Conservative treatment of refractures after modified tension band wiring of fifth metatarsal base stress fractures in athletes.

OBJECTIVE: Recurrent fifth metatarsal base stress fractures (MT5-BSF) in athletes present a challenging problem. The aim of this study was to evaluate the result of conservative treatment for the refracture of MT5-BSF after modified tension band wiring (MTBW). MATERIALS AND METHODS: The outcomes of 15 elite athletes undergoing conservative treatment for refracture of MT5-BSF after MTBW were retrospectively reviewed. They were instructed to avoid weight-bearing with short leg cast for 6 weeks. After that, they started partial weight with a postop shoe. Stepwise exercise followed bone union by radiographs. RESULTS: Thirteen cases (86.6%) had a complete bone union after a mean of 18.9 ± 8.6 weeks. Twelve cases (80%) returned to their previous activity level and maintained for at least two consecutive seasons. CONCLUSION: Eighty percent of all athletic patients with the conservative treatment for refractures with healed MT5-BSF after MTBW on the plantar-lateral side could maintain and return to their previous sports activity for at least 2 years.

Operative Results of Plantar Plating for Fifth Metatarsal Stress Fracture.

BACKGROUND: The treatment of fifth metatarsal stress fractures can be challenging. Various operative fixation methods have been reported for fracture management. Among them, intramedullary screw fixation has become increasingly popular. However, recent reports have described failures after screw fixation in athletes. The aim of this study was to determine the rates of clinical and radiographic healing, time to return to sport, and complications of elite athletes with proximal fifth metatarsal fractures treated with plantar plating. METHODS: Thirty-eight athletes with fifth metatarsal stress fractures treated using a plantar plating technique in 3 hospitals from 2013 to 2018 were evaluated retrospectively. Demographic data, radiographic evaluation, and the time until union and return to sports activities were collected and analyzed. A total of 38 patients underwent the plantar plating for a fifth metatarsal stress fracture with a mean follow-up of 23 (range, 12-49) months. RESULTS: The mean time to the radiologic union, as determined by plain radiography, was 9.3 (range, 8-16) weeks. Although there were no nonunions or delayed unions during follow-up, 4 refractures developed (10.5%). All but 1 patient were able to return to their previous levels of sporting activity at 22.2 ± 4.5 (range, 12-40) weeks. CONCLUSION: With a minimum of 1-year follow-up, the described plantar plating technique could be an alternative method for the operative treatment of fifth metatarsal stress fractures without nonunion problems. LEVEL OF EVIDENCE: Level IV, case series.

Return to Play after Modified Broström Operation for Chronic Ankle Instability in Elite Athletes.

BACKGROUND: This study assessed the average time to return to training and official game participation after modified Broström operation (MBO) in elite athletes. METHODS: Sixty athletes diagnosed with lateral ankle instability underwent MBO from October 2011 to December 2013. Their average age was 19.3 years, and the average follow-up time was 28.8 months. We measured the time sequence of three phases of rehabilitation: start of personal training, start of team training, and start of the first official game after recovery. Patients were divided into an early return to play (RTP) group and late RTP group. The groups were compared to identify possible risk factors affecting the RTP time. RESULTS: The mean length of time to return to personal training was 1.9 months, return to team training was 2.9 months, and return to competitive play was 3.9 months. There were no significant differences of any variables including age, sex, body mass index, level of sports, grade of instability, presence of os subfibulare, and preoperative functional score between the early RTP and late RTP groups. CONCLUSIONS: The RTP was 83.3% at 4 months after lateral ankle ligament repair and 100% at 8 months postoperatively. The results provide reference data for orthopedic surgeons in evaluating surgical results and informing patients about expectations after surgery in terms of performance level and timing of return to sports.

Consequences of Avulsion Fracture of the Proximal Phalanx Caused by a Technical Failure of Hallux Valgus Surgery.

