Minimally invasive Chevron-Akin (MICA) osteotomies without Akin fixation in hallux valgus correction: a case series with 2-year follow-up.

PURPOSE: The minimally invasive Chevron-Akin (MICA) is considered the third generation of minimally invasive hallux valgus (HV) surgery, and its original description included fixation of the Akin osteotomy with a screw. The aim of this study is to evaluate a series of patients undergoing HV correction using the MICA technique without screw fixation of the Akin osteotomy. METHODS: We retrospectively evaluated 58 consecutive patients who underwent surgical correction for HV between August 2018 and March 2020. A total of 69 feet were evaluated with a minimum follow-up of 2 years. Clinical outcomes such as pain (VAS), function (AOFAS), range of movement, criteria personal satisfaction and complications were evaluated. RESULTS: The AOFAS score (mean ± standard deviation) significantly improved from 57.0 ± 8.6 preoperatively to 93.9 ± 8.7 postoperatively (p < .001) with a minimum follow-up of 2 years. The VAS score improved from 6.0 ± 1.8 preoperatively to 0.6 ± 1.4 at 2-year follow-up (p < .001), and the hallux valgus angle reduced from 39.7 ± 6.9 to 8.9 ± 9.0 (p < .001). The majority of patients (95.6%) reported the result as excellent or good, and the most common complication was the need to remove the screw (7.2%). CONCLUSIONS: The use of MICA without Akin osteotomy fixation resulted in successful correction of hallux valgus with improvements in clinical and radiographic parameters. LEVEL OF EVIDENCE: IV, case series.

IMPLEMENTATION OF OTTAWA ANKLE RULES IN UNIVERSITY HOSPITAL EMERGENCY ROOM: PILOT STUDY.

Ankle injuries are the most common musculoskeletal injuries in emergency rooms and are associated with a great social and economic impact. The need to request additional tests for ankle sprains is based on suspicion of fracture. The Ottawa Ankle Rules (OAR) establish criteria for ordering radiographs to avoid performing unnecessary examinations. OBJECTIVE: To evaluate the implementation of the Ottawa Rules as a protocol for treating ankle sprains in the emergency department of a university hospital. METHODS: This is a retrospective observational study, conducted over a period of three months before and three months after implementation of the protocol. RESULTS: In the first phase, all patients complaining of ankle sprain underwent radiographs. In the second phase, after the application of the OAR, out of 85 patients evaluated, only 58 underwent complementary exams, showing a reduction of 31.8% in the request for imaging exams. There was no significant difference in fracture detection between the two groups (p=0.476). CONCLUSION: The OAR can be used as a tool in diagnosing ankle sprains, and their implementation reduced the request for imaging exams. Level of Evidence III, Retrospective Comparative Study.

Os traumatismos de tornozelo são as lesões musculoesqueléticas mais comuns nas salas de emergência e estão associadas a um grande impacto social e econômico. A solicitação de exames complementares para a entorse de tornozelo baseia-se na suspeita de fratura. As Regras de Ottawa para Tornozelo (ROT) estabelecem critérios para a solicitação de radiografias com o intuito de evitar a realização de exames desnecessários. Objetivo: Avaliar a implementação das ROT como protocolo de atendimento das entorses de tornozelo no pronto-socorro de um hospital universitário. Métodos: Estudo observacional retrospectivo que visou comparar a solicitação de radiografias e a presença de fraturas três meses antes e três meses após a implantação do protocolo. Resultados: Na primeira fase, todos os pacientes com queixa de entorse de tornozelo realizaram radiografias. Na segunda fase, após aplicação das ROT, de 85 pacientes avaliados, apenas 58 realizaram exames complementares, apresentando uma redução de 31,8% na solicitação dos exames de imagem. Não houve diferença na detecção de fraturas entre os dois grupos (p=0,476). Conclusão: As ROT podem ser utilizadas como ferramenta no atendimento das entorses de tornozelo e sua implantação reduziu a solicitação de exames de imagem. Nível de Evidência III, Estudo Comparativo Retrospectivo.

CAN THE PERCUTANEOUS CHEVRON AND AKIN (PECA) TECHNIQUE CORRECT THE PRONATION OF THE FIRST METATARSAL IN HALLUX VALGUS?

Objective: Pronation of the first metatarsal in hallux valgus has recently been discussed among foot and ankle surgeons. This study aimed to evaluate the potential radiographic correction of moderate and severe hallux valgus using the percutaneous Chevron and Akin (PECA) technique. Methods: We evaluated 45 feet in 38 patients (mean age 65.3 years old [36 - 83]; 4 men; 34 women; 7 bilateral) who underwent surgical correction using the PECA technique. The radiographic images evaluated were anteroposterior radiographs obtained pre- and postoperatively at least 6 months after surgery, including the metatarsophalangeal angle, the intermetatarsal angle, pronation of the first metatarsal, displacement of the distal fragment, medial sesamoid position and bone union. Results: All parameters evaluated showed significant postoperative improvement, including correction of pronation of the first metatarsal (p < .05) and position of the sesamoid (p < .05). There was a union of osteotomies in all feet. No complications were observed, such as screw loosening or necrosis of the first metatarsal head. Conclusion: The PECA technique can correct pronation of the first metatarsal in moderate and severe hallux valgus, and other deformity-associated parameters. Level of Evidence IV; Case Series.

