Quantifying increased lateral column instability in Adult Acquired Flatfoot Deformity (AAFD).

AAFD comprises ligamentous failure and tendon overload, mainly focused on the symptomatic posterior tibial tendon and the spring ligament. Increased lateral column (LC) instability arising in AAFD is not defined or quantified. This study aims to quantify the increased LC motion in unilateral symptomatic planus feet, using the contralateral unaffected asymptomatic foot as an internal control. In this case matched analysis, 15 patients with unilateral stage 2 AAFD foot and an unaffected contralateral foot were included. Lateral foot translation was measured as a guide to spring ligament competency. Medial and LC dorsal sagittal instability were assessed by direct measurement of dorsal 1st and 4th/5th metatarsal head motion and further video analysis. The mean increase in dorsal LC sagittal motion (between affected vs unaffected foot) was 5.6 mm (95% CI [4.63-6.55], p < 0.001). The mean increase in the lateral translation score was 42.8 mm (95% CI [37.48-48.03], p < 0.001). The mean increase in medial column dorsal sagittal motion was 6.8 mm (95% CI [5.7-7.8], p < 0.001). Video analysis also showed a statistically significant increase in LC dorsal sagittal motion between affected and unaffected sides (p < 0.001). This is the first study that quantifies a statistically significant increased LC dorsal motion in feet with AAFD. Understanding its pathogenesis and its link to talonavicular/spring ligament laxity improves foot assessment and may allow the development of future preventative treatment strategies.

Tracheal laceration causing important post-intubation delayed subcutaneous emphysema and ventilatory deterioration in a COVID-19 patient with severe rheumatoid arthritis: a case report.

A 68-year-old man with a background of severe active rheumatoid arthritis (RA) was admitted to Intensive Care Unit (ICU) for respiratory support due to COVID-19 infection. Two days after an elective and uneventful intubation he developed severe and worsening surgical emphysema affecting his face, neck and both upper limbs. Ventilation was difficult to be achieved. Based on a negative chest X-ray, a CT scan of the chest was organized which showed extensive pneumomediastinum with no obvious cause. Therefore, urgent bronchoscopy was performed which showed a glassy lesion/laceration measuring 2 cm × 2 cm at the level of mid-trachea but no other signs of penetration through the airways were noted. Since events appeared 2 days after intubation, this was perceived as secondary to trauma during intubation on an inflammatory process background from RA and COVID-19 in the airways. The endotracheal tube was progressed beyond the site of laceration and bilateral pectoral fasciotomies were performed with negative suction vacuum dressings, which was successful in decreasing the surgical emphysema and achieving decreased ventilation requirements. Despite multi-organ support the patient continued to deteriorate and unfortunately passed away a week following admission. This scenario hightlighted that endotracheal sequalae should be suspected in patients with similar background and presentation.