Does collective efficacy drive readiness for interprofessional learning? Evidence from a large-scale interprofessional education program in Hong Kong.

Interprofessional education has been widely integrated into health education curricula to enable students to work comfortably as members of a healthcare team. However, not much is known about the psychosocial mechanism that defines students' readiness for interprofessional learning. Drawing from social cognitive theory, we examined the pathway where collective efficacy was construed to influence subsequent students' satisfaction with team experiences, readiness for interprofessional learning, and attainment of interprofessional learning outcomes. Through path analysis, we examined data from 1,005 health and social care students who participated in a large-scale interprofessional education in Hong Kong. Results indicated that collective efficacy directly and indirectly predicted students' readiness for interprofessional learning and perception of attainment of IPE learning outcomes. Theoretical and practical implications of findings in the management of interprofessional education are discussed.

Which of the four models? Examining the measurement properties of the Interdisciplinary Education Perception Scale (IEPS) in healthcare and socialcare prelicensure curriculum in Hong Kong.

Interdisciplinary Education Perception Scale (IEPS) is one of the popular measures of perceptions of collaboration. In its original inception, a four-factor model was proposed but subsequent study offered alternative measurement models: three-factor model, two-factor model, and further revision of the three-factor model. Despite the changes in the model structures, none of these has been examined in the Asian context which could have paved the way for local researchers to start representing Asian perspectives in the discussion of interprofessional practice and cooperation in medical education. This study therefore aimed to examine the measurement properties of the IEPS by testing the four a priori models using the data from 335 Chinese students from eight prelicensure health and social care programs from two universities in Hong Kong. Through item analysis, confirmatory factor analysis, and regression, the results suggest that the 12-item, three-factor model best represented the sample and was invariant across genders and year levels. Theoretical and practical implications to interdisciplinary education literature are discussed.

Psychometric validation of team experiences questionnaire in preregistration Chinese health and social care students in Hong Kong.

The complexity of patients' healthcare needs can be addressed more adequately by professionals working as a healthcare team. In view of this, it is important to prepare students for collaborative work when they become professionals through a students' team training at the preregistration level. As intervention programs are implemented to promote students' collaboration, instruments like Team Experiences Questionnaire (TEQ) are needed. In this connection, this study which involved 335 Chinese students enrolled in eight health and social care programs from two universities in Hong Kong investigated the factor structures of the TEQ using construct validation approach. Using confirmatory factor analysis, we examined the fit of three competing models: unidimensional model, first-order correlated model, and second-order hierarchical model. The results demonstrated that the second-order hierarchical model obtained the best fit, with a higher-order construct called total team experiences subsuming the following first order factors: overall satisfaction with team experiences, team impact on quality of learning, satisfaction with team evaluation, team impact on clinical reasoning ability, and professional development. The "total team experience" construct explained from 21.1% to 35.7% of the variance in predicting students' future perception of team competency and autonomy, perceived need for cooperation, and perception of actual cooperation. Results support the applicability of the TEQ second-order hierarchical model. Implications are discussed.

Construct validation of the English version of Readiness for Interprofessional Learning Scale (RIPLS): Are Chinese undergraduate students ready for 'shared learning'?

Interprofessional education has been receiving attention as a result of research suggesting the benefits of interpersonal collaboration in healthcare. In Hong Kong, the implementation of the Interprofessional Team-based Learning programme provides implicit call to study the psychometric properties of Readiness for Interprofessional Learning Scale (RIPLS) to clarify if this is a valid measure when used in the Chinese undergraduate healthcare context. This study examines the psychometric properties of RIPLS involving predominantly Chinese undergraduate healthcare students in Hong Kong. Using within- and between-network approaches to construct validity, we investigated the applicability of English version of RIPLS among 469 predominantly Hong Kong Chinese students who have competence in the English language. These participants were from complementary health professional programmes: biomedical sciences, chinese medicine, medicine, nursing, and pharmacy, from two universities in Hong Kong. The within-network test results indicated that RIPLS had good internal consistency reliability. Results of the confirmatory factor analysis lend support to the overall factor structure of hypothesized four-factor solution although one item obtained non-significant factor loading. The between-network test also suggests that various subscales of RIPLS correlated systematically with theoretically relevant constructs: collective efficacy, team impact on quality of learning, and team impact on clinical reasoning ability. The RIPLS is a valid measure to estimate the Chinese undergraduate healthcare students' readiness to engage in interprofessional learning.