Objetivo: A pronação do primeiro metatarso no hálux valgo tem sido um tema de discussão recente entre os cirurgiões de pé e tornozelo. O objetivo deste estudo foi avaliar o potencial de correção radiográfica do hálux valgo moderado e grave utilizando a técnica percutânea de Chevron e Akin (PECA). Métodos: Avaliamos 45 pés em 38 pacientes (média de idade 65,3 anos [36 - 83]; 4 homens; 34 mulheres; 7 bilaterais) submetidos à correção cirúrgica pela técnica PECA. As imagens radiográficas avaliadas foram radiografias anteroposteriores obtidas no pré e pós-operatório com no mínimo 6 meses após a cirurgia, incluindo ângulo metatarsofalângico, ângulo intermetatarsal, pronação do primeiro metatarso, deslocamento do fragmento distal, posição do sesamoide medial e união óssea. Resultados: Todos os parâmetros avaliados apresentaram melhora significativa no pós-operatório, incluindo correção da pronação do primeiro metatarso (p < 0,05) e posição do sesamoide (p < 0,05). Houve união de osteotomias em todos os pés. Não foram observadas complicações, como soltura do parafuso ou necrose da cabeça do primeiro metatarso. Conclusão: A técnica PECA pode corrigir a pronação do primeiro metatarso no hálux valgo moderado e grave, bem como outros parâmetros associados à deformidade. Nível de Evidência IV; Série De Casos.

Treatment of hallux rigidus with percutaneous metatarsophalangeal arthrodesis: a case series with a minimum follow-up of 2 years.

BACKGROUND: Percutaneous metatarsophalangeal arthrodesis is an option for the treatment of hallux rigidus in more advanced cases. The aim of this study was to investigate the clinical and radiographic results at least 2 years after percutaneous metatarsophalangeal arthrodesis in patients with hallux rigidus. METHODS: This is a case series of consecutive patients undergoing percutaneous metatarsophalangeal arthrodesis in patients with hallux rigidus grades III and IV with a minimum of 24 months of clinical and radiographic follow-up. The primary outcome was clinical assessment using the Visual Analog Scale for Pain (VAS). Secondary outcomes included American Orthopedic Foot & Ankle Society (AOFAS) score, patient satisfaction, complications, and bone healing (radiographic analysis). RESULTS: Between August 2017 and February 2020, 29 feet (24 patients) underwent percutaneous metatarsophalangeal arthrodesis. The mean follow-up was 38.4 (range 24-54) months. There was an improvement in the pain (VAS) from 7.8 to 0.6 (p < 0.001) and in the AOFAS score from 49.9 to 83.6 (p < 0.001). There was a rate of bone union of 82.8% and screw removal of 13.8%. All patients considered the result to be excellent or good. CONCLUSION: The treatment of grade III and IV hallux rigidus with percutaneous metatarsophalangeal arthrodesis demonstrated high patient satisfaction and significantly improves in clinical outcomes but the nonunion rate was higher than reported outcomes for open 1st metatarsophalangeal joint arthrodesis. LEVEL OF EVIDENCE: IV, case series.

Plantar Vein Thrombosis in a Patient with COVID-19: Case Report.

Plantar thrombophlebitis is a rare abnormality with few cases reported in the literature. Coexistence with severe acute respiratory syndrome coronavirus 2 infection increases its relevance. The disease is generally classified as idiopathic, and it is suggested that it is attributed to conditions that lead to hypercoagulability. We present the case of a 68-year-old female patient with thrombosis of the lateral plantar veins and a diagnosis of coronavirus disease of 2019. The plantar vein thrombosis diagnosis was made by means of Doppler ultrasonography and magnetic resonance imaging. Severe acute respiratory syndrome coronavirus 2 infection was suspected per clinical information and confirmed with reverse-transcriptase polymerase chain reaction technique. Treatment was successful using rivaroxaban and nonsteroidal antiinflammatory drugs.

Can the percutaneous chevron and akin (peca) technique correct the pronation of the first metatarsal in hallux valgus? / A técnica percutânea de chevron e akin (peca) pode corrigir a pronação do primeiro metatarso em halux valgo?

