[Comparison of the effectiveness of two kinds of surgeries for treatment of flexible flatfoot combined with painful accessory navicular bone in children].

Objective: To compare the effectiveness of subtalar arthroereisis (STA) combined with modified Kidner procedure versus STA alone in the treatment of flexible flatfoot combined with painful accessory navicular bone in children. Methods: The clinical data of 33 children with flexible flatfoot combined with painful accessory navicular bone who were admitted between August 2018 and August 2021 and met the selection criteria were retrospectively analyzed. They were divided into a combination group (17 cases, treated by STA combined with modified Kidner procedure) and a control group (16 cases, treated by STA alone) according to the surgical methods. There was no significant difference in baseline data between the two groups ( P>0.05), such as gender, age, affected side of the foot, disease duration, and preoperative visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, talus-first metatarsal angle (T1MT), talus-second metatarsal angle (T2MT), talonavicular coverage angle (TCA), talus first plantar angle (Meary angle), calcaneal inclination angle (Pitch angle), and heel valgus angle (HV). The operation time, incision length, intraoperative blood loss, number of intraoperative fluoroscopies, and perioperative complications were recorded in both groups. The anteroposterior, lateral, and calcaneal axial X-ray films for the affected feet were taken regularly, and T1MT, T2MT, TCA, Meary angle, Pitch angle, and HV were measured. The VAS score, AOFAS ankle-hindfoot score were used to evaluate pain and functional recovery before and after operation. Results: Surgeries in both groups were successfully performed without surgical complication such as vascular, nerve, or tendon injuries. Less operation time, shorter incision length, less intraoperative blood loss, and fewer intraoperative fluoroscopies were found in the control group than in the combination group ( P<0.05). One case in the combination group had partial necrosis of the skin at the edge of the incision, which healed after the dressing change and infrared light therapy, and the rest of the incisions healed by first intention. All children were followed up 12-36 months, with a mean of 19.6 months. At last follow-up, VAS score and AOFAS ankle-hindfoot score significantly improved in both groups when compared with preoperative ones ( P<0.05), and the differences of these scores between before and after operation improved more significantly in the combination group than in the control group ( P<0.05). Imaging results showed that the T1MT, T2MT, TCA, Meary angle, and HV significantly improved in both groups at last follow-up when compared with preoperative ones ( P<0.05), and the Pitch angle had no significant difference when compared with preoperative one ( P>0.05). But there was no significant difference in the difference of these indicators between before and after operation between the two groups ( P>0.05). Conclusion: Both procedures are effective in the treatment of flexible flatfoot children with painful accessory navicular bone. STA has the advantage of minimally invasive, while STA combined with modified Kidner procedure has better effectiveness.

Manual Reduction and Plaster External Fixation for the Treatment of Closed Total Talus Dislocation: Case Report and Literature Review.

BACKGROUND: Total dislocation of the talus from all its surrounding joints (talonavicular, tibiotalar, subtalar) is one kind of serious injury of the lower extremity with rare occurrence. It is usually accompanied by fractures of the talus and its periphery, as well as severe soft tissue injury, which is difficult to reset. Complications such as skin necrosis and infection are prone to occur in the early stage, and talus necrosis are prone to occur in the late stage, all of which aggravate disease severity and increase difficulties for its treatment. CASE PRESENTATION: Herein, we reported a case of right talus total dislocation accompanied by medial malleolus fracture and posterior tubercle fracture caused by traffic accident. One hour after injury, the doctor tried to perform manual reduction but failed. Then, we successfully performed manual reduction and plaster external fixation on this patient under anesthesia 6 h after injury, followed by the oral administration of Chinese medicine for 3 months. Twenty months of follow-up investigations revealed that no skin necrosis, talus dislocation, talus necrosis, or other complications occurred; no obvious joint degeneration was observed and the fractures of medial malleolus and talus healed well. MRI of ankle joint indicated the disappearance of ankle effusion caused by injury, and the bone marrow edema had also subsided at talus, medial malleolus, and lateral malleolus and calcaneus. Patient presented with no ligament relaxation, ankle instability, pain, swelling, or functional limitation of the injured limb. AOFAS score reached 100. Daily functions and recreation activities were recovered back to the normal level. CONCLUSION: For patients with closed total dislocation of the talus, fine therapeutic effects can be achieved by early closed manual reduction and plaster external fixation under anesthesia, in combination with oral Chinese herbal medicine afterwards. It is worthy of reference for clinicians.