Implementation of an interprofessional team-based learning program involving seven undergraduate health and social care programs from two universities, and students' evaluation of their readiness for interprofessional learning.

BACKGROUND: Interprofessional learning is gaining momentum in revolutionizing healthcare education. During the academic year 2015/16, seven undergraduate-entry health and social care programs from two universities in Hong Kong took part in an interprofessional education program. Based on considerations such as the large number of students involved and the need to incorporate adult learning principles, team-based learning was adopted as the pedagogy for the program, which was therefore called the interprofessional team-based learning program (IPTBL). The authors describe the development and implementation of the IPTBL program and evaluate the effectiveness of the program implementation. METHODS: Eight hundred and one students, who are predominantly Chinese, participated in the IPTBL. The quantitative design (a pretest-posttest experimental design) was utilized to examine the students' gains on their readiness to engage in interprofessional education (IPE). RESULTS: Three instructional units (IUs) were implemented, each around a clinical area which could engage students from complementary health and social care disciplines. Each IU followed a team-based learning (TBL) process: pre-class study, individual readiness assurance test, team readiness assurance test, appeal, feedback, and application exercise. An electronic platform was developed and was progressively introduced in the three IUs. The students' self-perceived attainment of the IPE learning outcomes was high. Across all four subscales of RIPLS, there was significant improvement in student's readiness to engage in interprofessional learning after the IPTBL. A number of challenges were identified: significant time involvement of the teachers, difficulty in matching students from different programs, difficulty in making IPTBL count towards a summative assessment score, difficulty in developing the LAMS platform, logistics difficulty in managing paper TBL, and inappropriateness of the venue. CONCLUSIONS: Despite some challenges in developing and implementing the IPTBL program, our experience showed that TBL is a viable pedagogy to be used in interprofessional education involving hundreds of students. The significant improvement in all four subscales of RIPLS showed the effects of the IPTBL program in preparing students for collaborative practice. Factors that contributed to the success of the use of TBL for IPE are discussed.

Medial subtalar arthroscopy: a cadaveric study of the tarsal canal portal.

PURPOSE: To study the safety of the tarsal canal portal in medial subtalar arthroscopy. METHODS: Twenty-three fresh frozen foot and ankle specimens were divided into two groups with different orientation of the portal tract. Three types of tarsal canal portals were identified. The relationships of the metal rod and the flexor digitorum longus tendon and the posterior neurovascular bundle were studied. RESULT: In group A, a type 1 tarsal canal portal tract was established in seven specimens, a type 2 portal tract in three specimens, and a type 3 portal tract in two specimens. In group B, a type 1 portal tract was established in ten specimens and a type 2 portal tract in one specimen. No type 3 portal tract was established in group B. There was no statistical significance demonstrated for establishment of a type 1 portal tract and "non type 1" (type 2 or 3) portal tract in group A and group B. The average shortest distance between the rod and the posterior tibial neurovascular bundle was 7 mm in group A and 9 mm in group B. CONCLUSIONS: This study provides the anatomic basis for the establishment of the tarsal canal portal. There is a risk of injury to the flexor digitorum longus tendon and the posterior tibial neurovascular bundle with the tarsal canal portal, and it should be used with great caution.

Deep peroneal nerve injury following external fixation of the ankle: case report and anatomic study.