ABSTRACT Objective Pronation of the first metatarsal in hallux valgus has recently been discussed among foot and ankle surgeons. This study aimed to evaluate the potential radiographic correction of moderate and severe hallux valgus using the percutaneous Chevron and Akin (PECA) technique. Methods We evaluated 45 feet in 38 patients (mean age 65.3 years old [36 - 83]; 4 men; 34 women; 7 bilateral) who underwent surgical correction using the PECA technique. The radiographic images evaluated were anteroposterior radiographs obtained pre- and postoperatively at least 6 months after surgery, including the metatarsophalangeal angle, the intermetatarsal angle, pronation of the first metatarsal, displacement of the distal fragment, medial sesamoid position and bone union. Results All parameters evaluated showed significant postoperative improvement, including correction of pronation of the first metatarsal (p < .05) and position of the sesamoid (p < .05). There was a union of osteotomies in all feet. No complications were observed, such as screw loosening or necrosis of the first metatarsal head. Conclusion The PECA technique can correct pronation of the first metatarsal in moderate and severe hallux valgus, and other deformity-associated parameters. Level of Evidence IV; Case Series.

RESUMO Objetivo A pronação do primeiro metatarso no hálux valgo tem sido um tema de discussão recente entre os cirurgiões de pé e tornozelo. O objetivo deste estudo foi avaliar o potencial de correção radiográfica do hálux valgo moderado e grave utilizando a técnica percutânea de Chevron e Akin (PECA). Métodos Avaliamos 45 pés em 38 pacientes (média de idade 65,3 anos [36 - 83]; 4 homens; 34 mulheres; 7 bilaterais) submetidos à correção cirúrgica pela técnica PECA. As imagens radiográficas avaliadas foram radiografias anteroposteriores obtidas no pré e pós-operatório com no mínimo 6 meses após a cirurgia, incluindo ângulo metatarsofalângico, ângulo intermetatarsal, pronação do primeiro metatarso, deslocamento do fragmento distal, posição do sesamoide medial e união óssea. Resultados Todos os parâmetros avaliados apresentaram melhora significativa no pós-operatório, incluindo correção da pronação do primeiro metatarso (p < 0,05) e posição do sesamoide (p < 0,05). Houve união de osteotomias em todos os pés. Não foram observadas complicações, como soltura do parafuso ou necrose da cabeça do primeiro metatarso. Conclusão A técnica PECA pode corrigir a pronação do primeiro metatarso no hálux valgo moderado e grave, bem como outros parâmetros associados à deformidade. Nível de Evidência IV; Série De Casos.

Implementation of ottawa ankle rules in university hospital emergency room: pilot study / Implementação das regras de ottawa para tornozelo em pronto-socorro de hospital universitário: estudo piloto

ABSTRACT Ankle injuries are the most common musculoskeletal injuries in emergency rooms and are associated with a great social and economic impact. The need to request additional tests for ankle sprains is based on suspicion of fracture. The Ottawa Ankle Rules (OAR) establish criteria for ordering radiographs to avoid performing unnecessary examinations. Objective: To evaluate the implementation of the Ottawa Rules as a protocol for treating ankle sprains in the emergency department of a university hospital. Methods: This is a retrospective observational study, conducted over a period of three months before and three months after implementation of the protocol. Results: In the first phase, all patients complaining of ankle sprain underwent radiographs. In the second phase, after the application of the OAR, out of 85 patients evaluated, only 58 underwent complementary exams, showing a reduction of 31.8% in the request for imaging exams. There was no significant difference in fracture detection between the two groups (p=0.476). Conclusion: The OAR can be used as a tool in diagnosing ankle sprains, and their implementation reduced the request for imaging exams. Level of Evidence III, Retrospective Comparative Study.

RESUMO Os traumatismos de tornozelo são as lesões musculoesqueléticas mais comuns nas salas de emergência e estão associadas a um grande impacto social e econômico. A solicitação de exames complementares para a entorse de tornozelo baseia-se na suspeita de fratura. As Regras de Ottawa para Tornozelo (ROT) estabelecem critérios para a solicitação de radiografias com o intuito de evitar a realização de exames desnecessários. Objetivo: Avaliar a implementação das ROT como protocolo de atendimento das entorses de tornozelo no pronto-socorro de um hospital universitário. Métodos: Estudo observacional retrospectivo que visou comparar a solicitação de radiografias e a presença de fraturas três meses antes e três meses após a implantação do protocolo. Resultados: Na primeira fase, todos os pacientes com queixa de entorse de tornozelo realizaram radiografias. Na segunda fase, após aplicação das ROT, de 85 pacientes avaliados, apenas 58 realizaram exames complementares, apresentando uma redução de 31,8% na solicitação dos exames de imagem. Não houve diferença na detecção de fraturas entre os dois grupos (p=0,476). Conclusão: As ROT podem ser utilizadas como ferramenta no atendimento das entorses de tornozelo e sua implantação reduziu a solicitação de exames de imagem. Nível de Evidência III, Estudo Comparativo Retrospectivo.

ARTHROSCOPIC FOOT AND ANKLE SURGERY: BRAZILIAN SURGEON PROFILE.