A retrospective analysis of the definitive management of open talus fractures at a major trauma centre, comparing ORIF to FUSION: cohort study and audit of BOAST 4 guidelines.

PURPOSE: Open talus fractures are notoriously difficult to manage, and they are commonly associated with a high level of complications including non-union, avascular necrosis and infection. Currently, the management of such injuries is based upon BOAST 4 guidelines although there is no suggested definitive management, and thus, definitive management is based upon surgeon preference. The key principles of open talus fracture management which do not vary between surgeons are early debridement, orthoplastic wound care, anatomic reduction and definitive fixation whenever possible. However, there is much debate over whether the talus should be preserved or removed after open talus fracture/dislocation and proceeded to tibiocalcaneal fusion. METHODS: A review of electronic hospital records for open talus fractures from 2014 to 2021 returned fourteen patients with fifteen open talus fractures. Seven cases were initially managed with ORIF, and five cases were definitively managed with FUSION, while the others were managed with alternative methods. We collected patient's age, gender, surgical complications, surgical risk factors and post-treatment functional ability and pain and compliance with BOAST guidelines. The average follow-up of the cohort was 4 years and one month. EQ-5D-5L and FAAM-ADL/Sports score was used as a patient reported outcome measure. Data were analysed using the software PRISM. RESULTS: Comparison between FUSION and ORIF groups showed no statistically significant difference in EQ-5D-5L score (P = 0.13), FAAM-ADL (P = 0.20), FAAM-Sport (P = 0.34), infection rate (P = 0.55), surgical times (P = 0.91) and time to weight bearing (P = 0.39), despite a higher proportion of polytrauma and Hawkins III and IV fractures in the FUSION group. CONCLUSION: FUSION is typically used as second line to ORIF or failed ORIF. However, there is a lack of studies that directly compared outcome in open talus fracture patients definitively managed with FUSION or ORIF. Our results demonstrate for the first time that FUSION may not be inferior to ORIF in terms of patient functional outcome, infection rate and quality of life, in the management of patients with open talus fracture patients. Of note, as open talus fractures have increased risks of complications such as osteonecrosis and non-union, FUSION should be considered as a viable option to mitigate these potential complications in these patients.

Talus mobilization-based manual therapy is effective for restoring range of motion and enhancing balance in older adults with limited ankle mobility: A randomized controlled trial.

BACKGROUND: The ankle plays a key role in balance, but ankle range of motion decreases with ageing. RESEARCH QUESTION: To establish whether a talus mobilization-based manual therapy intervention may be effective for increasing range of motion and balance in older adults with limited ankle mobility due to the ageing process. METHODS: Randomized clinical trial in which 42 community-dwelling older adults with limited ankle mobility were allocated to an experimental or a control group. The experimental intervention consisted of six sessions of anteroposterior talus mobilization, whereas the control intervention was a sham treatment. Baseline change in weight and non-weight bearing ankle range of motion (ROM), balance outcome in terms of the Timed up and go (mobility and dynamic balance), Single-leg stand (static balance and stability), Functional reach (margins of stability) and Romberg tests (static balance) were assessed. Analysis of variance based on a mixed-linear model of repeated measures looked for group interactions. RESULTS: Forty participants completed the study. Participants who received six sessions of manual therapy showed greater improvements in the Timed up and go, Functional reach and Single-leg stand tests than participants who received a sham intervention (p < 0.001). Both groups presented similar performance in post-treatment static balance measures (p > 0.05). SIGNIFICANCE: An anteroposterior talus mobilization-based manual therapy intervention is effective for increasing ankle ROM, with a positive effect on dynamic balance, mobility and stability in community-dwelling older adults with limited ankle mobility.

Effectiveness of Mobilization of the Talus and Distal Fibula in the Management of Acute Lateral Ankle Sprain.