BACKGROUND: We present a case of deep peroneal nerve injury after application of external fixator and conducted a cadaveric study of the relationship of the deep peroneal nerve to the lateral tibial cortex. MATERIALS AND METHODS: A case of toe drop after application of the external fixator is reported. Twelve cadaveric lower legs were dissected to identify the course of the deep peroneal nerve. The tibia were divided into four Zones with equal length. The course of the nerve through each Zone of the tibia was studied Result: In Zone 1, the deep peroneal nerve went around the fibular neck and was found on the interosseous membrane at the distal portion of Zone 1. In Zone 2, the nerve still lay on the interosseous membrane in all specimens at the posterior edge of the lateral tibia. In Zone 3, the nerve moved away from the interosseous membrane and had direct contact with the tibia in nine specimens. In Zone 4, the nerve was on the anterior surface of the distal tibia. CONCLUSION: The deep peroneal nerve can be injured during the application of a unilateral frame ankle external fixator. The nerve is particularly at risk in Zone 2 and 3. CLINICAL RELEVANCE: The study provided an anatomic basis for the safe application of a unilateral external fixator of the tibia.

Adaptions and perceptions on histology and embryology teaching practice in China during the Covid-19 pandemic.

Backgroud: Under the circumstance of school closures caused by the coronavirus outbreak, medical schools in China began implementing online teaching, including histology and embryology (HE) beginning in the middle of February 2020. The changes in HE education in responding to the pandemic in China needs to be determined, for further adaption of online teaching delivery or blended learning. Methods: A nationwide survey of the major medical colleges was conducted via WeChat. Results: In total, 83 medical schools (one respondent per school) were invited to survey, 78 medical schools responded which represented most medical schools across all the provinces in mainland China, as well as Hong Kong and Macao. The results revealed that 77% (n = 60) and 58% (n = 45) of the responding schools had conducted HE theoretical and practical online teaching, respectively, prior to the pandemic; however, 27% (n = 21) of the medical schools had temporally suspended practical sessions at the time the survey was completed. During the pandemic, 73% (n = 57) and 29% (n = 23) of the medical schools delivered HE theoretical and practical sessions by synchronous live broadcasting, respectively; 65% (n = 51) of the medical schools increased virtual microscopy using during practical sessions. During the pandemic, 54% (n = 42) of the medical schools implemented teaching activities promoting active learning; meanwhile, online assessment was implemented in 84% (n = 66) of the responding medical schools. With regard to the satisfaction with the effectiveness of online teaching during the pandemic, 64% (n = 50) of the medical schools gave positive answers and considered that it was a good opportunity to develop novel and diversified teaching methods. Despite various difficulties such as work overload and unstable online teaching environments, most medical schools are willing to continue or increase theoretical online teaching after the pandemic. Conclusions: Medical institutes in China were the earliest of closing campuses and having complete online teaching experience during the pandemic. This paper presents overall HE teaching situation extracted from the survey, to assist other medical schools optimizing the transitions to quality online teaching within a short time, and to serve as reference for schools that demand essential knowledge in online teaching methods, infrastructure construction, and platform integrations.

Gross Anatomy Education in China during the Covid-19 Pandemic: A National Survey.

The Covid-19 pandemic launched the use of online courses in Chinese medical schools during February 2020. To evaluate the state of gross anatomy education in China during the pandemic, a nationwide survey was conducted through convenience sampling by email or respondent invitations on social media. A total of 359 questionnaires were received from the respondents. The first response from a given school was included in the study to represent that school, thus, 77 questionnaires were used for analyses. Schools represented were from all provinces in mainland China as well as Hong Kong and Macao. The survey found that before the pandemic, 74.0% and 33.8% of the 77 schools conducted online theoretical and practical sessions, respectively, on gross anatomy, and 36 (46.8% of 77) had temporarily suspended practical sessions at the time the survey was conducted. Body donation programs were also affected with 26.0% and 27.3% of the 77 schools having suspended donation programs or saw a decreased number of donations. During the pandemic, 40.3% of the 77 schools kept or initiated the implementation of active learning, and online assessment was continued in 49.4% of the 77 medical schools. Another 26 (33.8%) schools initiated online assessment during the pandemic. A total of 359 answers were included for the analysis of the "teachers' perception of the online teaching experience." Over half (51.0%) of the 359 responded teachers were very statisfied or satisfied with the effectiveness of online teaching during the pandemic. A total of 36.2% of these respondents preferred to implement online teaching of theoretical sessions after the pandemic, and 89 (24.8%) teachers were keen to return to traditional face-to-face anatomy education.