Objective: To study the profile of the practice of arthroscopy among ankle and foot surgeons in Brazil and its evolution in recent years. Methods: Observational, cross-sectional study, using a survey sent to all members of the Associação Brasileira de Medicina e Cirurgia do Tornozelo e Pé (ABTPé) in 2017 and 2019. Results: In total, 75 surgeons participated in 2017 and 82 in 2019 and most had over 10 years of experience. Of these, 56 participants in 2017 (75%) and 68 in 2019 (82%) used arthroscopy. The number of specialists with no to five years of experience (p = 0.027) and who learned the technique during fellowship (p = 0.007) increased. The use of the 4.0 mm optics and 30° optics (p = 0.040) increased whereas the routine use of traction (p = 0.049) and radiofrequency (p = 0.002) decreased. The main pathology treated with anterior ankle arthroscopy was bone injury. The most frequent complication was neuropraxia. Conclusion: Most of the foot and ankle surgeons who use arthroscopy have more than 10 years of experience, performed anterior access, and are concentrated in the Southeast region of the country. The number of younger surgeons who learned the technique during fellowship increased. Level of Evidence III, Cross-Sectional Comparative Study.

Objetivo: Mostrar o perfil da prática da artroscopia entre cirurgiões de tornozelo e pé no Brasil e sua evolução nos últimos anos. Métodos: Estudo observacional, transversal, realizado por meio de questionário eletrônico enviado para todos os membros da Associação Brasileira de Medicina e Cirurgia do Tornozelo e Pé (ABTPé) em 2017 e 2019. Resultados: Obtivemos 75 respondentes em 2017 e 82 em 2019; a maioria tinha mais de 10 anos de experiência. Dos respondentes, 56 realizavam artroscopia em 2017 (75%) e 68 em 2019 (82%). Foi observado aumento no número de especialistas com até 5 anos de experiência (p = 0,027) e que aprenderam a técnica durante o estágio de especialização (p = 0,007). Houve aumento no uso da ótica de 4,0 mm e 30° de angulação (p = 0,040), e diminuição do uso rotineiro de tração (p = 0,049) e de radiofrequência (p = 0,002). A principal patologia tratada com artroscopia anterior do tornozelo foi o impacto ósseo, e a complicação mais frequente foi a neuropraxia. Conclusão: A maioria dos cirurgiões de pé e tornozelo que utiliza artroscopia tem mais de 10 anos de experiência, usa o acesso anterior e concentra-se na região Sudeste do país. Foi observado aumento no número de cirurgiões mais novos e que aprenderam a técnica durante o estágio de especialização. Nível de Evidência III, Estudo Transversal Comparativo.

Treatment of Morton's neuroma with minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) and percutaneous release of the deep transverse metatarsal ligament (DTML): a case series with minimum two-year follow-up.

BACKGROUND: The optimal treatment of symptomatic Morton's neuroma remains unclear; conservative methods are sometimes ineffective and neurectomy has significant rates of patient dissatisfaction. The aim of this study was to evaluate the outcome of minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) and percutaneous release of the deep transverse metatarsal ligament (DTML) in patients with Morton's neuroma. METHODS: Between January 2018 and November 2019, 27 patients (29 feet) diagnosed with Morton's neuroma after clinical and radiological evaluation underwent DMMO and percutaneous DTML release. The primary clinical outcomes were pain (VAS) and function (AOFAS score). Secondary outcomes included patient satisfaction, complications, and radiographic outcomes. Patients were followed up for a minimum of two years. RESULTS: The median age of the participants was 66 years (range 48-79) and the follow-up time was 28 months (24-47). There was a decrease of 5.7 points in the VAS for pain (p < .001) and an increase of 19.9 in AOFAS (p < .001) after the surgical procedure. There was one case of superficial infection and one patient required resection of the neuroma (neurectomy). The majority of patients (89.7%) were satisfied and considered the procedure outcome as excellent or good. CONCLUSION: Treatment of Morton's neuroma with minimally invasive distal metatarsal metaphyseal osteotomy and percutaneous release of the deep transverse metatarsal ligament showed significant improvement in pain and function with a low incidence of complications and a high rate of personal satisfaction.

Technique Tip: Medial prominence bone spur resection in the third-generation percutaneous Chevron-Akin Osteotomy Technique (PECA) for hallux valgus correction.

The third-generation percutaneous chevron and Akin osteotomy (PECA) technique for surgical management of hallux valgus has shown improvement in clinical and radiographic outcomes. During this procedure, lateral translation and fixation of the first metatarsal head results in the formation of a bony prominence on the medial side of the distal aspect of the first metatarsal which can cause pain and discomfort to the patient. We describe two techniques to address this bony prominence; either i) excision osteotomy and removal of the fragment or ii) a dorsal closing wedge osteotomy retaining the bony fragment. LEVEL OF EVIDENCE: Level V, expert opinion.