OBJECTIVE: Distal fibular mobilization with movement (MWM), with and without a posterior gliding fibular tape, and anteroposterior mobilization of the talus (MOB) are widely used to treat acute lateral ankle sprains. The purpose of this study was to investigate the short-term and long-term relative effectiveness of these techniques. METHODS: In this double-blind randomized controlled trial, 45 amateur soccer players with acute (<72 hours) lateral ankle sprain were randomly allocated to 6 sessions (3/wk within the first 2 weeks) of either MWM, MWM with tape (MWMtape), or MOB. All participants also received general advice, transcutaneous electrical nerve stimulation, edema draining massage, and a program of proprioception exercises. Participant ratings of function on the Foot and Ankle Ability Measure and Patient Global Impression of Improvement Scale were the primary outcomes measured over 52 weeks. Secondary outcomes were ankle pain, pressure pain threshold, range of motion, volume, and strength. RESULTS: MWM and MWMtape were equally effective and participants demonstrated greater function on the Foot and Ankle Ability Measure at 12 and 52 weeks when compared with those receiving MOB; however, the latter demonstrated superior function at 2 weeks. No differences between groups were observed for Patient Global Impression of Improvement Scale or any of the secondary outcomes. CONCLUSION: There are limited differences in the short term among techniques, with the exception of better sport function with MOB. Over the longer term, the distal fibular MWM is most effective to achieve activities of daily living and sport function when added to usual physical therapy care. The addition of a posterior gliding fibular tape provides no additional benefit. IMPACT: Distal fibular mobilization with movement may be the most appropriate choice of treatment for acute lateral ankle sprain to achieve long-term activities of daily living and sport function. In the short term, anteroposterior mobilization of the talus offers greater improvement in sport function. The use of fibular tape provides no added benefit as an adjunct to a treatment that includes distal fibular mobilization with movement.

Effects of Walking With Talus-Stabilizing Taping on Passive Range of Motion, Timed Up and Go, Temporal Parameters of Gait, and Fall Risk in Individuals With Chronic Stroke: A Cross-sectional Study.

OBJECTIVE: The purpose of this study was to determine the effects of walking with talus-stabilizing taping on ankle dorsiflexion passive range of motion, the timed up-and-go test, temporal parameters of gait, and fall risk in individuals with chronic stroke. METHODS: In this cross-sectional design study, 20 participants with chronic stroke (9 female, 11 male), aged 60.5 ± 8.1 years, were included. Three conditions were evaluated: barefoot, immediately after applying talus-stabilizing taping, and after 5 minutes of walking with talus-stabilizing taping. One-way repeated-measures analysis of variance was used to determine the differences in ankle dorsiflexion passive range of motion, timed up-and-go test results, temporal parameters of gait, and fall risk across the 3 conditions. RESULTS: Ankle dorsiflexion passive range of motion, walking speed, and single-limb support phase were significantly improved after 5 minutes of walking with talus-stabilizing taping compared to those in the barefoot and immediately-after-taping conditions. The timed up-and-go test, double-limb support phase, and fall-risk results significantly decreased more after 5 minutes of walking with talus-stabilizing taping compared to barefoot and immediately after taping. CONCLUSION: After the application of talus-stabilizing taping, ankle dorsiflexion passive range of motion, timed up-and-go test results, temporal parameters of gait, and fall risk were reduced in individuals with chronic stroke.

A Randomized Controlled Trial Assessing the Evolution of the Weight-Bearing Ankle Dorsiflexion Range of Motion Over 6 Sessions of Talus Mobilizations in Older Adults.