Cadaveric study of zone 2 flexor hallucis longus tendon sheath.

PURPOSE: The purpose of this study was to investigate the anatomy of the zone 2 flexor hallucis longus (FHL) tendon sheath. METHODS: Dissection of the zone 2 FHL tendon sheath was performed in 12 feet of 6 cadavers. The tendon sheath was subdivided into proximal fibrous (zone 2A) and distal fascial (zone 2B) parts. The lengths of the zone 2A and 2B FHL tendon were measured and represented the length of the corresponding tendon sheaths, and the relation of the medial plantar nerve to each part of the zone 2 FHL tendon sheath was studied. RESULTS: In all specimens there were fibrous and fascial components of the zone 2 FHL tendon sheath. The medial plantar nerve crossed the zone 2B tendon sheaths and then became plantar lateral to the sheath in 7 specimens. The distance between the medial plantar nerve and the orifice of the zone 2A tendon sheath averaged 7.6 mm. The distance between the medial plantar nerve and the junction between zones 2A and 2B averaged 3.2 mm. The distance between the medial plantar nerve and the distal end of the zone 2B tendon sheath averaged 4.2 mm. The mean length of the zone 2A tendon sheath was 35.9 mm, and the mean length of the zone 2B tendon sheath was 30.5 mm. CONCLUSIONS: The zone 2 FHL tendon sheath can be subdivided into a proximal fibrous zone (2A) and a distal fascial zone (2B). Because of the close proximity of the medial plantar nerve to the tendon sheath, there is a significant risk of iatrogenic nerve injury when surgical procedures are performed in zone 2B. CLINICAL RELEVANCE: An understanding of the anatomy of the zone 2 FHL tendon sheath is useful for the safe practice of zone 2 FHL tendoscopy.

Endoscopic distal soft-tissue release in the treatment of hallux valgus: a cadaveric study.

PURPOSE: To study the efficacy and safety of the lateral release of the endoscopic distal soft-tissue procedure in the treatment of hallux valgus. METHODS: Twenty fresh-frozen foot and ankle specimens were used. Ligament-sacrificing release was performed in 10 specimens (group 1). Ligament-sparing release was performed in another 10 specimens (group 2). The relation between the metal rod that passed through the toe web and plantar portal wounds and neural structures, degree of completeness of release of the intermetatarsal ligament, adductor hallucis insertion, and lateral capsular structures was studied. RESULTS: The common digital nerve of the first intermetatarsal space ran along the medial side of the rod, the medial digital nerve of the second toe ran obliquely and plantar to the rod just proximal to the proximal edge of the intermetatarsal ligament, and the lateral digital nerve of the hallux ran along the plantar lateral border of the metatarsal head and fibular sesamoid in all specimens. The intermetatarsal ligament, adductor hallucis insertion, and lateral capsular ligamentous structures were released completely in all specimens in group 1. The intermetatarsal ligament was preserved and the lateral capsular ligamentous structures were completely released in all specimens in group 2. The adductor hallucis insertion was completely released in 7 specimens. No nerve injury or cartilage damage was noted in all 20 specimens. CONCLUSIONS: With the release of the intermetatarsal ligament, all lateral capsular ligamentous structures including the adductor were released, but with intermetatarsal ligament preservation, only 70% of the specimens had complete adductor release. There was no neural or articular cartilage damage in either group. CLINICAL RELEVANCE: The study provides an anatomic basis for safe practice of endoscopic distal soft-tissue release in the correction of hallux valgus deformity.

Advantages of video trigger in problem-based learning.