Arthroscopic foot and ankle surgery: brazilian surgeon profile / Cirurgia artroscópica do pé e tornozelo: perfil do cirurgião brasileiro

ABSTRACT Objective: To study the profile of the practice of arthroscopy among ankle and foot surgeons in Brazil and its evolution in recent years. Methods: Observational, cross-sectional study, using a survey sent to all members of the Associação Brasileira de Medicina e Cirurgia do Tornozelo e Pé (ABTPé) in 2017 and 2019. Results: In total, 75 surgeons participated in 2017 and 82 in 2019 and most had over 10 years of experience. Of these, 56 participants in 2017 (75%) and 68 in 2019 (82%) used arthroscopy. The number of specialists with no to five years of experience (p = 0.027) and who learned the technique during fellowship (p = 0.007) increased. The use of the 4.0 mm optics and 30° optics (p = 0.040) increased whereas the routine use of traction (p = 0.049) and radiofrequency (p = 0.002) decreased. The main pathology treated with anterior ankle arthroscopy was bone injury. The most frequent complication was neuropraxia. Conclusion: Most of the foot and ankle surgeons who use arthroscopy have more than 10 years of experience, performed anterior access, and are concentrated in the Southeast region of the country. The number of younger surgeons who learned the technique during fellowship increased. Level of Evidence III, Cross-Sectional Comparative Study.

RESUMO Objetivo: Mostrar o perfil da prática da artroscopia entre cirurgiões de tornozelo e pé no Brasil e sua evolução nos últimos anos. Métodos: Estudo observacional, transversal, realizado por meio de questionário eletrônico enviado para todos os membros da Associação Brasileira de Medicina e Cirurgia do Tornozelo e Pé (ABTPé) em 2017 e 2019. Resultados: Obtivemos 75 respondentes em 2017 e 82 em 2019; a maioria tinha mais de 10 anos de experiência. Dos respondentes, 56 realizavam artroscopia em 2017 (75%) e 68 em 2019 (82%). Foi observado aumento no número de especialistas com até 5 anos de experiência (p = 0,027) e que aprenderam a técnica durante o estágio de especialização (p = 0,007). Houve aumento no uso da ótica de 4,0 mm e 30° de angulação (p = 0,040), e diminuição do uso rotineiro de tração (p = 0,049) e de radiofrequência (p = 0,002). A principal patologia tratada com artroscopia anterior do tornozelo foi o impacto ósseo, e a complicação mais frequente foi a neuropraxia. Conclusão: A maioria dos cirurgiões de pé e tornozelo que utiliza artroscopia tem mais de 10 anos de experiência, usa o acesso anterior e concentra-se na região Sudeste do país. Foi observado aumento no número de cirurgiões mais novos e que aprenderam a técnica durante o estágio de especialização. Nível de Evidência III, Estudo Transversal Comparativo.

RELIABILITY OF WIRELESS INSOLE BAROPODOMETRY OF NORMAL INDIVIDUAL'S GAIT.

OBJECTIVE: The plantar pressure distribution can be assessed quantitatively by computerized baropodometry such as carpet or insole. An insole-type system with wireless transmission was developed and plantar pressure results were previously validated by force platform. However, the reproducibility of the system had not been determined. Our objective was to evaluate the reliability of the results in different gait cycles, clinical characteristics and in different plantar anatomical sites. METHODS: 41 healthy adults (age, 34 ± 13 years; body mass index, 25 ± 5 kg/m2; 26 [63%], male, 26 [63%] practicing physical activity) were evaluated. Baropodometer evaluations were performed in 3 walking cycles with 100 m each, and the reliability between the cycles was examined. Pressure points on the heel, first metatarsal, fifth metatarsal and total plantar pressure were analyzed and compared. RESULTS: Moderate agreement was identified between the second and third cycles (ICC, 0.66; 95% CI, 0.14-0.83). Physical activity practitioners showed higher total plantar pressure (70.8 vs 68.2 Kpa; p = 0.04) and higher pressure in the heel (70.7 vs 68.1 Kpa; p = 0.036) in relation to sedentary ones. CONCLUSION: The insole was able to assess plant pressure with moderate reliability from the adaptation period. Level of Evidence III, Case control study - Investigating a diagnostic test.

OBJETIVO: A distribuição da pressão plantar pode ser avaliada quantitativamente por baropodometria computadorizada tipo tapete ou palmilha. Um sistema tipo palmilha com transmissão sem fio foi desenvolvido, cujos resultados de pressão plantar foram previamente validados por plataforma de força. No entanto, a reprodutibilidade do sistema não havia sido determinada. Nosso objetivo foi avaliar a confiabilidade dos resultados em relação a diferentes ciclos de marcha, características clínicas e em diferentes sítios anatômicos plantares. MÉTODOS: Foram avaliados 41 adultos saudáveis (idade, 34 ± 13 anos; índice de massa corpórea, 25 ± 5 kg/m2; 26 [63%], sexo masculino, 26 [63%] praticantes de atividade física). Avaliações com o baropodômetro foram realizadas em 3 ciclos de marcha com distância de 100 m, e avaliada a concordância entre os ciclos. Pontos de pressão no calcanhar, primeiro metatarsal, quinto metatarsal e a pressão plantar total foram analisados e comparados. RESULTADOS: Houve moderada concordância entre o segundo e terceiro ciclos (CCI, 0,66; IC95%, 0,14-0,83). Praticantes de atividades físicas apresentaram pressão plantar total (70,8 vs 68,2 Kpa; p = 0,04) e no calcanhar (70,7 vs 68,1 Kpa; p = 0,036) aumentada em relação aos sedentários. CONCLUSÃO: A palmilha foi capaz de avaliar a pressão plantar com confiabilidade moderada a partir do período de adaptação. Nível de Evidência III, Estudo diagnóstico - Investigando um teste diagnóstico.