Several cases of avulsion fracture of the proximal phalanx of the big toe during the lateral capsular release procedure were observed. However, these fractures have not been reported as a complication of hallux valgus surgery. The purpose of the present study was to report the proximal phalanx base fracture as an unrecognized complication and to evaluate the clinical and radiographic consequences of this complication. We retrospectively reviewed 225 feet that had undergone hallux valgus surgery involving proximal chevron osteotomy and distal soft tissue release from May 2009 to December 2012. Of these 225 feet (198 patients), 12 (5.3%) developed proximal phalanx base fracture postoperatively. These patients were assigned to the fracture group. The remaining patients were assigned to the nonfracture group. Patients were followed to observe whether the fractures united and whether degenerative changes developed at the first metatarsophalangeal joint because of this fracture. The mean follow-up period was 36 (range 12 to 72) months. All the subjects in the fracture and nonfracture groups underwent weightbearing anteroposterior and lateral radiographs of the foot at the initial presentation and final follow-up point. The 2 groups were compared with respect to the hallux valgus angle, intermetatarsal angle, range of motion, American Orthopaedic Foot and Ankle Society score, satisfaction, and degenerative changes. No significant differences were found in age, follow-up period, hallux valgus angle, intermetatarsal angle, range of motion of the first metatarsophalangeal joint, American Orthopaedic Foot and Ankle Society score, satisfaction, and degenerative changes between the 2 groups. Ten (83.3%) of the 12 fractures healed, 2 (16.7% of the fractures, 0.89% of the operated feet) progressed to asymptomatic nonunion, and 3 (1.33%) developed first metatarsophalangeal joint degeneration. Avulsion fracture of the proximal phalanx of the big toe is an uncommon complication of hallux valgus surgery. It seems to be caused by excessive tension placed on the lateral soft tissues that attach to the base of the proximal phalanx at the time of plantarlateral soft tissue release. However, this fracture does not seem to cause significant clinical problems.

Accessory Navicular Syndrome in Athlete vs General Population.

BACKGROUND: Symptomatic accessory navicular syndrome (ANS) typically develops in young athletes. The symptoms are exacerbated during exercise or while walking, affecting the sports performance of athletes. The purpose of this study was to evaluate the radiologic findings and clinical course in athletes with accessory navicular syndrome (ANS) in comparison with a nonathletic population. METHODS: Seventy-nine patients with ANS between August 2012 and August 2013 were included. Overall, 29 were athletes and 50 were not athletes, and 19 (2 athletes and 17 nonathletes) of them improved after at least 6 months of conservative treatment. The records of 60 patients (64 consecutive feet) of ANS treated by modified Kidner operation were evaluated retrospectively. The study population included 27 athletes (31 feet) and 33 nonathletes (33 feet). Clinical features and radiologic findings were compared between them. RESULTS: Overall, 34% of the nonathletes improved after conservative treatment, but only 6.9% of athletes improved (P < .001). Mean age at surgery in the athlete group was 16.1 years (range, 12-26), and 24.3 years (range, 12-52) in the nonathlete group (P < .001). There was a history of trauma in 23 feet (74%) of the athlete group and in 13 feet (39%) of the nonathlete group (P = .006). Eighteen feet (58%) in the athlete group and 11 feet (32%) in the nonathlete group showed movement between the 2 bones (P = .047). Bone marrow edema was observed in both navicular and accessory navicular in all of the athletes (27/27, 100%). But it was only present in 80% (16/20) for nonathletes (P = .012). CONCLUSION: The radiologic findings and clinical course of athletes were different from that of the general population. Their symptoms were more refractory to conservative treatment than the nonathletes group. Therefore, early operative treatment could be considered in cases of symptomatic ANS especially for athletes. LEVEL OF EVIDENCE: Level III, retrospective comparative case series.

The relationship between stroke and quality of life in Korean adults: based on the 2010 Korean community health survey.

