Assuntos
Traumatismos do Tornozelo/cirurgia , Traumatismos do Pé/cirurgia , Tendão do Calcâneo/lesões , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/cirurgia , Traumatismos do Tornozelo/diagnóstico por imagem , Artrodese/métodos , Artroplastia de Substituição/métodos , Calcâneo/lesões , Moldes Cirúrgicos , Doença de Charcot-Marie-Tooth/diagnóstico por imagem , Doença de Charcot-Marie-Tooth/cirurgia , Neuropatias Diabéticas/diagnóstico por imagem , Neuropatias Diabéticas/cirurgia , Úlcera do Pé/prevenção & controle , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Instabilidade Articular/cirurgia , Osteonecrose/prevenção & controle , Ruptura/cirurgia , Tálus/lesões , Tendinopatia/diagnóstico por imagem , Tendinopatia/cirurgia , Tomografia Computadorizada por Raios XAssuntos
Tornozelo/cirurgia , Pé/cirurgia , Procedimentos Ortopédicos/tendências , Tendão do Calcâneo/lesões , Amputação Cirúrgica/tendências , Fraturas do Tornozelo , Traumatismos do Tornozelo/cirurgia , Artrite/cirurgia , Artroplastia de Substituição do Tornozelo/tendências , Artroscopia/tendências , Transplante Ósseo/tendências , Pé Diabético/cirurgia , Deformidades do Pé/cirurgia , Doenças do Pé/cirurgia , Traumatismos do Pé/cirurgia , Fraturas Ósseas/cirurgia , Humanos , Artropatias/cirurgia , Dor Musculoesquelética/etiologiaRESUMO
This update summarizes recent research pertaining to orthopaedic foot and ankle surgery that was published or presented between August 2011 and July 2012. The sources of these studies include The Journal of Bone and Joint Surgery (American and British Volumes); Foot and Ankle International; and the proceedings of Specialty Day at the annual meeting of the American Academy of Orthopaedic Surgeons (AAOS), on February 11, 2012, in San Francisco, California, and the summer meeting of the American Orthopaedic Foot & Ankle Society (AOFAS), on June 20 through 23, 2012, in San Diego, California.
Assuntos
Traumatismos do Tornozelo/cirurgia , Artrite/cirurgia , Traumatismos do Pé/cirurgia , Fraturas Ósseas/cirurgia , Instabilidade Articular/cirurgia , Traumatismos dos Tendões/cirurgia , Tendão do Calcâneo/lesões , Tendão do Calcâneo/cirurgia , Amputação Cirúrgica , Traumatismos do Tornozelo/diagnóstico , Artroplastia/métodos , Artroscopia/métodos , Transplante Ósseo , Calcâneo/lesões , Calcâneo/cirurgia , Fíbula/lesões , Fíbula/cirurgia , Traumatismos do Pé/diagnóstico , Fixação de Fratura , Fraturas Ósseas/diagnóstico , Síndrome do Dedo do Pé em Martelo/cirurgia , Humanos , Instabilidade Articular/diagnóstico , Tálus/lesões , Tálus/cirurgiaRESUMO
This update summarizes recent research pertaining to the subspecialty of orthopaedic foot and ankle surgery that was published or presented between August 2009 and July 2010. The sources of these studies include The Journal of Bone and Joint Surgery (American and British Volumes), Foot & Ankle International, and the proceedings of Specialty Day at the annual meeting of the American Academy of Orthopaedic Surgeons (AAOS), held on March 13, 2010, in New Orleans, Louisiana, and the summer meeting of the American Orthopaedic Foot & Ankle Society (AOFAS), held on July 7 through 10, 2010, in National Harbor, Maryland.
