Efficacy and Safety of Split Peroneal Tendon Lateral Ankle Stabilization.

Chronic lateral ankle instability is a common condition. Split peroneal tendon lateral ankle stabilization, a modification of the Chrisman-Snook procedure, is biomechanically stable and often used for severe and/or recurrent chronic lateral ankle instability. The purpose of the present study was to evaluate the efficacy and safety of this technique. Specifically, the midterm recurrence of instability and postoperative complications, such as stiffness, neurologic pain, and wound healing complications, were evaluated. We evaluated 30 consecutive procedures with a minimal follow-up period of 1 year. The mean follow-up period was 25 ± 13 (median 19, range 13 to 62) months. Five patients (17%) developed recurrent ankle instability, of whom 4 underwent revision surgery. One superficial infection and two wound disruptions developed. Two patients experienced stiffness and eight (27%) surgically induced neurologic complaints, such as sural neuritis. Finally, 2 patients developed complex regional pain syndrome.

A push-pull distraction method for arthroscopic subtalar joint arthrodesis.

Unlike ankle joint arthroscopy, distraction of the subtalar joint can be challenging. We introduce a powerful distraction method that can be used during an arthroscopic subtalar joint arthrodesis procedure using a "push-pull" technique. A fully threaded screw is used to push the talus while the calcaneus is pulled to distract the joint. The technique allows the surgeon to access the rather tight joint without disrupting a significant amount of the ligamentous and capsular structures. It also allows preservation of the vascular structures that supply the talus. The "push-pull" screw can also be converted to a second point of fixation at the end of the procedure.

A New Paradigm in Foot and Ankle Outcomes?: Away From Radiographs and Toward Patient-Centered Outcomes.

Having reasonable outcome measures is essential to unbiased research. For years, provider-measured outcomes have been valued as they are more objective and convenient for investigators. However, with the popularity of patient-centered medical care delivery, patient-reported outcome measures are appropriately becoming more popular in foot and ankle research.

Efficacy and safety of high-dose vitamin C on complex regional pain syndrome in extremity trauma and surgery--systematic review and meta-analysis.

Complex regional pain syndrome (CRPS) is a devastating condition often seen after foot and ankle injury and surgery. Prevention of this pathology is attractive not only to patients but also to surgeons, because the treatment of this condition can be difficult. We evaluated the effectiveness of vitamin C in preventing occurrence of CRPS in extremity trauma and surgery by systematically reviewing relevant studies. The databases used for this review included: Ovid EMBASE, Ovid MEDLINE, CINAHL, and the Cochrane Database. We searched for comparative studies that evaluated the efficacy of more than 500 mg of daily vitamin C. After screening for inclusion and exclusion criteria, we identified 4 studies that were relevant to our study question. Only 1 of these 4 studies was on foot and ankle surgery; the rest concerned the upper extremities. All 4 studies were in favor of this intervention with minimal heterogeneity (Tau(2) = 0.00). Our quantitative synthesis showed a relative risk of 0.22 (95% confidence interval = 0.12, 0.39) when daily vitamin C of at least 500 mg was initiated immediately after the extremity surgery or injury and continued for 45 to 50 days. A routine, daily administration of vitamin C may be beneficial in foot and ankle surgery or injury to avoid CRPS. Further foot and ankle specific and dose-response studies are warranted.

Distraction arthrodesis of subtalar joint using a laterally placed hinged distractor.

Many joint-depressive, neglected calcaneal fractures need distraction arthrodesis of the subtalar joint. Because the calcaneal tuberosity is usually malunited in the varus position, more distraction is required on the medial side to place the tuberosity in the everted position before insertion of a bone graft. Traditionally, a distractor is placed on the medial side to achieve this task. However, the medially placed distractor hinders with the positioning of the extremity and exposure of the main operative site, which is commonly on the lateral side. We introduce a technique to avoid this burden by placing a hinged distractor device on the lateral aspect of the foot while maintaining the correction of the varus deformity.

Is calcaneal inclination higher in patients with insertional Achilles tendinosis? A case-controlled, cross-sectional study.

Insertional Achilles tendinosis is a condition where a patient complains of isolated pain at the Achilles tendon insertion site due to intratendinous degeneration. It has been suggested that this condition is associated with cavus foot deformity. However, to our knowledge, there is no study that has confirmed this observation. We carried out a cross-sectional, case-controlled study to explore the association of increased calcaneal inclination-a surgically important characteristic of cavus foot deformity-with insertional Achilles tendinosis. Patients with Achilles tendinosis and matched controls without the pathology were compared. Although a statistically significant difference was detected in calcaneal inclination angle between these 2 groups (p = .038), we felt that the difference was not clinically significant (calcaneal inclination angle = 20.9 vs. 18.9, respectively). Within the limitations of the study, we conclude that there is no clinically significant difference in calcaneal inclination between those with or without insertional Achilles tendinosis.

Suspension and dynamic compression of the medial column using a tension band mesh plate.

Medial column fusion is becoming increasingly popular for flatfoot reconstruction. The authors describe a new technique for medial column arthrodesis via tension band mesh plating. Plating on the tension side would provide dynamic compression of the arthrodesis sites via weightbearing. This technique may be useful to allow patients to bear weight early in the postoperative course after flatfoot reconstruction.

Evans calcaneal osteotomy using an anterior lumbar distractor-inserter.

Although it is a relatively simple procedure for an experienced foot and ankle surgeon, Evans calcaneal opening wedge osteotomy requires 2 separate steps: 1) distraction of the osteotomy, and 2) insertion of a bone graft, and each of these maneuvers can be difficult without the use of appropriate instrumentation. In this report, a simplified method of executing this procedure with an anterior lumbar distractor-inserter is introduced. With the use of this particular instrument, a surgeon can avoid excessive distraction of the osteotomy while positioning a large bone graft in the distracted osteotomy without fracturing the anterior calcaneal fragment. The device also allows the surgeon to fine tune the correction of deformity by controlling the depth of bone graft insertion. The instrument provides all of these benefits without a high learning curve or additional cost to the procedure.