BACKGROUND: Ankle range of motion declines with age, affecting mobility and postural control. OBJECTIVE: The objective of this study was to investigate the effects of a talus mobilization-based intervention among healthy community-dwelling older adults presenting with limited weight-bearing ankle dorsiflexion range of motion and determine how ankle mobility evolved over the treatment. DESIGN: This was a randomized clinical trial. SETTING: This study was conducted in an outpatient clinic. PARTICIPANTS: Community-dwelling, older adults over 60 years of age who had limited ankle mobility participated in this study. INTERVENTIONS: The experimental intervention consisted of 6 sessions of manual therapy applied in the ankle joint. The control group received the same volume of sham treatment. MEASUREMENTS: The primary outcome was the weight-bearing ankle dorsiflexion range of motion as measured using the lunge test. Data were collected at 9 time points: baseline, after each session, and follow-up. RESULTS: A total of 36 participants were analyzed. A single session of mobilization increased ankle range of motion by 8 degrees (95% confidence interval = 6 to 11). At the end of the sixth session, this effect had increased slightly to 11 degrees (95% confidence interval = 9 to 13). Significant between-group differences were found throughout the intervention. LIMITATIONS: Optimal dose and effects from follow-up evaluations for treatment volumes of fewer than 6 sessions remain unknown. CONCLUSIONS: Six sessions of a talus mobilization-based intervention in healthy community-dwelling older adults found that the greatest mobility gain in terms of the weight-bearing ankle dorsiflexion range of motion is produced after the first session. Additional sessions produce smaller improvements with a slight upward trend. Importantly, the restoration of joint mobility is enhanced over time after the end of the intervention.

Comparison of Platelet Rich Plasma and Prolotherapy in the Management of Osteochondral Lesions of the Talus: A Retrospective Cohort Study.

BACKGROUND Osteochondral lesions of talus (OLT) are among the most common ankle problems. Platelet-rich plasma (PRP) and prolotherapy (PrT) are 2 successful injection-based techniques for treatment of chronic musculoskeletal problems. The aim of the present study was to compare PRP and PrT injections for the management of OLT. MATERIAL AND METHODS This was a retrospective cohort study of 49 patients with OLT symptoms of more than 6 months who had been refractory to 3 months of treatment using conservative methods. The patients were divided into 2 groups: PrT injections (PrT group, n=27) or PRP injections (PRP group, n=22). The patients were given 3 injections of 4 mL solution into periarticular and intra-articular ankle joint spaces. After treatment, patients were evaluated via Visual Analogue Scale (VAS), American Orthopedic Foot and Ankle Society Score (AOFAS), and Ankle Osteoarthritis Scale (AOS) at baseline and 21-, 90-, 180-, and 360-day follow-up periods. RESULTS Both PRP and PrT treatments resulted in greater improvement in pain and ankle functions at follow-up periods extending to 1 year (P<0.001) and there was no difference between the groups for the outcomes at follow-up periods (P>0.05). Excellent or good outcomes were reported by 88.8% of the patients in PrT group and 90.9% of the patients in PRP group. CONCLUSIONS Both PRP and PrT are efficient and safe methods in treatment of OLT. PrT offers advantages of less cost and minimal invasiveness.

Matrix-associated stem cell transplantation is successful in treating talar osteochondral lesions.

PURPOSE: Osteochondral lesions (OCLs) of the talus are a challenging and increasingly recognized problem in chronic ankle pain. Many novel techniques exist to try and treat this challenging entity. Difficulties associated with treating OCLs include lesion location, size, chronicity, and problems associated with potential graft harvest sites. Matrix-associated stem cell transplantation (MAST) is one such treatment described for larger lesions > 15 mm2 or failed alternative therapies. This cohort study describes a 3 year review of the outcomes of talar lesions treated with MAST. METHODS: A review of all patients treated with MAST by a single surgeon was conducted. Pre-operative radiographs, MRIs, and FAOS outcome questionnaire scores were reviewed. Intraoperative classification was undertaken to correlate with imaging. Post-operative outcomes included FAOS scores, return to sport, revision surgery/failure of treatment, and progression to ankle fusion. RESULTS: In this study, 38 OCLs in 32 patients were identified. Median patient age was 35 years of which (68.8%) were male. Median length of follow-up was 36.7 months (range 12-64 months). (83%) returned to playing sport. Twenty-three patients underwent MAST in the setting of a failed previous operative attempt, with just nine having MAST as a first option. Nine patients out of 32 had a further procedure. Improvements were seen in all domains of the FAOS (p < 0.05). CONCLUSION: MAST has demonstrated encouraging results in lesions which prove challenging to treat, even in a "failed microfracture" cohort. LEVEL OF EVIDENCE: IV.

An Alumina Ceramic Total Talar Prosthesis for Avascular Necrosis of the Talus.