BACKGROUND: Traditionally, paper cases are used as 'triggers' to stimulate learning in problem-based learning (PBL). However, video may be a better medium because it preserves the original language, encourages the active extraction of information, avoids depersonalization of patients and allows direct observation of clinical consultations. In short, it exposes the students to the complexity of actual clinical problems. AIM: The study aims to find out whether students and facilitators who are accustomed to paper cases would prefer video triggers or paper cases and the reasons for their preference. METHOD: After students and facilitators had completed a video PBL tutorial, their responses were measured by a structured questionnaire using a modified Likert scale. RESULTS: A total of 257 students (92%) and 26 facilitators (100%) responded. The majority of students and facilitators considered that using video triggers could enhance the students' observational powers and clinical reasoning, help them to integrate different information and better understand the cases and motivate them to learn. They found PBL using video triggers more interesting and preferred it to PBL using paper cases. CONCLUSION: Video triggers are preferred by both students and facilitators over paper cases in PBL.

Portal safety and efficacy of anterior subtalar arthroscopy: a cadaveric study.

Anterior subtalar arthroscopy was performed in 14 feet of 7 cadaveric bodies using the primary visualization and working portals. The cartilage of the anterior/middle calcaneal facet that can be reached was marked. The feet were dissected and the distances between the portals and surrounding cutaneous nerves were measured. Any damage to the ligaments of the sinus tarsi was noted. The percentage area of the articular cartilage that was marked was measured. In all specimens, the primary visualization portal tract passed through the lateral root of the inferior extensor retinaculum. The primary working portal tract passed through the lateral root in nine specimens (64%). Cervical ligament was intact in all specimens. In three specimens (21%), the primary visualization portal tract passed through the posterior edge of the intermediate root of the inferior extensor retinaculum. The interosseous talocalcaneal ligament was intact in all specimens. The primary visualization portal tract passed through the medial root of the inferior extensor retinaculum in eight specimens (57%). The primary working portal tract passed through the medial root of the inferior extensor retinaculum in one specimen. The average working area on the calcaneal facet was 95% +/- 4% of the total articular surface. There was no case of nerve injury in all specimens. In conclusion, anterior subtalar arthroscopy is a minimally invasive approach to deal with pathologies of this joint without the need of extensive resection of the ligamentous structures of the sinus tarsi.

Survey of Gross Anatomy Education in China: The Past and the Present.

Medical education in mainland China has undergone massive expansion and reforms in the past decades. A nation-wide survey of the five-year clinical medicine programs aimed to examine the course hours, pedagogies, learning resources and teaching staff of anatomy both at present and over the past three decades (1990-1999, 2000-2009, and 2010-2018). The directors or senior teachers from 90 out of the 130 five-year clinical medicine programs were invited to fill out a factual questionnaire by email. Ultimately, sixty-five completed questionnaires were received from 65 different schools. It was found that the total number of gross anatomy course hours has decreased by 11% in the past 30 years and that systematic and regional anatomy have been increasingly taught separately among the surveyed medical schools. Problem-based learning has been adopted in thirty-five (54%) of the surveyed schools, and team-based learning is used in ten (15%) of the surveyed schools. The surveyed schools reported receiving more donated cadavers in recent years, with the average number increasing from 20.67 ± 20.29 in 2000-2009 to 36.10 ± 47.26 in 2010-2018. However, this has not resulted in a decrease in the number of students who needed to share one cadaver (11.85 ± 5.03 in 1990-1999 to 14.22 ± 5.0 in 2010-2018). A decreasing trend regarding the teacher-student ratio (1:25.5 in 2000-2009 to 1:33.2 in 2010-2018) was also reported. The survey demonstrated the historical changes in gross anatomy education in China over the past thirty years.

Histology and Embryology Education in China: The Current Situation and Changes Over the Past 20 Years.

