A Modified Suture Bridge Technique for Application With Bone Anchors in Foot and Ankle Surgery.

We present a suture bridge technique for reattachment of tendon or ligament to bone for use in foot and ankle surgery. The method is a simple, strong, and reproducible technique that could decrease the risk of irritation of the overlying cutaneous barrier and minimizes the likelihood of tendon strangulation when combined with soft tissue bone anchors. The present report serves as a guide to the use of this suture technique for reattachment of the Achilles tendon.

Association of calcaneal and spinal fractures.

Calcaneus fractures are common injuries that often lead to chronic pain and long-term disability. Appropriate initial management of calcaneal fractures involves assessment for concomitant trauma (polytrauma), and the vertebral column, in particular, the lumbar spine, is known to be especially vulnerable to simultaneous injury when the os calcis has been fractured. We undertook a retrospective cohort study that included 208 consecutive patients with data recorded in a radiographic database to determine the incidence of concomitant vertebral fracture in association with fracture of the calcaneus. A total of 15 calcaneal fractures (7.21%) were associated with concomitant vertebral fracture, and the lumbar spine was involved in 12 (80%) of these cases. The only clinical variable that was statistically significantly associated with the presence of concomitant calcaneal and vertebral fracture was localization of the vertebral fracture to the lumbar spine (p = .0001). The results of our investigation have indicated that the incidence of concomitant calcaneal and vertebral fractures was significantly lower clinically than the traditional 10% association described in previous studies.

Open Ankle Arthrodesis.

First described in 1879, ankle arthrodesis is a procedure that has undergone significant advancements not only in technique but also in technology and fixation. Surgeon preference has often dictated those changes with regard to incisional approaches, fixation methods, and use of bone graft and biologics but one constant has always remained: open ankle arthrodesis is a predictable, time-tested procedure with consistent results when performed in appropriate patients. This article highlights the changes that have occurred since the introduction of this procedure and provides a brief overview of the preferred technique.

The flexible adult flatfoot: anatomy and pathomechanics.

Adult acquired flatfoot deformity is generally associated with a collapsing medial longitudinal arch and progressive loss of strength of the tibialis posterior tendon. It is most commonly associated with posterior tibial tendon dysfunction that can have an arthritic or traumatic cause. With an increasing population of obese patients, the often misdiagnosed and overlooked posterior tibial tendon dysfunction will only continue to present more often in the foot and ankle specialist's office. This article focuses on the anatomy, classification, and pathomechanics of the flexible adult flatfoot.

Flexible adult flatfoot: soft tissue procedures.

Classically, adult posterior tibial tendon dysfunction (PTTD) was considered primarily a tendon rupture and was treated as such with soft tissue repair alone. The understanding that PTTD involves more than simply an inflammatory condition or tendon rupture but also a muscle imbalance, leading to a flatfoot, osteoarthritis, and peritalar subluxation, led to surgeons advocating osseous procedures as well. The advancements in knowledge of the pathomechanics of the deformity have modified the role that soft tissue repair plays in surgical treatment, but the importance of soft tissue restoration in flatfoot repair should not be overlooked.