Avascular necrosis tends to occur in the talus because of poor blood supply caused by the extended coverage to the articular cartilage on its surface. Treatment is conservative in the earlier stage of this disease; however, surgical treatment is usually indicated in the advanced stage. Nonunion, leg length discrepancy, or hindfoot instability may occur in patients treated with ankle or tibio-talo-calcaneal fusion. Arthroplasty using a customized total talar prosthesis designed using the computed tomography image of contralateral talus has the potential advantages of weightbearing in the earlier postoperative phase, prevention of lower extremity discrepancy, and maintenance of joint function.

Medial Longitudinal Arch: Accuracy, Reliability, and Correlation Between Navicular Drop Test and Footprint Parameters.

OBJECTIVE: The purpose of this study was to evaluate the correlation among the navicular drop test, the arch angle, the Staheli index and the Chippaux-Smirak index. The reliability and the correlation among the footprint parameters were also estimated. METHODS: A cross-sectional study (n = 86; 59.3% women; 27.8 years, standard deviation: 4.8 years) was carried out. The navicular drop test was evaluated and footprint parameters using a plantar pressure platform were recorded in the dominant foot. Pearson correlation coefficients, intraclass correlation coefficient, standard error of measurement, and minimum detectable change were calculated. RESULTS: Both intrarater and interrater reliability were excellent for all the parameters evaluated (intraclass correlation coefficients > 0.880). Statistically significant correlations existed between the navicular drop test and footprints parameters (arch angle = 0,643; Staheli index = 0.633; Chippaux-Smirak index = 0.614). The footprint parameters had excellent correlation with each other (0.838-0.881). The navicular drop test and the footprint parameters studied were reproducible and thus had excellent reliability. CONCLUSION: The correlations obtained between the navicular drop test and the footprint parameters evaluated were good. The navicular drop test appears to be a reproducible, valid, and simple test for evaluating medial longitudinal arch height, having fewer disadvantages than using footprint parameters.

Luxo-fractura de Chopart / Fracture-luxation de l'articulation de Chopart / Chopart luxo-fracture

La articulación de Chopart o transversa del tarso está constituida por la articulación calcaneocuboidea y la astragaloescafoidea. Las lesiones que ocurren en estas articulaciones se conocen como luxo-fractura de Chopart y son extremadamente raras. Entre las causas más frecuentes se encuentran los accidentes en motocicletas y las caídas de altura. El tratamiento es la reducción anatómica y fijación estable. La necrosis avascular del astrágalo, así como la artritis postraumática son las complicaciones más temidas. Con este trabajo se pretende describir la conducta y evolución perioperatoria de dos pacientes con luxo-fractura de Chopart, atendidos en el Servicio de Urgencias del Hospital Militar Central Dr Luis Díaz Soto. Fueron diagnosticados tempranamente y se les realizó reducción abierta más fijación interna con una recuperación en los primeros tres meses. La baja prevalencia de la luxo-fractura de Chopart requiere un diagnóstico adecuado y correcto para lograr un buen resultado clínico(AU)

The Chopart joint or transverse tarsus is constituted by the calcaneocuboid and the astragaloescafoidea joints. The injuries that occur in these joints are known as Chopart luxo-fracture and are extremely rare. Motorcycle accidents and falls from heights are among the most frequent causes of Chopart luxo-fractures. The treatment is the anatomical reduction and stable fixation. The avascular necrosis of the talus, as well as post-traumatic arthritis are the most feared complications. This paper aims to describe the behavior and perioperative evolution of two patients with Chopart luxo-fracture, treated in the Emergency Service at Dr Luis Díaz Soto Central Military Hospital. They were early diagnosed and underwent open reduction and internal fixation. They recovered in the first three months. The low prevalence of Chopart luxo-fracture requires adequate and correct diagnosis to achieve good clinical results(AU)

