Etiology, Clinical Assessment, and Surgical Repair of Plantar Plate Tears.

The plantar plate has recently gained more attention as an important structure contributing to lesser metatarsophalangeal joint stability. This has prompted a significant growth of interest in the anatomy and biomechanics of the plantar plate and in the diagnosis and treatment of its injuries. Improved understanding of plantar plate function and predictable patterns of degeneration and failure has led to the development of a clinical staging and surgical grading system of plantar plate lesions. Relatively recent innovations allow the surgeon to access and repair plantar plate tears directly with reinsertion onto the base of the proximal phalanx. The addition of direct plantar plate repair represents a significant advance in the surgical restoration of alignment and functional stability of the lesser metatarsophalangeal joint.

Assessment of Compensated Turnout Characteristics and their Relationship to Injuries in University Level Modern Dancers.

Dancers may compensate alignment at the spine, hip, knees, ankles, and feet to achieve a greater turnout than is available at the hip alone. Such compensations are believed to lead to many of the musculoskeletal injuries experienced by dancers, especially overuse injuries. The aim of this study was to explore the relationship between compensated turnout and injury of the lower extremities and low back. Twenty-two university level modern dancers age 19 to 23 participated. Measurements were taken of active hip external rotation (AHER) prone and functional turnout (FTO) in first position. The difference between FTO and AHER was designated as compensated turnout (CTO). A questionnaire was conducted to gather information about dancers' injuries within the past 2 years. A total of 17 participants (77%) reported experiencing at least one injury in the 24 month period. All dancers compensated turnout. Results revealed a large variability in CTO among participants, ranging from 3° to 72°. Statistical analysis showed a significant relationship (r = 0.45, N = 22, p = 0.04) between CTO and the number of injuries experienced, especially as related to low back pain (r = 0.50, N = 22, p = 0.02). Students with no injury had a CTO mean of 26°, while those with two or more injuries had a CTO mean of 43°. Results contribute to previous studies that have examined the effects of CTO in ballet dancers and further indicate that compensatory patterns of turnout may increase the risk of experiencing more than one injury in university level modern dancers.

Al Andalus Ultra Trail: an observation of medical interventions during a 219-km, 5-day ultramarathon stage race.

OBJECTIVE: To record the injuries and health problems suffered by ultramarathon runners during a 219-km, 5-day stage race and to help race organizers plan medical provision for these events. DESIGN: Observational study. SETTING: Al Andalus Ultra Trail 2010, in southern Spain. PARTICIPANTS: All 69 ultramarathon runners. MAIN OUTCOME MEASURES: Total numbers and percentages of each clinical encounter with a health professional and their respective health problems. RESULTS: Sixty-nine competitors started the race, and 39 runners were seen with a medical problem (56.5%). There were a total of 99 clinical encounters. The most common reasons for consulting were foot blisters (33.3%), followed by chafing (9.1%). Lower limb musculoskeletal injuries accounted for 22.2%, predominantly affecting the knee. CONCLUSIONS: This is the first report of a multistage ultramarathon race where medical coverage was present throughout and has reported on musculoskeletal, dermatological, and other medical problems. When providing medical coverage for stage events, the medical team needs to promote practices that minimize injury and address both running-related injuries and non-running-related injuries, taking account of environmental conditions.

Epidemiology of foot injury in a high-income developing country.

OBJECTIVES: To study the epidemiology of foot injuries and factors predicting their severity in a high-income developing country so as to define prevention priorities. PATIENTS AND METHODS: All patients admitted to Al-Ain Hospital with foot injury between March 2003 and March 2006 were identified from a prospectively collected Trauma Registry. Injuries were scored using foot and ankle severity scale (FASS). Bilateral, multiple or segmental injuries, open fractures or those with FASS score higher than 3 were included in severe foot injury group and compared with simple foot injury group regarding patients' demography, co-morbidities, trauma mechanism and energy, incident location, number of associated injuries, Injury Severity Score (ISS) and hospital stay using a univariate analysis. A logistic regression model was then used to study factors predicting severity of foot injury. RESULTS: 171 patients (156 males) were studied. The average (range) age was 34 (2-75). 95 had right foot injury, 66 had left, and 10 had both. Fall from height was the most common mechanism. 105 (61%) had work-related injuries. 130 (76%) had isolated foot injury. 151 (88%) had 212 foot fractures. 20 (12%) had soft tissue injuries. 70 (41%) had severe injuries while 101 (59%) had simple ones. The multiple logistic model was highly significant (p=0.002). Number of associated injuries (p=0.025) and location of trauma (p=0.044) were significant while the amount of energy (p=0.054) showed a strong trend to predict severity. CONCLUSIONS: Fall from height is the most common mechanism of foot injury in United Arab Emirates. The number of associated injuries, high-energy trauma, and being work related are predictors of foot injury severity. Prevention priorities include counteractions against falling from height and falling heavy objects as occupational hazards.

Foot injuries associated with all-terrain vehicle use in children and adolescents.