Reliability of wireless insole baropodometry of normal individual's gait / Confiabilidade da baropodometria por palmilha sem fio na marcha de indivíduos normais

ABSTRACT Objective: The plantar pressure distribution can be assessed quantitatively by computerized baropodometry such as carpet or insole. An insole-type system with wireless transmission was developed and plantar pressure results were previously validated by force platform. However, the reproducibility of the system had not been determined. Our objective was to evaluate the reliability of the results in different gait cycles, clinical characteristics and in different plantar anatomical sites. Methods: 41 healthy adults (age, 34 ± 13 years; body mass index, 25 ± 5 kg/m2; 26 [63%], male, 26 [63%] practicing physical activity) were evaluated. Baropodometer evaluations were performed in 3 walking cycles with 100 m each, and the reliability between the cycles was examined. Pressure points on the heel, first metatarsal, fifth metatarsal and total plantar pressure were analyzed and compared. Results: Moderate agreement was identified between the second and third cycles (ICC, 0.66; 95% CI, 0.14-0.83). Physical activity practitioners showed higher total plantar pressure (70.8 vs 68.2 Kpa; p = 0.04) and higher pressure in the heel (70.7 vs 68.1 Kpa; p = 0.036) in relation to sedentary ones. Conclusion: The insole was able to assess plant pressure with moderate reliability from the adaptation period. Level of Evidence III, Case control study - Investigating a diagnostic test.

RESUMO Objetivo: A distribuição da pressão plantar pode ser avaliada quantitativamente por baropodometria computadorizada tipo tapete ou palmilha. Um sistema tipo palmilha com transmissão sem fio foi desenvolvido, cujos resultados de pressão plantar foram previamente validados por plataforma de força. No entanto, a reprodutibilidade do sistema não havia sido determinada. Nosso objetivo foi avaliar a confiabilidade dos resultados em relação a diferentes ciclos de marcha, características clínicas e em diferentes sítios anatômicos plantares. Métodos: Foram avaliados 41 adultos saudáveis (idade, 34 ± 13 anos; índice de massa corpórea, 25 ± 5 kg/m2; 26 [63%], sexo masculino, 26 [63%] praticantes de atividade física). Avaliações com o baropodômetro foram realizadas em 3 ciclos de marcha com distância de 100 m, e avaliada a concordância entre os ciclos. Pontos de pressão no calcanhar, primeiro metatarsal, quinto metatarsal e a pressão plantar total foram analisados e comparados. Resultados: Houve moderada concordância entre o segundo e terceiro ciclos (CCI, 0,66; IC95%, 0,14-0,83). Praticantes de atividades físicas apresentaram pressão plantar total (70,8 vs 68,2 Kpa; p = 0,04) e no calcanhar (70,7 vs 68,1 Kpa; p = 0,036) aumentada em relação aos sedentários. Conclusão: A palmilha foi capaz de avaliar a pressão plantar com confiabilidade moderada a partir do período de adaptação. Nível de Evidência III, Estudo diagnóstico - Investigando um teste diagnóstico.

Which clinical outcome scores are more frequently used in the literature on osteochondral lesions of the talus? a systematic review / Quais escores de desfechos clínicos são usados com mais frequência na literatura lesões osteocondrais do tálus? uma revisão sistemática

ABSTRACT Objective: This study aimed to identify the most used scales in the assessment of the clinical outcomes for the treatment of osteochondral lesions of the talus. Methods: We performed a systematic review of the PubMed/MEDLINE databases from September 1999 to September 2019, based on the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The research strategy was: osteochondral [All Fields], AND ("talus" [MeSH Terms] OR "talus" [All Fields]) AND lesion [All Fields]. Of the 364 articles found in the literature, 166 (45%) were included in the study and 198 (55%) excluded. In total, 23 clinical assessment tools were used in the studies. Results: We found 49.4% of the studies to use the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS Ankle-Hindfoot Scale) and 29.5% the Visual Analogue Scale (VAS). Conclusion: The use of AOFAS increased in relation to VAS in the last 6 years (p = 0.046), and these two scales, either alone or combined, were the most used for studying osteochondral lesions of the talus. Level of Evidence III, Systematic Review of Level II studies.