Assuntos
Traumatismos do Tornozelo/cirurgia , Tornozelo/cirurgia , Doenças do Pé/cirurgia , Traumatismos do Pé/cirurgia , Fraturas Ósseas/cirurgia , Procedimentos Ortopédicos/métodos , Medicina Baseada em Evidências , HumanosAssuntos
Tornozelo/cirurgia , Pé/cirurgia , Procedimentos Ortopédicos , Tendão do Calcâneo/lesões , Tendão do Calcâneo/cirurgia , Traumatismos do Tornozelo/cirurgia , Artrite/cirurgia , Artrodese , Artropatia Neurogênica/cirurgia , Calcâneo/lesões , Contraindicações , Pé Diabético/cirurgia , Fixação de Fratura , Fraturas Ósseas/cirurgia , Hallux Valgus/cirurgia , Humanos , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/tendências , Osteotomia , RupturaRESUMO
BACKGROUND: First metatarsocuneiform (MC) instability is recognized as a pathologic contributor to hallux valgus. There are no studies identifying the first MC joint as an independent pain generator in the foot that may require surgical arthrodesis for its management. MATERIALS AND METHODS: The authors reviewed the records of all patients with this newly described pathology in the first MC joint. There were 61 patients with 85 feet who underwent a fluoroscopically guided local anesthetic injection into the first metatarsocuneiform joint to assess pain relief. Patient's complaints, physical exam findings, treatment decisions, patient characteristics, and radiographic findings were evaluated. RESULTS: Seventy-nine percent of patients (67/85) injected had relief of their symptoms. Eight or these 67 patients were eventually treated with first MC arthrodesis with complete relief of symptoms. The average time from onset of symptoms to presentation was 21 (range, 1 to 72) months. Eighty-five percent of feet (72/85) had multiple previous diagnoses. Radiographic plantar widening of the first M-C joint on weightbearing views was inconsistent with pathology. CONCLUSION: The first MC joint is an independent pain generator in the foot that can have variable presentations. Radiographic data can often be helpful, but clinical exam findings are paramount in the diagnosis. Fluoroscopically-guided long acting local anesthetic injections of this joint are helpful in the diagnosis, especially in the patient with multiple possible pain generators in the foot and ankle. Failure to recognize the first MC joint as a source of pain may lead to delay in treatment, misdiagnosis, and mistreatment of foot pathology.
Assuntos
Artralgia/tratamento farmacológico , Artralgia/fisiopatologia , Articulações do Pé/fisiopatologia , Instabilidade Articular/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/uso terapêutico , Artrodese , Bupivacaína/uso terapêutico , Feminino , Fluoroscopia , Articulações do Pé/cirurgia , Humanos , Injeções Intra-Articulares , Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Lidocaína/uso terapêutico , Masculino , Ossos do Metatarso/fisiopatologia , Ossos do Metatarso/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Ossos do Tarso/fisiopatologia , Ossos do Tarso/cirurgia , Adulto JovemAssuntos
Traumatismos do Tornozelo/cirurgia , Traumatismos do Pé/cirurgia , Fraturas Ósseas/cirurgia , Procedimentos Ortopédicos/tendências , Tendão do Calcâneo , Traumatismos do Tornozelo/epidemiologia , Artroplastia , Comorbidade , Neuropatias Diabéticas/epidemiologia , Fasciíte Plantar/terapia , Pé Chato/epidemiologia , Traumatismos do Pé/epidemiologia , Hallux Rigidus/cirurgia , Hallux Valgus/cirurgia , Humanos , Instabilidade Articular/cirurgia , Ossos do Metatarso/cirurgia , Osteotomia , Próteses e Implantes , Ruptura , Tálus/lesões , Tendinopatia/epidemiologia , Tendinopatia/cirurgiaRESUMO
BACKGROUND: The modalities currently available to clinicians to confirm the clinical suspicion of posterior tibial tendinitis include MRI, CT, sonography, tenography, and local anesthetic tendon sheath injections. There are no reports in the literature comparing local anesthetic tendon sheath injection to MRI as tools for diagnosing posterior tibial tenosynovitis. METHODS: The authors reviewed the records of all patients with stage 1 posterior tibial tendon dysfunction between the dates of September 1, 2001, to November 21, 2004. Fifteen patients (17 ankles) had a local anesthetic injection into the posterior tibial tendon sheath and MRI for clinically suspected tenosynovitis of the posterior tibial tendon. RESULTS: Seventeen (100%) of 17 ankles had complete relief of symptoms after the local anesthetic tendon sheath injections. Fifteen (88%) of 17 ankles had abnormally increased fluid signal within the posterior tibial tendon sheath seen on MRI. Two of two ankles (100%), after having negative MRI findings, had complete relief with a local anesthetic tendon sheath injection. In addition, conservative treatment failed in these two patients, and they subsequently had tenosynovectomy with gross confirmation at surgery of inflammatory changes within the tendon sheath. These two patients had complete symptom relief after tenosynovectomy. CONCLUSIONS: Local tendon sheath injections and MRI are both reliable diagnostic tools. Injection of the posterior tibial tendon is an accurate, safe, and sensitive modality useful in patients in whom MRI studies are negative in the face of continued clinical suspicion.