[Purpose] The purpose of this study was to investigate the status of stroke in the Republic of Korea and its relationship with QOL based on standardized data. [Subjects and Methods] This study utilized raw data from the 2010 KCHS. In total, 229,229 individuals participated in the 2010 survey. The final analysis identified 4,604 individuals who had been diagnosed by a doctor with stroke. To identify the correlation between the aftereffect-related characteristics of stroke patients and QOL, a multiple linear regression analysis was performed. [Results] Participants experiencing aftereffects had a statistically significantly lower QOL than participants who had not experienced aftereffects. Regarding the types of aftereffects, participants experiencing palsy in the arms and legs, facial palsy, communication disabilities, swallowing or eating disabilities, and visual disabilities had a statistically significantly lower QOL than participants without aftereffects. The QOL of participants with one, two, three, four, or five aftereffects was statistically significantly less than that of participants without aftereffects [Conclusion] Stroke directly influences QOL and the number of types of aftereffects experienced by patients. Therefore, it is highly important that physical therapists seek to end the occurrence of one or more types of aftereffects in stroke patients.

Osteoarthritis of the second metatarsophalangeal joint associated with hallux valgus deformity.

BACKGROUND: Hallux valgus is speculated to increase the load on the second metatarsophalangeal (MTP) joint, possibly inducing degenerative osteoarthritis. In addition, the severity of arthritis may be correlated with the severity of hallux valgus. This study evaluated the association of arthritis of the second MTP joint in hallux valgus patients and the relationship between arthritis of the second MTP joint and hallux valgus deformity. METHODS: A total of 382 patients (509 feet) underwent surgery for symptomatic hallux valgus deformities by the 2 senior authors (KTL, YUP) from November 2011 to December 2012. A total of 54 patients (61 feet), all female, were included in the osteoarthritis (OA) group. The rest were assigned to the nonosteoarthritis (NOA) group. There were 328 patients (448 feet) consisting of 16 men and 432 women. Osteoarthritis patients were then evaluated and classified according to joint space narrowing (JSN) and osteophyte (OP) formation. A statistical analysis was conducted to compare the 2 groups in terms of their hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), hypermobility of the first metatarsal ray, the length of the second metatarsal bone, and the length ratio of the first and second metatarsal bones. Correlation coefficients were calculated to compare the severity of hallux valgus and the degree of osteoarthritis of the second MTP joint. RESULTS: The IMA of the OA group was 16.2 ± 2.9 degrees, and that of the NOA group was 15.4 ± 3.3 degrees (P = .034, Mann-Whitney U test). The DMAA of the OA group was 18.2 ± 8.3 degrees, and that of the NOA group was 16.1 ± 8.0 degrees (P = .029, Mann-Whitney U test). There were no significant differences between the 2 groups in terms of the HVA, hypermobility, the length of the second metatarsal bone, and the length ratio of the second and first metatarsal bones. In the OA group, there was a positive correlation between the HVA and the degree of osteoarthritis (osteophyte formation) (É£ = 0.278, P = .030). In addition, there was a positive correlation between the IMA and the degree of osteoarthritis (É£ = 0.284 [JSN], 0.327 [OP] for the HVA, P = .026 [JSN], .010 [OP]). However, there was no significant difference between hypermobility and the degree of osteoarthritis (P = .356 [JSN], .635 [OP], Mann-Whitney U test). Furthermore, there were no positive correlations between the DMAA, the length of the second metatarsal bone, and the metatarsal length ratio. CONCLUSION: Our study demonstrated a positive correlation between HVA, IMA, and osteoarthritis of the second MTP joint. Other studies will be needed to determine the factors that are responsible for this correlation. LEVEL OF EVIDENCE: Level III, retrospective comparative series.

Deceptions in hallux valgus: what to look for to limit failures.

