoDK device. In a given year, all patients who appeared at our institution with a diagnostic of CLE were screened for possible inclusion. Exclusion criteria were: confounding factors on pain and function of the upper limb, cognitive impairment, inability or unwilling to give informed consent or to comply with treatment protocol. Our primary outcome measure was the pain reduction measured by the VAS pain scale (VAS) at 6 weeks. Our intervention consisted in applying a pressure from 0.5 to 10kg/100mm(2) for 20 minutes, once a week for 6 weeks, using the MyoDK device. RESULTS: Thirty patients were screened. Two were excluded for incomplete protocol, remaining 28 for analysis. Mean age was 47.3, 23 were male (82.1%), 24 were affected on their dominant side (85.7%). We had a significant reduction in VAS pain score at 12 weeks (80.8 vs 13.0; p<0.01). There were no side effects reported. CONCLUSION: Our study showed the safety of the use of a standard protocol using the MyoDK device for treatment of CLE. We believe that further controlled studies will establish the MyoDK as a reliable option for treatment of CLE.

Effect of unintentional partial Achilles tenotomy on Ponseti clubfoot management outcomes.

The congenital talipes equinovarus (clubfoot) is one of the most common congenital conditions requiring orthopedic intervention. This study was carried out to evaluate the effect of unintentional partial Achilles tendon cut during percutaneous tenotomy on the success rate of Ponseti management. Percentage of Achilles tendon cut following percutaneous tenotomy was measured by ultrasound in 16 clubfeet (11 patients). After a mean of 21 months of follow-up, the final results (Dimeglio score) were compared between two groups of patients: those with complete tendon cut and those with partial cut. Complications and parameters such as feeling of pop during tenotomy and ankle dorsiflexion during tenotomy were also compared. There was no significant correlation between the percentage of Achilles tendon cut and increase in ankle joint dorsiflexion, age at diagnosis, or pop sensation. There was no statistically significant difference between the two groups in their ankle joint dorsiflexion, feeling of pop, and final follow-up Dimeglio score. No complications were encountered following tenotomy. One patient needed tibialis anterior transfer at his last follow-up visit. Partial cut of Achilles tendon following tenotomy does not necessarily compromise the final results of Ponseti management. Achieving more than 10°-20° ankle dorsiflexion even with a partial tendon cut can ensure good final results.