Assuntos
Anestésicos Locais , Bupivacaína , Imageamento por Ressonância Magnética , Tenossinovite/diagnóstico , Adolescente , Adulto , Idoso , Anestésicos Locais/uso terapêutico , Bupivacaína/uso terapêutico , Feminino , Pé/patologia , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Medição da Dor , Sinovectomia , Tendões/patologia , Tenossinovite/terapia , Resultado do TratamentoRESUMO
BACKGROUND: Autogenous bone graft from the distal tibia provides cancellous bone graft for foot and ankle operations, and it has osteogenic and osteoconductive properties. The site is in close proximity to the foot and ankle, and published retrospective studies show low morbidity from the procedure. METHODS: One-hundred autografts were obtained from the distal tibia between 2000 and 2003. In four cases the distal tibial bone graft harvest resulted in a stress fracture. There were three women and one man. RESULTS: The average time of diagnosis of the stress fracture from the operation was 1.8 months. All stress fractures healed with a short course (average 2.4 months) of cast immobilization. CONCLUSIONS: This study demonstrated that a stress fracture from the donor site of autogenous bone graft of the distal tibia occurs and can be successfully treated nonoperatively.
Assuntos
Transplante Ósseo/efeitos adversos , Fraturas de Estresse/etiologia , Tíbia/cirurgia , Fraturas da Tíbia/etiologia , Transplante Autólogo/efeitos adversos , Adulto , Idoso , Tornozelo/cirurgia , Feminino , Pé/cirurgia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The current study examined the outcomes of operative treatment of unstable ankle fractures in patients at least 80 years old at the time of injury. METHODS: Of 2,682 patients who presented for treatment of ankle fractures, 17 patients met the study criteria. These patients had open reduction and internal fixation after sustaining 15 closed and two open unstable ankle fractures. There were 11 type B fractures and six type C fractures by the Danis-Weber classification, and 12 supination-external rotation and five pronation-external rotation fractures by the Laugen-Hansen classification systems. RESULTS: When noncompliant patients who developed complications were removed from analysis, the fixation failure and deep infection rates were 0% each. CONCLUSIONS: These results highlight the importance of patient compliance and non-weightbearing status in the treatment of ankle fractures in patients over 80 years.