The treatment of hallux valgus depends on multiple factors, including clinical examination, patient considerations, clinical findings, radiographic assessment, and surgeon preference. Appropriate procedure selection and proper technique will usually result in good-to-excellent outcomes. Complications following hallux valgus correction include recurrence, transfer metatarsalgia, avascular necrosis, hallux varus, and nonunion and malunion of metatarsal osteotomies. In order to decrease the risks of complication, a precise and meticulous physical examination should be conducted preoperatively. In addition, a surgeon should select appropriate osteotomies to correct complex hallux valgus deformities. As a general principle, the severity of deformity dictates treatment options.

Femoral and sciatic nerve block for hindfoot and ankle surgery.

BACKGROUND: The use of regional anesthesia, such as ankle block or sciatic nerve block, has gained in popularity due to considerations of patient comfort and safety in foot and ankle surgery. However, if the operation extends above the midfoot or if a thigh tourniquet is required, general or spinal anesthesia is needed. The authors aimed to determine by prospective study whether a 'double block', involving femoral and sciatic nerve blocks, is advantageous under such conditions. MATERIALS AND METHODS: The effectiveness of a preoperative double block was prospectively evaluated in 26 consecutive patients undergoing a variety of foot and ankle procedures, compared with 32 patients with sciatic nerve block alone. Time of analgesia onset, length of block coverage, and complications were noted. Degree of pain was measured using VAS (Visual Analog Scale) scores at the operation, just after surgery, and at 2 h, 1 day, and 2 days after surgery. RESULTS: The surgical procedures performed under double block were ankle arthroscopy and medial ankle ligament reconstruction, and Achilles tendon repair, and the following conditions were treated; surgery for medial ankle fracture, ankle fusion, subtalar fusion, and surgery for hindfoot diseases, such as, talocalcaneal coalition. The average time required to analgesia onset was 63 min for a double block and 61 min for sciatic nerve block alone. Analgesia time lasted 12.0 h for a double block and 12.4 h for sciatic nerve block alone. Average VAS scores at the operation and immediately after the operation were 0.03 (range 0-1) and 0.16 (range 0-2) for sciatic nerve block, and 0.35 (range, 0-4), 0.31 (range 0-2) for double block. Average VAS scores at 2 h, 1 day, and 2 days postoperatively were 0.28 (range, 0-2), 2.16 (range 0-6), and 1.63 (range 0-5) for sciatic nerve block, and 0.42 (range 0-5), 2.27 (range 0-7), and 1.72 (range 0-8), respectively, for double block. CONCLUSION: The results of this prospective study suggest that double block provides good surgical anesthesia and good postoperative pain control for hindfoot and ankle surgery.

New method of diagnosis for chronic ankle instability: comparison of manual anterior drawer test, stress radiography and stress ultrasound.

PURPOSE: To diagnose chronic ankle instability, clinicians frequently use manual anterior drawer test and stress radiography. However, both exams can yield incorrect results and do not reveal the extent of ankle instability. The use of stress ultrasound during a manual anterior drawer stress procedure might enable the diagnosis of chronic ankle instability. METHODS: Seventy-three patients with chronic ankle pain or laxity after remote ankle sprain were included. The study population included 41 males and 32 females. The mean age of the patients at the time of the operation was 29 years. A standardized physical examination (manual anterior drawer test), stress radiography and stress ultrasonography were performed to assess the anterior talofibular ligament (ATFL). Ultrasound images were taken in the resting position and the maximal anterior drawer position. The statistical significance of stress ultrasound among the three groups according to manual anterior drawer test and a specific degree (5 mm) of anterior translation of stress radiography were analysed. Correlation coefficients between stress ultrasound, stress radiography and manual anterior drawer test were calculated. RESULTS: There was a significant difference for ATFL length (ATFL stress) and ATFL ratio (ATFL stress/ATFL resting) among the three groups (both p < 0.001). However, there was no significant difference for anterior translation of stress radiography among three groups according to manual anterior drawer test (p = 0.159). There was a significant difference for ATFL length (ATFL stress) and ATFL ratio between two groups with 5-mm anterior translation of stress radiography (p = 0.002 and p = 0.011, respectively). The mean value of grade of manual anterior drawer test between the two groups also differed (p = 0.021). There was a moderately positive linear relationship between stress ultrasound and manual anterior drawer test. Also, there was a positive linear relationship between stress ultrasound and stress radiography. CONCLUSION: The results suggest that the value of ATFL length (ATFL stress) and ATFL ratio of stress ultrasound could be used for diagnosis of chronic ankle instability in addition to manual anterior drawer test and stress radiography.