In mainland China, histology and embryology (HE) are taught in one course as an essential component of medical curricula. The effectiveness of HE courses directly affects the quality of medical students. To determine the present situation and changes in HE teaching in Chinese medical schools, a nationwide survey was conducted among the HE departmental leaders. In total, 66 responses were included in the study, representing prominent Chinese mainland medical schools. The results revealed that most HE teachers have medical educational backgrounds; an increasing number of teaching staff with PhDs have joined the teaching staffs. A range of 71 to 90 HE curriculum contact hours is predominant. The ratio of theory to practice for HE contact hours is 1:1 at half of the surveyed medical schools. The numbers of students in each laboratory are less than 30 and from 31 to 60 at 23 and 36 medical schools, respectively. Virtual microscopy is employed in 40% of the surveyed medical schools. Didactic teaching is the most common strategy, although new teaching approaches are being employed gradually. During the past 20 years, both the total number of HE teachers and the number of HE teachers with medical educational backgrounds have been reduced in at least half of the surveyed schools. A total of 83.33% of the surveyed schools have reduced their HE contact hours. Almost half of the Chinese medical schools remained unchanged in both their ratio of theory to practice and the number of students in each laboratory. The data derived from this study help to understand the development of the HE discipline at Chinese medical schools.

Learning environments for interprofessional education: A micro-ethnography of sociomaterial assemblages in team-based learning.

BACKGROUND: Teamwork and collaboration are central to interprofessional education but fostering these attributes in large undergraduate cohorts is challenging. OBJECTIVES: This study aimed to examine the complexities of IPE group learning processes by examining how the material and intersubjective intertwine when newly formed interprofessional groups (Chinese medicine, medicine, nursing, pharmacy, and social work) synchronously engaged with face-to-face and online learning in a blended, team-based learning environment. METHODS: It was a micro-ethnography study using a sociomaterial theoretical lens. We selected two undergraduate interprofessional healthcare student groups within a large scale programme for contrastive video analysis of synchronous spatial and physical configurations, associated talk, and online activity. RESULTS: Video analysis of evolving physical configurations indicated that Group B was spatially more evenly grouped, and physically orientated to an identifiable leader, despite their blinded peer evaluations indicating distributed leadership. Group A faced a critical event at a public forum leading to spatial disruption breaking into subgroups and isolates; however, this group identified one member as a defined leader in the peer evaluations. CONCLUSIONS: Based on online scores, we found that peer identification of leaders may influence learning processes but not learning outcomes in the first IPE team meeting. The design of the physical and virtual learning environments contributed to the developing, sociomaterial processes of group cohesion in interprofessional team-based learning.

Zone 2 flexor hallucis longus tendoscopy: a cadaveric study.

BACKGROUND: The purpose of this study was to verify the safety and efficacy of zone 2 flexor hallucis longus tendoscopy with the patient in the prone position. MATERIALS AND METHODS: The technique was performed in 12 cadaver feet (6 pairs). The endoscopic findings were compared to an anatomic dissection. The locations of the posteromedial and plantar portals were studied. The relationship between the medial plantar nerve and the tract of FHL tendoscopy was also studied. RESULT: The average distance of the posteromedial portal above the medial malleolar tip was 10.3 mm. The average distance between the posteromedial portal and the posterior tibial nerve was 9.9 mm. The average distance between the plantar portal and the intermalleolar line was 41.5 mm. The average distance between the rod simulating the tenoscope and the nerve was 4.8 mm. The nerve was medial to the rod in 4 specimens and lateral to the rod in 8 specimens. CONCLUSION: Zone 2 flexor hallucis longus tendoscopy was a feasible approach to the deep portion of the flexor hallucis longus tendon in this cadaveric study. There is potential risk of damage to the medial plantar nerve. CLINICAL RELEVANCE: These findings can help guide a surgeon who is considering trying this clinically.

The range of passive arm circumduction in primates: do hominoids really have more mobile shoulders?