Assuntos
Traumatismos do Tornozelo/cirurgia , Fraturas Ósseas/cirurgia , Idoso de 80 Anos ou mais , Falha de Equipamento , Feminino , Seguimentos , Fixação de Fratura/instrumentação , Fixação de Fratura/métodos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/classificação , Fraturas Fechadas/classificação , Fraturas Fechadas/cirurgia , Fraturas Expostas/classificação , Fraturas Expostas/cirurgia , Humanos , Masculino , Pronação/fisiologia , Estudos Retrospectivos , Rotação , Supinação/fisiologia , Deiscência da Ferida Operatória/etiologia , Infecção da Ferida Cirúrgica/etiologia , Resultado do Tratamento , Recusa do Paciente ao Tratamento , Caminhada/fisiologiaRESUMO
BACKGROUND: Arthrodesis of the metatarsophalangeal joint of the hallux is frequently used for treatment of a variety of disorders. However, occasionally patients who have complex deformities or degenerative changes of the hallux require reconstruction of both the metatarsophalangeal and interphalangeal joints. There is concern that arthrodesis of both the metatarsophalangeal and ipsilateral interphalangeal joints could be problematic, interfering with the toe-off phase of gait or with shoewear. METHODS: A retrospective evaluation of seven feet in five patients who had simultaneous arthrodesis of the metatarsophalangeal and ipsilateral interphalangeal joints of the hallux was undertaken. These cases represented all the patients who had this procedure within the practice of three orthopaedic foot and ankle specialists, totaling over 50 surgeon-years of experience. The indication for surgery in all patients was moderate to severe pain with ambulation with severe fixed deformity of both the interphalangeal and metatarsophalangeal joints of the hallux. All patients had pain that limited their ambulation and interfered with their daily activities. All patients required modified shoewear to accommodate their foot deformity. The mean age of patients was 53 years. The patients were evaluated by questionnaire and radiographic examination. RESULTS: At an average of 46 months followup, all patients had resolution of their pain and were able to wear nonprescription shoes. All had limitations that interfered with full athletic activities but had no limitation of daily activities. Three patients who were employed returned to their occupations and two who were not employed were able to continue housework. CONCLUSION: Arthrodesis of the metatarsophalangeal and ipsilateral interphalangeal joints of the hallux results in painless function in patients with moderate demands.
Assuntos
Artrodese/métodos , Hallux/cirurgia , Articulação Metatarsofalângica/cirurgia , Articulação do Dedo do Pé/cirurgia , Atividades Cotidianas , Adulto , Artralgia/cirurgia , Emprego , Seguimentos , Deformidades do Pé/cirurgia , Hallux/diagnóstico por imagem , Humanos , Articulação Metatarsofalângica/diagnóstico por imagem , Pessoa de Meia-Idade , Medição da Dor , Satisfação do Paciente , Radiografia , Estudos Retrospectivos , Sapatos , Articulação do Dedo do Pé/diagnóstico por imagem , Resultado do Tratamento , Caminhada/fisiologiaRESUMO
BACKGROUND: Adult patients with nontraumatic plantar heel pain often present to orthopaedic surgeons for evaluation. A thorough history and physical examination are often sufficient for diagnosis, yet radiographs usually are ordered during the initial evaluation. The purpose of this study was to evaluate the value and cost-effectiveness of these radiographs. METHODS: A retrospective chart and radiographic review of 157 consecutive adults (215 heels) presenting with nontraumatic heel pain was done to evaluate the utility of routine radiographs in the initial evaluation. RESULTS: The most common diagnosis was plantar fasciitis (80.9%, 174 of 215). Radiographs were normal in (17.2%, 37 of 215), and incidental radiographic findings were observed in 81.4% (175 of 215). The most common incidental findings were plantar calcaneal spurs (59.5%, 128 of 215) and Achilles spurs (46.5%, 100 of 215). Only (2%, 4 of 215) of all patients had abnormal findings that prompted further evaluation. CONCLUSIONS: Routine radiographs are of limited value in the initial evaluation of nontraumatic plantar heel pain in adults and were not necessary in the initial evaluation. Radiographs should be reserved for patients who do not improve as expected or present with an unusual history or confounding physical findings.