Factors associated with recurrent fifth metatarsal stress fracture.

BACKGROUND: Many surgeons agree that fifth metatarsal stress fractures have a tendency toward delayed union, nonunion, and possibly refracture. Difficulty healing seems to be correlated with fracture classification. However, refracture sometimes occurs after low-grade fracture, even long after apparent resolution. METHODS: The records of 168 consecutive cases of fifth metatarsal stress fracture (163 patients) treated by modified tension band wiring from March 2002 to June 2011 were evaluated retrospectively. Mean length of follow-up was 23.6 months (range, 10-112 months). Forty-nine cases classified as Torg III were bone grafted initially also. All enrolled patients were elite athletes. Eleven patients experienced nonunion and 18 refracture. The 11 nonunion cases were bone grafted. The 157 patients (excluding nonunion cases) were allocated to either a refracture group or a union group. Clinical features, such as age, weight, fracture classification, time to union, and reinjury history, were compared. Radiological parameters representing cavus deformity and fifth metatarsal head protrusion were compared to evaluate the influence of structural abnormalities. RESULTS: Mean group weights were significantly different (P = .041), but mean ages (P = .879), fracture grades (P = .216, P = .962), and time from surgery to rehabilitation (P = .539) were similar. No significant intergroup differences were found for talocalcaneal (TC) angle (P = .470), calcaneal pitch (CP) angle (P = .847), or talo-first metatarsal (T-MT1) angle (P = .407) on lateral radiographs; for fifth metatarsal lateral deviation (MT5-LD) angle (P = .623) on anteroposterior (AP) radiographs; or for MT5-LD angle (P = .065) on the 30-degree medial oblique radiographs. However, the mean fourth-fifth intermetatarsal (IMA4-5) angle on AP radiographs was significantly greater in the refracture group, and for Torg II cases, mean weight (P = .042), IMA4-5 angle on AP radiographs (P = .014), and MT5-LD angle (P = .043) on 30-degree medial oblique radiographs were significantly greater in the refracture group. For B2 cases (incomplete fracture and a plantar gap of 1 mm or larger), mean weight (P = .046), IMA4-5 angle on AP radiographs (P = .019), and MT5-LD angle (P = .045) on 30-degree medial oblique radiographs were significantly greater in the refracture group. All cases of refracture had a traumatic history after bone union. Refracture developed within 6 months of starting rehabilitation in 13 cases and within 3 months in 8 cases. CONCLUSION: The development of refracture after the surgical treatment of fifth metatarsal stress fractures was found to be associated with higher body mass index (BMI) and with radiological parameters (IMA4-5 on AP radiographs, MT5-LD on oblique radiographs) associated with protrusion of the fifth metatarsal head. The study indicates that patients with a protruding fifth metatarsal head and a high BMI should approach rehabilitation with care before considering a return to previous sporting activity levels. LEVEL OF EVIDENCE: Level III, retrospective comparative series.

Comparison of sagittal subluxation in two different three-component total ankle replacement systems.