RESUMO Objetivo: Este estudo propõe revisar sistematicamente a literatura para identificar as escalas mais utilizadas da avaliação clínica de resultados do tratamento das LOTs. Métodos: Foi realizada revisão sistemática das bases de dados do PubMed/MEDLINE, desde setembro de 1999 a setembro 2019 baseado nas diretrizes PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses). A estratégia de pesquisa foi: osteochondral [All Fields], AND ("talus" [MeSH Terms] OR "talus" [All Fields]) AND lesion [All Fields]. De 364 artigos, foram incluídos no estudo 166 (45%) e excluídos 198 (55%). Foram observadas 23 escalas de avaliação clínica utilizadas. Resultados: A escala AOFAS e EVA de dor foram as mais utilizadas, ocorrendo em 49,4% e 29,5% dos artigos, respectivamente. Foi observado aumento de uso de AOFAS e diminuição EVA nos últimos 6 anos (p = 0,046). Conclusão: As ferramentas Escala AOFAS e EVA para dor demonstraram ser as mais usadas na literatura para avaliação de resultados do tratamento da lesão osteocondral de tálus, tanto isoladamente, quanto combinadas. Nível de Evidência III, Revisão Sistemática de Estudos de Nível II.

WHICH CLINICAL OUTCOME SCORES ARE MORE FREQUENTLY USED IN THE LITERATURE ON OSTEOCHONDRAL LESIONS OF THE TALUS? A SYSTEMATIC REVIEW.

OBJECTIVE: This study aimed to identify the most used scales in the assessment of the clinical outcomes for the treatment of osteochondral lesions of the talus. METHODS: We performed a systematic review of the PubMed/MEDLINE databases from September 1999 to September 2019, based on the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The research strategy was: osteochondral [All Fields], AND ("talus" [MeSH Terms] OR "talus" [All Fields]) AND lesion [All Fields]. Of the 364 articles found in the literature, 166 (45%) were included in the study and 198 (55%) excluded. In total, 23 clinical assessment tools were used in the studies. RESULTS: We found 49.4% of the studies to use the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS Ankle-Hindfoot Scale) and 29.5% the Visual Analogue Scale (VAS). CONCLUSION: The use of AOFAS increased in relation to VAS in the last 6 years (p = 0.046), and these two scales, either alone or combined, were the most used for studying osteochondral lesions of the talus. Level of Evidence III, Systematic Review of Level II studies.

OBJETIVO: Este estudo propõe revisar sistematicamente a literatura para identificar as escalas mais utilizadas da avaliação clínica de resultados do tratamento das LOTs. MÉTODOS: Foi realizada revisão sistemática das bases de dados do PubMed/MEDLINE, desde setembro de 1999 a setembro 2019 baseado nas diretrizes PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses). A estratégia de pesquisa foi: osteochondral [All Fields], AND ("talus" [MeSH Terms] OR "talus" [All Fields]) AND lesion [All Fields]. De 364 artigos, foram incluídos no estudo 166 (45%) e excluídos 198 (55%). Foram observadas 23 escalas de avaliação clínica utilizadas. RESULTADOS: A escala AOFAS e EVA de dor foram as mais utilizadas, ocorrendo em 49,4% e 29,5% dos artigos, respectivamente. Foi observado aumento de uso de AOFAS e diminuição EVA nos últimos 6 anos (p = 0,046). CONCLUSÃO: As ferramentas Escala AOFAS e EVA para dor demonstraram ser as mais usadas na literatura para avaliação de resultados do tratamento da lesão osteocondral de tálus, tanto isoladamente, quanto combinadas. Nível de Evidência III, Revisão Sistemática de Estudos de Nível II.

Endoscopy for the treatment of posterior ankle impact syndrome: Learning curve.

BACKGROUND: This study aimed to demonstrate our learning curve of endoscopy for the treatment of Posterior Ankle Impact Syndrome (PAIS), assessing the operative time and evolution of the outcomes. METHODS: We conducted a retrospective review of 39 patients submitted to endoscopic treatment by a single surgeon over a period of ten years. We divided the study population into four blocks of ten consecutive patients and compared the mean operative time and outcomes between the four blocks. For the learning curve model, we performed linear regression analysis and logarithmic transformation. RESULTS: We found a decrease in the surgery duration over time (P = .0273). All patients had an improvement in the AOFAS Scale (P < .0001), regardless of the group (P = .07). The learning rate was estimated at 83%, indicating a 17% reduction of the operative time as the cumulative cases doubled. CONCLUSIONS: This study showed a decrease in the operative time of the posterior ankle endoscopy over the years, with an estimated learning rate of 83%. The outcomes and incidence of complications showed no relationship with operative time and the number of cases operated. LEVEL OF EVIDENCE: Level IV, case series.

The Association Between Rearfoot Motion While Barefoot and Shod in Different Types of Running Shoes in Recreational Runners.

