Vascular Assessment of the Foot Surgery Patient.

Foot surgery is common. Orthopaedic nurses charged with evaluating and treating patients who have undergone foot surgery are required to evaluate the vascular status of the patient's foot (or feet). As a result, these nurses are often the first to identify vascular issues. This article provides orthopaedic nurses with the background to understand how the patient's history, the procedure(s) performed, and a thorough assessment of the foot's circulation will allow them to promptly identify circulatory problems and potentially save a patient from having a serious complication.

Flexible fixation for ligamentous lisfranc injuries.

Lisfranc injuries require anatomic reduction and stabilization of the tarsometatarsal joints. We describe a novel technique that provides flexible fixation that is simple, cost-effective and that may offer certain advantages over more traditional techniques.

Relationships among subjective patient-reported outcome, quality of life, and objective gait characteristics using wearable foot inertial-sensor assessment in foot-ankle patients.

BACKGROUND: This study aimed to determine the relationships between subjective validated patient-reported outcomes and health-related quality of life, to objective gait characteristics in patients with foot-ankle conditions. Objective gait characteristics were obtained using a wearable foot inertial-sensor device as well as by assessing the relationships between spatiotemporal or gait parameters by analyzing the inter-metric correlations. METHODS: Fifty-two patients with foot-ankle conditions (37 women/15 men, aged 21-75 years) were included in this study. Clinical assessments, including evaluations of validated patient-reported outcomes using visual analog scale foot and ankle score, health-related quality of life using validated Short Form-36, and gait characteristics using a wearable foot inertial-sensor device, were performed and recorded for each patient. RESULTS: A significant negative correlation was observed between the physical component summary (PCS) and maximal cadence (r = - 0.308, P = 0.025). Significant positive correlations were noted between mean walking speed and mean cadence (r = 0.776, P < 0.001) and between maximal walking speed and mean step length (r = 0.498, P < 0.001). Significant negative correlations were found between the mean cadence and mean step length (r = - 0.491, P < 0.001) and between maximal cadence and mean step length (r = - 0.355, P = 0.009). CONCLUSIONS: Cadence is an important objective spatiotemporal parameter to assess in foot and ankle patients as it relates well to outcome, with a significantly negatively correlation to subjectively reported PCS in health-related quality of life. Based on inter-metric relationships, an increased cadence might be used to maintain walking speed as a compensatory mechanism in patients with foot-ankle conditions.

Do columns or sagittal displacement matter in the assessment and management of Lisfranc fracture dislocation? An alternate approach to classification of the Lisfranc injury.

AIM: The classification of a Lisfranc injury has conventionally been based around Myerson's system. The aims of this study were to review whether a novel classification system based on sagittal displacement of the tarsometatarsal joint and breadth of injury as determined by a columnar theory was associated with functional outcomes and thus had a greater utility. PATIENTS: We retrospectively reviewed 54 Lisfranc injuries with a minimum follow up of two years at our Level One Trauma Centre. Each fracture was sub-classified based on our novel classification system which assessed for evidence of sagittal displacement and involvement of columns of the midfoot. Our primary outcome measures were the FFI and AOFAS midfoot scores. RESULTS: Injuries involving all three of the columns of the midfoot were associated with significantly worse functional outcome scores (FFI p=0.004, AOFAS p=0.036). Conversely, sagittal displacement, whether dorsal or plantar, had no significance (FFI p=0.147, AOFAS p=0.312). The best predictor of outcome was the quality of anatomical reduction (FFI p=0.008, AOFAS p=0.02). CONCLUSION: Column involvement and not sagittal displacement is the most significant factor in considering the severity Lisfranc injury and long term functional outcomes. This classification system has greater clinical utility than those currently proposed.

Mechanical Conflict System: A Novel Operant Method for the Assessment of Nociceptive Behavior.