BACKGROUND: Malalignment following total ankle arthroplasty (TAA) has been reported in 4% to 45% of patients. However, all reports to date have been related to coronal deformity. This study compared sagittal malalignment between the Mobility and Hintegra total ankle systems and assessed the positional stability of the implant components over time. METHODS: The study included 50 cases each of total ankle replacement arthroplasty with the Hintegra and Mobility total ankle systems performed between May 2008 and June 2010. The Mobility group included 24 men and 25 women, and the mean age was 60.3 years (range, 50.7-70.0 years). The Hintegra group included 25 men and 25 women, and the mean age was 59.8 years (range, 50.8-68.7 years). The 2 groups did not differ in terms of gender (P = .76) or age (P = .77). Three independent observers with different levels of training evaluated the radiographs and performed the measurements independently. Each observer evaluated the radiographs twice at a 6-week interval to determine the intraobserver reliability, and the anteroposterior offset ratio was evaluated. RESULTS: The anteroposterior offset ratio intra- and interobserver reliabilities all showed good or excellent levels of agreement in the Hintegra total ankle system and the Mobility total ankle system. With respect to the stability of sagittal translation of the talus, the Mobility system (0.08 ± 0.07 immediately, 0.0 ± 0.07 at 6 weeks postoperatively, and 0.01 ± 0.07 at 1 year postoperatively) was better than the Hintegra system (0.20 ± 0.08 immediately, 0.18 ± 0.11 at 6 weeks postoperatively, and 0.15 ± 0.10 at 1 year postoperatively) (P < .0001). CONCLUSIONS: The Mobility system had less sagittal malalignment of the talus than the Hintegra system. Consequently, when treating ankles in patients with osteoarthritis using the Hintegra system, one must pay careful attention to sagittal malalignment during surgery. LEVEL OF EVIDENCE: Level III, retrospective comparative series.

Prognostic classification of fifth metatarsal stress fracture using plantar gap.

BACKGROUND: There have been diverse results even in same Torg type of fifth metatarsal stress fractures. METHODS: Eighty-six cases with a fifth metatarsal stress fracture that were treated with modified tension band wiring from January 2003 to May 2009 were evaluated retrospectively. Each case was classified according to Torg's classification and a new classification. Using the new proposed classification, cases were subdivided into complete fracture and incomplete fracture. The cases of incomplete fracture were subdivided based on presence or absence of plantar gap more than 1 mm. After surgery, bone union was determined by CT. Statistical analysis of the Torg classification and time for bone union as well as the proposed new classification and time for bone union was performed. RESULTS: There was a significant difference in the time for bone union among the three Torg types (P = 0.004). The mean time for bone union in group A (complete fracture, n = 32) was 67.5 ± 28.8, and it was 103.2 ± 47.7 for group B (incomplete fracture, n = 54). There was a significant difference in time for bone union between them (P < 0.001). The mean time for bone union in group B1 (incomplete fracture, plantar gap less than 1 mm, n = 16) was 73.9 ± 26.7, and it was 115.5 ± 45.4 for group B2 (incomplete fracture, plantar gap 1 mm or more, n = 38). There was a significant difference in time for bone union between them (P < 0.001). CONCLUSION: The results of this study suggest that the classification incorporating the plantar gap might be used for classification of fifth metatarsal stress fractures. LEVEL OF EVIDENCE: Level III, retrospective comparative series.

Unilateral hallux valgus: is it true unilaterality, or does it progress to bilateral deformity?

BACKGROUND: This study was undertaken to determine whether unilateral hallux valgus progresses unilaterally and to evaluate the demographics, etiologies, and radiographic findings associated with symptomatic unilateral hallux valgus deformities. METHODS: Patients treated for hallux valgus between January 2004 and December 2008 were identified, and of these, 33 patients with unilateral deformities were enrolled. Progression of deformities in normal feet were evaluated at last follow-up visit, and the clinical information and radiographic measurements of those with a deformed normal foot or an unchanged normal foot were compared. RESULTS: Thirty-three patients (3.4%) had a unilateral hallux valgus deformity on preoperative radiographs. The mean length of follow up was 4.7 years (range, 2.4-11). Twenty-four cases had no deformity of the normal foot at last follow-up (the unchanged group), but 15 cases had developed hallux valgus deformity (the deformed group). No significant intergroup differences were found in terms of metatarsus adductus angle (P = .412), Meary angle (P = .771), talocalcaneal angle (P = 1.000), or calcaneal pitch angle (P = .267). However, members of the deformed group were significantly younger at disease onset (P = .045), exhibited a curved first metatarsal head (P = .046), and had a larger initial hallux valgus angle (P < .001). CONCLUSIONS: The frequency of bilateral symptomatic hallux valgus was found to be over 97.3%, and significant differences were found between the deformed and unchanged groups in terms of age of onset, metatarsal head shape, and hallux valgus angle.