The rearfoot angle (RFA) is a biomechanical variable widely used to determine the rearfoot motion (RM). Shoe manufacturers began to develop running shoes with RM control that would supposedly alter foot-ground interaction mechanics and neutralize excessive pronation or supination; moreover, some studies have not shown differences in rearfoot motion in shod condition compared to barefoot. This study intended to answer three questions: Do the shoes runners wear correspond to their respective barefoot RM? Does the eversion angle change during shod running, regardless the shoes worn? Can footwear designed for a specific RM (supination, pronation, neutral) correct or neutralize the eversion angle of runners? One hundred and eleven runners (38.6 ± 9.7years; 74.9 ± 12.0kg; 1.74 ± 0.08 m), who ran an average of 32 ± 17km/week, were included in this cross-sectional study. They had their RFA measured by a motion capture system when running barefoot and wearing their habitual running shoes (shod condition). Chi-squared test was used to assess associations between barefoot and shod condition and RFA was compared between conditions using Wilcoxon tests (p = 0.05). There was no association between the type of running shoe and barefoot RM (p > 0.05). There was an association between RFA when barefoot and when shod (p < 0.05). Among all participants classified as neutral, 61% continued to exhibit a normal/neutral RFA when wearing their habitual shoes. Among the overpronators, 100% showed a change in the RM to either normal or supinator. Among the participants classified as supinators, 62% exhibited normal pronation when shod even without using the appropriate footwear, claimed by the manufacturer. Only 44.1% of the sample chose the correct running shoe for their barefoot RM. The majority of runners did not choose their shoes designed for their natural type of RM. The rearfoot eversion angle changed an average 4 degrees when running shod and the RM barefoot altered quite a lot when using a running shoe. The running shoes did not correct the pronation detected barefoot, as claimed by the manufacturers.

Reliability of Two Smartphone Applications for Radiographic Measurements of Hallux Valgus Angles.

The objective of the present study was to assess the reliability of 2 smartphone applications compared with the traditional goniometer technique for measurement of radiographic angles in hallux valgus and the time required for analysis with the different methods. The radiographs of 31 patients (52 feet) with a diagnosis of hallux valgus were analyzed. Four observers, 2 with >10 years' experience in foot and ankle surgery and 2 in-training surgeons, measured the hallux valgus angle and intermetatarsal angle using a manual goniometer technique and 2 smartphone applications (Hallux Angles and iPinPoint). The interobserver and intermethod reliability were estimated using intraclass correlation coefficients (ICCs), and the time required for measurement of the angles among the 3 methods was compared using the Friedman test. A very good or good interobserver reliability was found among the 4 observers measuring the hallux valgus angle and intermetatarsal angle using the goniometer (ICC 0.913 and 0.821, respectively) and iPinPoint (ICC 0.866 and 0.638, respectively). Using the Hallux Angles application, a very good interobserver reliability was found for measurements of the hallux valgus angle (ICC 0.962) and intermetatarsal angle (ICC 0.935) only among the more experienced observers. The time required for the measurements was significantly shorter for the measurements using both smartphone applications compared with the goniometer method. One smartphone application (iPinPoint) was reliable for measurements of the hallux valgus angles by either experienced or nonexperienced observers. The use of these tools might save time in the evaluation of radiographic angles in the hallux valgus.

Avaliação da reprodutibilidade da classificação de Sanders para fraturas do calcâneo / Assessment of reproducibility of sanders classification for calcaneal fractures

Objetivo: Avaliar a reprodutibilidade intra e inter observadores da Classificação Tomográfica de Sanders das fraturas do calcâneo entre observadores mais e menos experientes em cirurgia do pé e tornozelo.Métodos: Foram avaliadas imagens tomográficas de 46 pacientes com diagnóstico de fratura do calcâneo. Quatro observadores, dois com dez anos de experiência em cirurgia do pé e tornozelo e dois residentes do terceiro ano em Ortopedia e Traumatologia classificaram as fraturas independentemente. Após três semanas, os mesmos observadores classificaram as fraturas apresentadas em ordem alterada aleatoriamente.A concordância intra e inter observadores foi analisada através do índice Kappa. Resultados: Houve boa concordância intra observador para os dois observadores mais experientes e um observador menos experiente (valores de Kappa 0,640; 0,632 e 0,629, respectivamente). Quando analisada a concordância inter observador, houve concordância fraca entre os mais experientes (Kappa = 0,289) e moderada entreos menos experientes (Kappa = 0,527). Conclusões: A Classificação Tomográfica de Sanders apresentou boa concordância intra observador,porém reprodutibilidade inter observadores abaixo da ideal, tanto entre observadores mais experientes quanto aqueles menos experientes.Nível de Evidência III, Estudos Diagnósticos.

Objective: To assess intra- and interobserver reproducibilityof Sanders Classification System of calcaneal fracturesamong experienced and less experienced observers. Methods:Forty-six CT scans of intra-articular calcaneal fractureswere reviewed. Four observers, two with ten years ofexperience in foot and ankle surgery and two third-year residentsin Orthopedics and Traumatology classified the fractureson two separate occasions three weeks apart from eachother. The intra and inter-observer reliability was analyzedusing the Kappa index. Results: There was good intraobserverreliability for the two experienced observers and oneless experienced observer (Kappa values 0.640, 0.632 and0.629, respectively). The interobserver reliability was fairbetween the experienced observers (Kappa = 0.289) andmoderate among the less experienced observers (Kappa= 0.527). Conclusions: The Sanders Classification Systemshowed good intraobserver reliability, but interobserver reproducibilitybelow the ideal level, both among experiencedand less experienced observers. Level of Evidence III,Diagnostic Studies.