L'articulation de Chopart, ou médio-tarsienne, est constituée de deux articulations distinctes: l'articulation calcanéo-cuboïdienne et l'articulation astragalo-scaphoïdienne. Les lésions produites dans ces articulations sont connues comme des fractures-luxations de l'articulation de Chopart, et sont assez rares. Parmi les causes les plus fréquentes, on peut trouver les accidents du trafic (surtout, de moto) et les chutes de haut. Le traitement consiste généralement à une réduction anatomique et une fixation stable. La nécrose avasculaire de l'astragale et l'arthrite post-traumatique sont les complications les plus souvent à craindre. Le but de ce travail est de décrire le comportement et l'évolution péri-opératoire de deux patients atteints d'une fracture-luxation de l'articulation de Chopart, et traités au service d'urgence de l'hôpital militaire Dr Luis Díaz Soto. Ils sont rapidement diagnostiqués, et traités par réduction ouverte et fixation interne. Leur récupération est réussie en trois mois. La faible prévalence de la fracture-luxation de l'articulation de Chopart exige un diagnostic précis pour atteindre de bons résultats cliniques(AU)

Restorative Tissue Transplantation Options for Osteochondral Lesions of the Talus: A Review.

Symptomatic osteochondral lesions of the talus remain a challenging problem due to inability for cartilage lesions to heal. Numerous treatment options exist, including nonoperative management, marrow stimulating techniques, and autograft-allograft. Arthroscopic marrow stimulation forms fibrocartilage that has been shown to be biomechanically weaker than hyaline cartilage. Restorative tissue transplantation options are being used more for larger and cystic lesions. Newer biologics and particulated juvenile cartilage are currently under investigation for possible clinical efficacy. This article provides an evidenced-based summary of available literature on the use of biologics for treatment of osteochondral lesions of the talus.

Effects of Anteroposterior Talus Mobilization on Range of Motion, Pain, and Functional Capacity in Participants With Subacute and Chronic Ankle Injuries: A Controlled Trial.

Objective: The purpose of this study was to measure the acute (1 session) and chronic effects (6 sessions) and the follow-up (2 weeks) of anteroposterior articular mobilization of the talus, grade III of Maitland, on the dorsiflexion range of motion (ROM), pain, and functional capacity of individuals with subacute and chronic traumatic injuries of the ankle. Methods: Thirty-eight volunteers, men and women, with a mean age of 40.8 years, with subacute and chronic ankle injuries participated. The volunteers were blinded to the study purpose and were allocated into the experimental group (EG) or sham group (SG). Dorsiflexion ROM, pain, and functional capacity were measured using the universal goniometer, visual analog scale, and Foot and Ankle Ability Measure, respectively. Measurements were taken on 4 different occasions: (1) baseline, (2) after the first session, (3) after the sixth session, and (4) at follow-up. Articular anteroposterior mobilization of the talus grade III of Maitland was applied to the EG, whereas manual contact was applied to the SG. Three series of 30 seconds each with a 30-second rest interval between the series were conducted. Results: Significant increases in ankle dorsiflexion ROM were observed only for the EG after the first (EG: 9.5 ± 1.1; SG: 7.6 ± 1.1) and sixth (EG: 12.8 ± 1.2; SG: 8.4 ± 1.2) sessions and were maintained at follow-up (EG: 13.2 ± 1.1; SG: 9.3 ± 1.3). Decreases in pain and improvements in functional capacity (FC) were identified for both groups after the first and sixth sessions (Pain, EG: 1.3 ± 0.5; SG: 1.8 ± 0.6 and EG: 0.7 ± 0.3; SG: 0.7 ± 0.3; FC, EG: 64.6 ± 3.5; SG: 67.4 ± 4.4 and EG: 79.9 ± 3.3; SG: 86.2 ± 3.3) and remained at follow-up (Pain, EG: 0.3 ± 0.2; SG: 0.5 ± 0.3; FC, EG: 86.8 ± 2.7; SG: 89.8 ± 3.7). Conclusion: Articular grade III mobilization improved ankle dorsiflexion ROM, when compared with the SG. Changes in pain and functional capacity were similar in both groups.

The Effect of 2 Forms of Talocrural Joint Traction on Dorsiflexion Range of Motion and Postural Control in Those With Chronic Ankle Instability.