A new operant test for preclinical pain research, termed the Mechanical Conflict System (MCS), is presented. Rats were given a choice either to remain in a brightly lit compartment or to escape to a dark compartment by crossing an array of height-adjustable nociceptive probes. Latency to escape the light compartment was evaluated with varying probe heights (0, .5, 1, 2, 3, and 4 mm above compartment floor) in rats with neuropathic pain induced by constriction nerve injury (CCI) and in naive control rats. Escape responses in CCI rats were assessed following intraperitoneal administration of pregabalin (10 and 30 mg/kg), morphine (2.5 and 5 mg/kg), and the tachykinin NK1 receptor antagonist, RP 67580 (1 and 10 mg/kg). Results indicate that escape latency increased as a function of probe height in both naive and CCI rats. Pregabalin (10 and 30 mg/kg) and morphine (5 mg/kg), but not RP 67580, decreased latency to escape in CCI rats suggesting an antinociceptive effect. In contrast, morphine (10 mg/kg) but not pregabalin (30 mg/kg) increased escape latency in naive rats suggesting a possible anxiolytic action of morphine in response to light-induced fear. No order effects following multiple test sessions were observed. We conclude that the MCS is a valid method to assess behavioral signs of affective pain in rodents.

Pedobarography in the Assessment of Postoperative Calcaneal Fracture Pressure With Gait.

The purpose of the present study was to evaluate the benefits and importance of pedobarography in the diagnosis and treatment of plantar pressure changes in the postoperative follow-up of calcaneus fractures treated with open reduction and internal fixation. The 28 patients included 23 males (82%) and 5 females (18%). The clinical evaluation was performed using the American Orthopaedic Foot and Ankle Society hindfoot scoring system. The Böhler and Gissane angles were measured on the preoperative and postoperative radiographs. In the postoperative follow-up period (mean ± standard deviation 22.25 ± 10.8 months), all the patients underwent analysis with a dynamic pedobarogram. Because the arch index of the operated feet was 29.73% and that of the nonoperated feet was 28.94%, a similar slightly low arch was seen in both feet (p = .078). When the plantar surface maximum pressures were evaluated, a significant reduction was seen in the operated feet in the second, third, fourth, and fifth metatarsals and the medial hindfoot (p < .05). Displaced intra-articular calcaneus fractures resulted in a significant reduction in maximum pressure of the second, third, fourth, and fifth metatarsals and the medial hindfoot. Also, the hindfoot pressure was lateralized. Pedobarography is a simple and useful method for the diagnosis of plantar pressure changes occurring postoperatively.

The double helix: when the system fails the intertwined needs of caregiver and patient.

When a family caregiver becomes injured, she learns the difficulties--and costs--of caring for herself and her chronically ill husband at the same time.

Time for a paradigm shift with computerized adaptive testing of general physical function outcomes measurements.

BACKGROUND: Patient-reported outcomes (PRO) are critical to understanding the value of orthopedic treatments. We hypothesized that use of the computerized adaptive testing from a well-characterized physical function item bank would show superiority in assessing all levels of physical function compared to current standard generic physical function outcomes instruments for foot and ankle patients. METHODS: In a population of 126 foot and ankle patients we compared the psychometric properties for three PROs: the Physical Function subscale of the Medical Outcomes General Health Survey (SF-36 PF) version 2, the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) Computerized Adaptive Test (CAT), and the Lower Extremity (LE) CAT. A Rasch item response theory (IRT) model was applied to assess and compare the fit, dimensionality, reliability, validity, and coverage. RESULTS: The unexplained variance for the PF CAT was 3.9% and the LE CAT was 2.1%, suggesting each instrument explained a single concept. The SF-36 PF had more concerning unexplained variance of 7.6%. We found no floor or ceiling effects for the PF CAT, a minimal floor effect (1.6%) but no ceiling effect for the LE CAT, and an 11.1% floor effect and 9.5% ceiling effect for the SF-36 PF. CONCLUSION: Foot and ankle clinicians and researchers interested in measuring patient perceived functional outcomes with a generic instrument should consider using either the PF CAT or the LE CAT rather than the SF-36 PF. Further studies comparing these CATs to anatomic specific instruments are needed. LEVEL OF EVIDENCE: Level I, diagnostic study.

Biomechanical evaluation of dancers and assessment of their risk of injury.

Professional dancers have a 90% risk of injury during their career. The lower extremity is involved in approximately 75% of the injuries sustained by dancers. Proper biomechanical evaluation, risk assessment, and prevention-oriented treatment are necessary to minimize future problems and promote a full and lasting recovery when an injury is sustained. This article outlines the in-office evaluation process and discusses backstage care.

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.