OBJECTIVES: Children can suffer serious foot injuries while riding or driving an all-terrain vehicle (ATV). The purpose of this study was to describe this injury pattern. METHODS: A search of the trauma registry of the Arkansas Children's Hospital for the years 1998 through 2006 was conducted to find cases of children admitted for treatment of foot injuries related to ATV use. The cases were deidentified and summarized. The study was reviewed and deemed to be exempt by the local institutional review board. RESULTS: Ten cases of foot injury were identified. The median age was 3 years. Eight had forefoot injuries, including 6 who had amputation of the great toe. All but one patient had multiple open foot fractures. Seven required skin grafting. Complications included infection, scar formation, disfigurement, and gait disturbance. The mean length of stay on initial hospitalization was 6 days, and the mean hospital charge was $12,890. CONCLUSIONS: Children, particularly young children, on an ATV can suffer serious foot injuries resulting in disfigurement and disability. The recommendation that young children not ride on ATVs is emphasized by these findings.

Foot burns: epidemiology and management.

This is a retrospective study of the epidemiology and management of isolated foot burns presenting to the Welsh Centre for Burns from January 1998 to December 2002. A total of 289 were treated of which 233 were included in this study. Approximately 40% were in the paediatric age group and the gender distribution varied dramatically for adults and children. In the adult group the male:female ratio was 3.5:1, however in the paediatric group the male:female ratio was more equal (1.6:1). Scald burns (65%) formed the largest group in children and scald (35%) and chemical burns (32%) in adults. Foot burns have a complication rate of 18% and prolonged hospital stay. Complications include hypertrophic scarring, graft loss/delayed healing and wound infection. Although isolated foot burns represent a small body surface area, over half require treatment as in patients to allow for initial aggressive conservative management of elevation and regular wound cleansing to avoid complications. This study suggests a protocol for the initial acute management of foot burns. This protocol states immediate referral of all foot burns to a burn centre, admission of these burns for 24-48 h for elevation, regular wound cleansing with change of dressings and prophylactic antibiotics.

Assessment of acute foot and ankle sprains.

Acute ankle and foot trauma is a regular emergency presentation and prompt strategic assessment skills are required to enable nurses to categorise and prioritise these injuries appropriately. This article provides background information on the anatomy and physiology of the lower limb to help nurses to identify various grades of ankle sprain as well as injuries that are limb threatening

Assessment and management of foot and ankle fractures.

Injuries to the foot and ankle are common presentations in A&E, and while these are rarely life-threatening, incorrect diagnosis and management can have serious consequences for patients. This article discusses the causes, assessment and treatment of patients with these fractures.

A comparison of standard vs. breakaway bases: an analysis of a preventative intervention for softball and baseball foot and ankle injuries.

More than 40 million individuals participate in organized baseball and softball leagues in the United States every year. Unfortunately, it has also been estimated by the Consumer Product Safety Commission that softball and baseball are the two main sports leading to emergency-room visits in the United States. A previous field study has determined that the utilization of breakaway bases has the potential of preventing 96% of sliding injuries, thereby preventing 1.7 million injuries a year in the United States with a savings of $2 billion a year in health care costs. It is the purpose of this study to analyze and compare the potential attenuating capabilities of various types of bases. We found the force at the ankle upon impact when compared to the standard base revealed all breakaway bases reduced the force of impact to a statistically significant level. The force at the foot upon impact when compared to the standard base revealed all breakaway bases reduced the force at variable levels, with the Rogers bases having the only statistically significant reduction. However, the force delivered to the tibia/fibula was increased with the Stay Down and Mag-Net large bases as compared to the standard stationary base. The moments of inversion/eversion and dorsiflexion/plantar flexion upon impact, when compared to the standard base, revealed all safety bases were reduced to a statistically significant level. We conclude breakaway bases reduce the force of impact and moments to a statistically significant level and confirm previous field studies. Though there is a difference among the breakaway bases themselves, they should be used on all fields.

Injuries of the foot and ankle in occupational medicine: a 1-year study.

With occupational injuries, both the employee and employer are impaired by monetary or physical damages. Administrative and clinical data can assist in identifying risks for these injuries. While musculoskeletal injuries are well known, foot and ankle injuries are not as frequently described as back and hand injuries. Changes in the workplace may then be implemented dependent on the risk factors identified. A retrospective study was completed on all foot and ankle injuries that were reported to the Oakwood Hospital Downriver Center Occupational Medicine Clinics over 1 year. Of 3851 new injuries, 245 (6.4%) were due to foot and ankle injuries. The mean age was 36.7+/-9.2 (mean +/- S.D.) years and 64% men. No seasonal variation was seen. Most commonly the ankle (46.9%) was injured. A diagnosis of sprain was most frequent (40.8%), followed by contusions (26.5%). A twisting mechanism of injury was seen 27.3% of the time. Medical charges ranged from $100 to $6414, although over two thirds of the patients had expenses between $250 and $749. Eleven patients required surgery, costing $9125+/-2321. Most often injured were operators, fabricators, and laborers. Workers were restricted for 20.5+/-21.4 days, although they were allowed light duty most of the time (16.8+/-16.5 days).