Postoperative Opioid Consumption Following Hallux Valgus and Rigidus Surgery: A Guide to Postoperative Prescription Writing.

Prescribing postoperative pain medications is essential to foot and ankle surgery; however, prescribing an amount that results in an excess of pills has shown to lead to opioid abuse. The opioid epidemic has forced surgeons to analyze how we manage postoperative pain with a goal to prescribe the optimal number of pills that will reduce a patient's pain while limiting the amount that is left over. The purpose of this study was to develop a guideline for prescribing postoperative pain medication for hallux valgus and rigidus procedures. One hundred eighty-five opioid naive patients were followed after undergoing surgery for hallux valgus or hallux rigidus. The number of opioids consumed was obtained and compared to a number of variables. There were 28 different prescriptions given during the study. As the number of pills given decreased, so did the number of pills consumed (p = .08). Of the 185 patients, 14 (7.56%) received a refill. Ninety-five patients were available for opioid consumption data analysis. Those patients consumed a median of 36.7% and 39.1% of their prescription for hallux valgus and hallux rigidus procedures respectively. Smokers consumed 2.4 times the number of narcotics compared to nonsmokers (p = .002). The median number of 5-325 mg hydrocodone-acetaminophen pills consumed was 8.5 for distal metatarsal osteotomies and 10 for first metatarsophalangeal joint procedures. Body mass index, gender, number of procedures performed did not have a statistical difference in the number of opioids taken. Foot and ankle surgeons can reduce the amount of excess opioids by decreasing the initial prescription and educating the patient on proper pain management modalities.

Cheilectomy Alone in Patients With Elevatus Yields Poor 5-Year Survival Rate.

This study was performed to evaluate the efficacy of the cheilectomy procedure for different degrees of elevatus. The study was Institutional Review Board approved and patients were evaluated retrospectively at Ascension St. John Hospital, St. John Surgery Center and St. John Macomb Township Surgery Center between 9/8/2012 and 1/8/2016. These were all performed by the same surgeon. The pre- and postoperative radiographs were analyzed and Seiberg's index was calculated. Charts were also reviewed, and demographic information was obtained. A telephone survey was performed, and Visual Analog Pain score and Foot and Ankle Ability Measure was obtained. Body mass index, age, calcaneal inclination angle, Seiberg's index, Foot and Ankle Ability Measure, and visual analog score were analyzed using chi-square test, bivariate regression analysis and independent t test. Seiberg's index had a statistically significant influence on 5-year survival rate for the cheilectomy procedure (p ≤ .05). For patients with Seiberg's index less than 0.20 cm demonstrated FAAM, and VAS p values .18 and .37 with 87.0% 5-year survival. Seiberg's index between 0.20 and 0.40 cm had FAAM and VAS scores with p values <.01 and .02 with 62.0% 5-year survival. Seiberg's index ≤0.40 cm p values <.01 and .55 with 5-year survival rate of 0.0%. Therefore, if Seiberg's index is greater than 0.20 cm based on this research a cheilectomy alone as a sole treatment is at greater risk of failure.

Progression of Healing on Serial Radiographs Following First Ray Arthrodesis in the Foot Using a Biplanar Plating Technique Without Compression.

A review of 195 first ray arthrodeses fixated with a twin-plate biplanar construct, without interfragmentary compression, is presented. This fixation construct was evaluated in a consecutive cohort of patients undergoing first metatarsophalangeal joint (MTP) arthrodesis or the first tarsometatarsal joint (TMT) arthrodesis. Multiple radiographs were used to assess the progression of healing at the following postoperative time frames: 4 to 9 weeks, 10 to 12 weeks, >12 weeks, and the final follow-up. In total, 85 feet underwent first MTP arthrodesis, and 110 feet underwent first TMT arthrodesis. At the final radiographic follow-up, 97.44% of all cases had shown progressive osseous gap filling at the arthrodesis site, stable position of the bone segments, and intact hardware without loosening, 98.24% of the first MTP arthrodesis group and 96.82% of the first TMT arthrodesis group. Five (5.43%) feet had the presence of lucency at the fusion interface at the final follow-up, without positional change or hardware failure. Four (1.8%) feet had a failure of the hardware, loss of position, or frank gapping at the fusion site. Lucency decreased consistently over time in this series of patients (p < .00001). Progressive increase in callus density at the fusion site on serial radiographs was noted to be a consistent finding for both procedures and was the primary indicator of secondary bone healing at the noncompressed, relatively stable arthrodesis site. Our results confirm that biplanar plating construct without interfragmentary compression produces high fusion rates following the first MTP or TMT arthrodesis, with early weightbearing.

Experimental Comparison of the Clinical Measurement of Ankle Joint Dorsiflexion and Radiographic Tibiotalar Position.

Clinical measurement of ankle dorsiflexion is typically used to diagnose limited ankle range of motion. Controversy and a lack of clarity continue regarding the most accurate clinical method of measuring ankle joint dorsiflexion and the effect that the foot position (supinated, neutral, pronated) has on the true tibiotalar position. We investigated the effects of supinated, neutral and pronated foot positions on the clinical dorsiflexion measurements in 50 healthy subjects and compared these results to the radiographic measurement of tibiotalar joint position with the ankle maximally dorsiflexed in each of the 3 foot positions. Interrater reliability was confirmed to be adequate among the 3 clinicians of varied skill levels. Radiographic measurements of the tibiotalar position showed very little change in each of the 3 foot positions, with a total difference of 0.35° between supination and pronation. However, we found a mean difference of 14° of dorsiflexion in the clinical measurements between the pronated and supinated foot position, with a 9.08° difference between the neutral and supinated positions. Motion of the foot between the neutral and supinated positions introduced an additional source of potential error from the measurement technique when using the neutral position as the standard, which has been recommended in the past. We recommend a supinated foot position as a more reliable foot position for measuring the clinical ankle joint range of motion and propose it as a potential standard.