The mobility total ankle replacement: techniques and pitfalls.

The Mobility total ankle replacement (DePuy, Leeds, United Kingdom) is an uncemented, 3-component, mobile-bearing design. This article highlights the design rationale and explains the surgical technique with the Mobility implant, as well as offering technical tips and pitfalls gained through personal experiences and literature review. The tibial component has a flat articular surface and a conical intramedullary stem on the tibial side.

Long-term results of neurectomy in the treatment of Morton's neuroma: more than 10 years' follow-up.

PURPOSE: The objective of this retrospective study was to evaluate the long-term follow-up results of neurectomy clinical outcomes and complications in the treatment of Morton's neuroma. MATERIALS AND METHODS: A total of 19 patients (19 different feet) were treated for Morton's neuroma by excision of the interdigital nerve at our institute between May 1997 and May 1999. Thirteen (13 feet) of them were followed up. The 13 patients were female and had an average age of 43 years (range 34-54 years) at the time of the operation. The patients were followed-up for a mean of 10.5 years (range 10.0-12.2 years) and scored using the American Orthopaedic Foot & Ankle Society (AOFAS) forefoot scoring system and Visual Analogue Scale (VAS) score. Subjective satisfaction was evaluated at the final follow-up. RESULTS: Eight patients scored more than 90 on the AOFAS forefoot scoring system. The VAS score was improved in all patients. The mean preoperative VAS score was 8.6 ± 0.8 cm (7-10) and the mean follow-up VAS score was 2.4 ± 1.8cm (0-6), which indicated no significant difference (P > .05). The final follow-up satisfaction results indicated that 4 patients were completely satisfied with the operation, 4 were satisfied with minor reservations, 5 were satisfied with major reservations, and no patient was unsatisfied. Neurectomy to treat Morton's neuroma had a good satisfaction rate (61%). Eleven of the patients complained of numbness on the plantar aspect of the foot adjacent to the interspace, and 2 of these 11 patients complained of disability induced by severe numbness. There was a complaint of residual pain by 1 patient. There were no skin problems on the operation lesions. CONCLUSION: The long-term results of neurectomy clinical outcomes in Morton's neuroma are slightly worse than the short- and mid-term results. LEVELS OF EVIDENCE: Therapeutic, Level IV, Retrospective case series.

Popliteal artery pseudoaneurysm after arthroscopic cystectomy of a popliteal cyst.

A case of popliteal artery aneurysm after arthroscopic cystectomy of a popliteal cyst is an uncommon complication, and no case has been reported. We present a case of pseudoaneurysm of the popliteal artery after arthroscopic cystectomy of a popliteal cyst 2 months after surgery. Open excision of the pseudoaneurysm and popliteal artery pin-point repair were done. At 30 months' follow-up, both the tibialis posterior and dorsalis pedis pulsations were felt equally on both sides with normal sensations over the limb. Retrospectively reviewing the case, we found that the relation of the popliteal artery and popliteal cyst on preoperative magnetic resonance images can predict the complication of pseudoaneurysm of the popliteal artery. It is better not to shave the lateral aspect of the cyst while performing arthroscopic cystectomy when magnetic resonance images show that the popliteal artery is close to the cyst.