Hominoids and lorines are assumed to possess greater shoulder mobility than other primates. This assumption is based on morphological characteristics of the shoulder, rather than on empirical data. However, recent studies have shown that the glenohumeral joint of hominoids is not more mobile than that of other primates (Chan LK. 2007. Glenohumeral mobility in primates. Folia Primatol (Basel) 78(1):1-18), and the thoracic shape of hominoids does not necessarily promote shoulder mobility (Chan LK. 2007. Scapular position in primates. Folia Primatol (Basel) 78(1):19-35). Moreover, lorines differ significantly from hominoids in both these features, thus challenging the assumption that both hominoids and lorines have greater shoulder mobility. The present study aims to test this assumption by collecting empirical data on shoulder mobility in 17 primate species. Passive arm circumduction (a combination of glenohumeral and pectoral girdle movement) was performed on sedated subjects (except humans), and the range measured on the video images of the circumduction. The motion differed among primate species mostly in the craniodorsal directions, the directions most relevant to the animal's ability to brachiate and slow climb. Hylobatids possessed the highest craniodorsal mobility among all primate species studied. However, nonhylobatid hominoids did not have greater craniodorsal mobility than arboreal quadrupedal monkeys, and lorines did not have greater craniodorsal mobility than arboreal quadrupedal prosimians. Nonhylobatid hominoids and lorines had similar craniodorsal mobility, but this was due to a longer clavicle, more dorsal scapula, and lower glenohumeral mobility in the former, and a shorter clavicle, less dorsal scapula, and greater glenohumeral mobility in the latter. This study provides evidence for the reexamination of the brachiation, slow climbing, and vertical climbing hypotheses.

Anatomy of the portal tract for endoscopic decompression of the first branch of the lateral plantar nerve.

PURPOSE: Our purpose is to study the anatomy of the portal tract for endoscopic decompression of the first branch of the lateral plantar nerve. METHODS: The anatomy of the portals and portal tract with endoscopic release of the first branch of the lateral plantar nerve was studied in 12 feet in 6 cadaveric bodies. RESULTS: The proximal portal is located at the fascial opening for the first branch of the lateral plantar nerve and is about 16 mm inferior and 23 mm posterior to the tip of the medial malleolus. The distal portal is located at the inferior edge of the deep fascia of the abductor hallucis muscle and just distal to the medial calcaneal tubercle. The portal tract is deep to the deep surface of the whole width of the deep abductor fascia. In 1 of 12 specimens, the nerve lay superficial to a rod placed between the portals, whereas the nerve was deep to the rod in the remaining 11 specimens. In all specimens the first branch of the lateral plantar nerve, after it pierced the deep fascia of the abductor hallucis at the fascial defect, ran anteriorly and distally, approximately parallel to the direction of the rod. CONCLUSIONS: The proximal portal for endoscopic decompression of the first branch of the lateral plantar nerve is located at the fascial opening for the first branch of the lateral plantar nerve. This can be consistently located with the Wissinger rod technique. The portal tract thus created is effective for deep abductor fascia release. However, percutaneous release without endoscopic visualization of the first branch of the lateral plantar nerve is not safe because of the potential risk of nerve injury, because the nerve can be sandwiched between the instrument and the deep abductor fascia without being noticed. CLINICAL RELEVANCE: The study confirmed the first branch of the lateral plantar nerve can be effectively released endoscopically.

A systematic review on ankle injury and ankle sprain in sports.

This article systematically reviews epidemiological studies on sports injury from 1977 to 2005 in which ankle injury was included. A total of 227 studies reporting injury pattern in 70 sports from 38 countries were included. A total of 201,600 patients were included, with 32,509 ankle injuries. Ankle injury information was available from 14,098 patients, with 11 847 ankle sprains. Results show that the ankle was the most common injured body site in 24 of 70 included sports, especially in aeroball, wall climbing, indoor volleyball, mountaineering, netball and field events in track and field. Ankle sprain was the major ankle injury in 33 of 43 sports, especially in Australian football, field hockey, handball, orienteering, scooter and squash. In sports injuries throughout the countries studied, the ankle was the second most common injured body site after the knee, and ankle sprain was the most common type of ankle injury. The incidence of ankle injury and ankle sprain was high in court games and team sports, such as rugby, soccer, volleyball, handball and basketball. This systematic review provides a summary of the epidemiology of ankle injury in sports.