CONTEXT: Talocrural joint mobilizations are commonly used to address deficits associated with chronic ankle instability (CAI). OBJECTIVE: Examine the immediate effects of talocrural joint traction in those with CAI. DESIGN: Blinded, crossover. SETTING: Laboratory. PARTICIPANTS: Twenty adults (14 females; age = 23.80 ± 4.02 y; height = 169.55 ± 12.38 cm; weight = 78.34 ± 16.32 kg) with self-reported CAI participated. Inclusion criteria consisted of a history of ≥1 ankle sprain, ≥2 episodes of giving way in the previous 3 mo, answering "yes" to ≥4 questions on the Ankle Instability Instrument, and ≤24 on the Cumberland Ankle Instability Tool. INTERVENTION: Subjects participated in 3 sessions in which they received a single treatment session of sustained traction (ST), oscillatory traction (OT), or a sham condition in a randomized order. Interventions consisted of four 30-s sets of traction with 1 min of rest between sets. During ST and OT, the talus was distracted distally from the ankle mortise to the end-range of accessory motion. ST consisted of continuous distraction and OT involved 1-s oscillations between the mid and end-range of accessory motion. The sham condition consisted of physical contact without force application. Preintervention and postintervention measurements of weight-bearing dorsiflexion, dynamic balance, and static single-limb balance were collected. MAIN OUTCOME MEASURES: The independent variable was treatment (ST, OT, sham). The dependent variables included pre-to-posttreatment change scores for the WBLT (cm), normalized SEBTAR (%), and time-to-boundary (TTB) variables(s). Separate 1-way ANOVAs examined differences between treatments for each dependent variable. Alpha was set a priori at P < .05. RESULTS: No significant treatment effects were identified for any variables. CONCLUSION: A single intervention of ST or OT did not produce significant changes in weight-bearing dorsiflexion range of motion or postural control in individuals with CAI. Future research should investigate the effects of repeated talocrural traction treatments and the effects of this technique when combined with other manual therapies.

Effects of Pulsed Electromagnetic Fields on Return to Sports After Arthroscopic Debridement and Microfracture of Osteochondral Talar Defects: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial.

BACKGROUND: Osteochondral defects (OCDs) of the talus usually affect athletic patients. The primary surgical treatment consists of arthroscopic debridement and microfracture. Various possibilities have been suggested to improve the recovery process after debridement and microfracture. A potential solution to obtain this goal is the application of pulsed electromagnetic fields (PEMFs), which stimulate the repair process of bone and cartilage. HYPOTHESIS: The use of PEMFs after arthroscopic debridement and microfracture of an OCD of the talus leads to earlier resumption of sports and an increased number of patients that resume sports. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 68 patients were randomized to receive either PEMFs (n = 36) or placebo (n = 32) after arthroscopic treatment of an OCD of the talus. The primary outcomes (ie, the number of patients who resumed sports and time to resumption of sports) were analyzed with Kaplan-Meier curves as well as Mann-Whitney U, chi-square, and log-rank tests. Secondary functional outcomes were assessed with questionnaires (American Orthopaedic Foot and Ankle Society ankle-hindfoot score, Foot and Ankle Outcome Score, EuroQol, and numeric rating scales for pain and satisfaction) at multiple time points up to 1-year follow-up. To assess bone repair, computed tomography scans were obtained at 2 weeks and 1 year postoperatively. RESULTS: Almost all outcome measures improved significantly in both groups. The percentage of sport resumption (PEMF, 79%; placebo, 80%; P = .95) and median time to sport resumption (PEMF, 17 weeks; placebo, 16 weeks; P = .69) did not differ significantly between the treatment groups. Likewise, there were no significant between-group differences with regard to the secondary functional outcomes and the computed tomography results. CONCLUSION: PEMF does not lead to a higher percentage of patients who resume sports or to earlier resumption of sports after arthroscopic debridement and microfracture of talar OCDs. Furthermore, no differences were found in bone repair between groups. REGISTRATION: Netherlands Trial Register NTR1636.

An Alumina Ceramic Total Talar Prosthesis for Osteonecrosis of the Talus.