Assuntos
Doenças do Pé/diagnóstico por imagem , Calcanhar , Artropatias/diagnóstico por imagem , Dor/diagnóstico por imagem , Radiografia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Feminino , Doenças do Pé/complicações , Humanos , Artropatias/complicações , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Valor Preditivo dos Testes , Radiografia/economia , Estudos RetrospectivosAssuntos
Tornozelo , Placas Ósseas/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Fraturas Ósseas/cirurgia , Histiocitoma Fibroso Maligno/etiologia , Idoso , Animais , Traumatismos do Tornozelo/complicações , Traumatismos do Tornozelo/cirurgia , Evolução Fatal , Feminino , Fixação Interna de Fraturas/instrumentação , Fraturas Ósseas/complicações , Histiocitoma Fibroso Maligno/patologia , Humanos , RatosRESUMO
BACKGROUND: The relationship between pes planus and injuries of the lower extremity is controversial. However, few studies have used standardized means of evaluating and defining pes planus, and none have had a controlled patient population. The objective of this study was to evaluate an ideal population of physically active individuals to establish a potential correlation between pes planus, as defined by a standardized method, and injuries to the lower extremity. METHODS: A standardized technique for evaluating arch height, based on a midfoot ratio established by Harris mat print calculations, was used to assess a consecutive series of 512 newly entered West Point cadets. Pes planus was defined as more than 2 standard deviations above the mean midfoot ratio of the population. After 46 months, a retrospective chart review was done to identify lower extremity injuries sustained in this group of young healthy patients. The results of the footprint analysis were correlated with the medical record findings. RESULTS: Thirty-three cadets were found to have pes planus; 13 had only left foot involvement, 15 had right foot only involvement, and five had bilateral pes planus. There were no cavus feet. Statistically significant relationships were seen between the degree of pes planus and total number of injuries sustained (p = 0.007), the overall size of the foot and total number of injuries (p = 0.041), left flat feet and left midfoot injuries (p = 0.028), left pes planus and right midfoot injuries (p = 0.008), left pes planus and left knee injuries (p = 0.038), and right pes planus and right knee injuries (p = 0.027). Women had smaller feet (p = 0.000), smaller midfoot ratios (right, p = 0.013; left p = 0.003), yet they had an increased number of injuries (Pearson's coefficient -0.119; p = 0.007). CONCLUSIONS: The current study found significant relationships between pes planus and number of injuries sustained over a 4-year period at West Point. While women were found to have smaller feet and lesser degrees of pes planus, they sustained more injuries than men.
Assuntos
Traumatismos do Tornozelo/complicações , Pé Chato/complicações , Traumatismos do Pé/complicações , Militares/estatística & dados numéricos , Traumatismos do Tornozelo/epidemiologia , Feminino , Traumatismos do Pé/epidemiologia , Humanos , Incidência , Masculino , Estudos Prospectivos , Fatores Sexuais , Estudantes/estatística & dados numéricos , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: The most consistent deformities that allow early diagnosis of fibrodysplasia ossificans progressiva are the presence of bilateral short first rays and hallux valgus. The purpose of this study was to describe the radiographic features observed in the feet of patients with fibrodysplasia ossificans progressiva. METHODS: The radiographs of 26 feet (15 patients with fibrodysplasia ossificans progressiva) were reviewed to evaluate the radiographic changes that occur in the first ray. Variables analyzed were the hallux valgus (HV) angle, the distal metatarsal articular (DMA) angle, the proximal phalangeal articular (PPA) angle, the intermetatarsal (IM) angle, ratio of the lengths of the first and second metatarsal lengths (MT1:MT2), and the first and second ray length ratio. The length ratios were then subtracted from similar ratios in radiographs of age- and gender-matched normal patients previously reported. RESULTS: The proximal phalanx was consistently shortened but morphologically dissimilar from subject to subject. Asymmetry was noted in some patients with bilateral radiographs. The mean HV angle was 28 degrees, and the mean IM angle was 10 degrees. The mean DMA angle was 33 degrees, and the mean PPA angle was 14 degrees. The MT1:MT2 ratio was 0.89, and the mean first ray to second ray length ratio was 0.87. The mean of the differences in the MT1:MT2 and first and second ray length ratios in patients with fibrodysplasia ossificans progressiva compared to the normal controls were 0.05 and 0.01, respectively. Fusion occurred between the abnormal tibial epiphysis of the proximal phalanx and metatarsal head with advancing age, and 68% of the metatarsal heads were fused with the abnormal proximal phalangeal epiphysis. CONCLUSIONS: Foot pathology in patients with fibrodysplasia ossificans progressiva is variable but consistently involves an abnormality of the tibial aspect of the proximal phalangeal epiphysis of the hallux. This results in the clinical observation of hallux valgus in these patients. The first metatarsal is consistently shortened, and fusion between the epiphysis of the abnormal proximal phalanx and the shortened first metatarsal head occurs with advancing age.