BACKGROUND: Treatment of osteonecrosis of the talus is challenging. Total talar replacement has the potential to restore the function of the ankle joint without an associated leg-length discrepancy. The purpose of the present study was to investigate postoperative function and pain after total talar replacement in patients with osteonecrosis of the talus. METHODS: Fifty-five ankles in fifty-one consecutive patients with osteonecrosis of the talus who were treated with a total talar replacement from 2005 to 2012 were included in the investigation. Scores according to the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale and the Ankle Osteoarthritis Scale (AOS) were assessed before surgery and at the final follow-up evaluation. RESULTS: According to the JSSF ankle-hindfoot scale, the score for pain improved from a mean (and standard deviation) of 15 ± 9.4 points (range, 0 to 20 points) to 34 ± 5.6 points (range, 20 to 40 points); the score for function, from 21.2 ± 9.7 points (range, 4 to 38 points) to 45.1 ± 4.0 points (range, 37 to 50 points); the score for alignment, from 6.0 ± 2.8 points (range, 5 to 10 points) to 9.8 ± 0.9 points (range, 5 to 10 points); and the total score, from 43.1 ± 17.0 points (range, 11 to 68 points) to 89.4 ± 8.4 points (range, 76 to 100 points). According to the AOS scale, the score for "pain at its worst" improved from a mean of 6.1 ± 3.3 points (range, 0 to 9.9 points) to 2.0 ± 1.7 points (range, 0 to 6.3 points). CONCLUSIONS: Prosthetic talar replacement is a useful procedure for patients with osteonecrosis of the talus as it maintains ankle function.

Treatment of bone marrow edema of the talus with pulsed electromagnetic fields: outcomes in six patients.

BACKGROUND: Bone marrow edema (BME) of the talus is a rare, mostly self-limiting cause of foot and ankle pain. We sought to investigate in patients with idiopathic BME of the talus the effectiveness of pulsed electromagnetic fields and to determine the effect of this therapy on magnetic resonance imaging findings. METHODS: Six patients with BME of the talus confirmed by magnetic resonance imaging were enrolled. Pain was quantified with a visual analog scale from 0 (no pain) to 10 (the worst pain imaginable). The clinical outcome was assessed using the American Orthopaedic Foot and Ankle Society scoring system. Treatment consisted of pulsed electromagnetic field stimulation 8 h/d for 30 days. The device used generated pulses 1.3 milliseconds in duration, with a frequency of 75 Hz and a mean ± SD induced electric field of 3.5 ± 0.5 mV. RESULTS: The mean American Orthopaedic Foot and Ankle Society score improved from 59.4 (range, 40-66) before treatment to 94 (range, 80-100) at the last follow-up. The visual analog scale score decreased significantly from 5.6 (range, 4-7) before treatment to 1 (range, 0-2) at the last follow-up. Magnetic resonance imaging showed that BME improved after 1 month of treatment and resolved completely within 3 months in 5 patients, with normal signal intensity and no signs of progression to avascular necrosis. CONCLUSIONS: A significant reduction in BME area was associated with a significant decrease in pain within 3 months of beginning treatment.

Local infiltration of liposome bupivacaine in foot and ankle surgery: case-based reviews.

Foot and ankle surgical procedures, ranging from simple procedures, such as bunionectomy and correction of hammer toe, to more complex surgery, such as ankle fusion and ankle replacement, are extremely painful. Moreover, there is increasing interest in performing these procedures in an outpatient setting. Nerve blocks are extensively used in foot and ankle surgery, and commonly used techniques include sciatic nerve block with saphenous nerve augmentation; ankle block; and local, digital, or field block. Whereas more extensive blocks are associated with increased medical risk, higher cost, and delayed ambulation, more local approaches may not provide an adequate duration of effect. EXPAREL® (bupivacaine liposome injectable suspension) is an extended-release local anesthetic that can be infiltrated directly into the surgical site by the orthopedic surgeon to provide continuous and effective analgesia at the site of surgical injury for up to 72 hours. Two cases that illustrate the use of EXPAREL® in foot and ankle surgery are described. The first case involves ankle replacement in an active 58-year-old man with a 20-plus-year history of arthritis. The second case involves a young woman undergoing surgery for a talar neck fracture-dislocation with an open injury, dislocated subtalar joint, avascular talus, and considerable deformity. Both patients reported excellent control of postsurgical pain.