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1.
J Foot Ankle Res ; 15(1): 33, 2022 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-35524275

RESUMO

BACKGROUND: Ankle arthroplasty, commonly known as ankle replacement, is a surgical procedure for treating end-stage ankle osteoarthritis. Whilst evidence shows good clinical results after surgery, little is known of the long-term survival of ankle replacements and the need for ankle revision. Using more recent implant data and long-term data, there is now opportunity to examine at a population-level the survival rate for ankle implants, to examine between-country differences in ankle revision surgery, and to compare temporal trends in revision rates between countries. METHODS: Four national joint registries from Australia, New Zealand, Norway and Sweden provided the necessary data on revision outcome following primary ankle replacement, for various periods of observation - the earliest starting in 1993 up to the end of 2019. Data were either acquired from published, online annual reports or were provided from direct contact with the joint registries. The key information extracted were Kaplan-Meier estimates to plot survival probability curves following primary ankle replacement. RESULTS: The survival rates varied between countries. At 2 years, across all registries, survival rates all exceeded 0.9 (range 0.91 to 0.97). The variation widened at 5 years (range 0.80 to 0.91), at 10 years (range 0.66 to 0.84) and further at 15-years follow-up (0.56 to 0.78). At each time point, implant survival was greater in Australia and New Zealand with lower rates in Sweden and Norway. CONCLUSIONS: We observed variation in primary ankle replacement survival rates across these national registries, although even after 5 years, these population derived data show an 80% revision free survival. These data raise a number of hypotheses concerning the reasons for between-country differences in revision-free survival which will require access to primary data for analysis.


Assuntos
Artroplastia de Substituição do Tornozelo , Osteoartrite , Tornozelo/cirurgia , Humanos , Osteoartrite/epidemiologia , Osteoartrite/cirurgia , Sistema de Registros , Reoperação
2.
J Foot Ankle Res ; 15(1): 32, 2022 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-35524334

RESUMO

INTRODUCTION: Patients with chronic foot/ankle pain are often referred for orthopaedic assessment. Psychological vulnerabilities influence pain states (including foot and ankle), therefore this study aimed to establish the prevalence and relative importance of compromised psychological health to perceived foot/ankle pain severity in people referred to an orthopaedic foot and ankle clinic with non-urgent presentations. METHODS: Patients with triaged non-urgent foot/ankle referrals to the Department of Orthopaedics at Gold Coast University Hospital were recruited over a 12-month period and completed the Manchester-Oxford Foot and Ankle Questionnaire which was the primary measure. Participants also completed questionnaires assessing their anthropometric, demographic and health characteristics (Self-Administered Comorbidity Questionnaire) as well as measures of health-related quality of life (EuroQol-5-Dimensions-5-Level Questionnaire and EQ Visual Analogue Scale) and psychological health (Center for Epidemiological Studies-Depression scale, Pain Catastrophizing Scale and Central Sensitization Inventory). Descriptive statistics were used to summarise participant characteristics and a hierarchical multiple linear regression was employed to establish the extent to which psychological variables explain additional variance in foot/ankle pain severity beyond the effects of participant characteristics (age, sex, body mass index (BMI)). RESULTS: One hundred and seventy-two adults were recruited ((64.0% female), median (IQR) age 60.9 (17.7) years and BMI 27.6 (7.5) kg/m2). Specific psychological comorbidities were prevalent including depressive symptoms (48%), central sensitisation (38%) and pain catastrophising (24%). Age, sex and BMI accounted for 11.7% of the variance in MOXFQ-index and psychological variables accounted for an additional 28.2%. Pain catastrophising was the most significant independent predictor of foot/ankle pain severity (accounting for 14.4% of variance), followed by BMI (10.7%) and depressive symptoms (2.3%). CONCLUSIONS: This study demonstrated that specific psychological comorbidities and increased BMI are common in this cohort and that these factors are associated with the symptoms for which patients are seeking orthopaedic assessment. This knowledge should prompt clinicians to routinely consider the psychosocial components of patient presentations and develop non-operative and pre-operative treatment strategies which consider these factors with the goal of improving overall patient outcomes.


Assuntos
Dor Crônica , Ortopedia , Adulto , Tornozelo/cirurgia , Índice de Massa Corporal , Dor Crônica/epidemiologia , Depressão/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Qualidade de Vida , Encaminhamento e Consulta , Inquéritos e Questionários
3.
Med Sci Monit ; 28: e936481, 2022 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-35526107

RESUMO

BACKGROUND There are various tools and methods used for strength exercise. Elastic bands, one of the resistance exercise tools, have been used for various purposes, including muscle strengthening; however, there is very little evidence supporting their efficacy. The study was performed to investigate the effect of knee-ankle elastic bands on knee muscle strength-related parameters according to sex in healthy adults. MATERIAL AND METHODS This was a cross-sectional study. Twenty-one participants (11 female and 10 male) were studied using a cross-over design. Isokinetic concentric knee extension and flexion strength was measured at 60°/s and 180°/s with and without application of a therapeutic elastic band in the shape of an "8", with knee flexion and ankle dorsiflexion. The variables related to muscle power automatically calculated in the protocol of the isokinetic system were compared according to sex and angular velocity. RESULTS Peak moment (PM), PM/body weight, average power, total work, and the agonist/antagonist ratio, demonstrated significant improvement (P<0.05) at both 60°/s and 180°/s "with" compared to "without" the elastic band according to sex. CONCLUSIONS The use of therapeutic elastic bands in the shape of a figure 8 with knee flexion and ankle dorsiflexion may be used as assistive devices for improving strength in muscles supporting the knee. Further high-quality studies are needed to assess the potential of elastic bands as assistive devices and not merely as exercise tools. Therapeutic elastic bands in the shape of an "8" with knee flexion and ankle dorsiflexion may be useful in sports activities.


Assuntos
Tornozelo , Equipamentos de Autoajuda , Adulto , Tornozelo/fisiologia , Estudos Transversais , Feminino , Humanos , Masculino , Força Muscular/fisiologia , Músculo Esquelético/fisiologia
5.
Sci Rep ; 12(1): 7561, 2022 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-35534614

RESUMO

This study sought to determine whether a foot-ankle therapeutic exercise program can improve daily physical activity (i.e. number of steps) and fast and self-selected gait speed in people with diabetic peripheral neuropathy (DPN). In this single-blind randomized controlled trial and intention-to-treat analysis, 78 volunteers with DPN were allocated into a control group, which received usual care, and an intervention group (IG), which received usual care plus a 12-week foot-ankle exercise program. The adherence at 12 weeks rate in the IG was 92.3% (36 participants) and the dropout was 5.1% in the control group (2 participants). The number of steps and self-selected gait speed did not change significantly in either group (p > 0.05), although a 1,365-step difference between groups were observed at 1-year followup. The 12-week foot-ankle therapeutic exercises improved significantly fast-gait speed (primary outcome) (p = 0.020), ankle range of motion (p = 0.048), and vibration perception (secondary outcomes) (p = 0.030), compared with usual-care at 12 weeks. At 24 weeks, the IG showed better quality of life than controls (p = 0.048). At 1-year, fast-gait speed and vibration perception remained higher in the IG versus controls. Overall, the program may be a complementary treatment strategy for improving musculoskeletal and functional deficits related to DPN.Trial registration ClinicalTrials.gov NCT02790931 (06/06/2016).


Assuntos
Diabetes Mellitus , Neuropatias Diabéticas , Tornozelo , Neuropatias Diabéticas/terapia , Terapia por Exercício , Marcha , Humanos , NAD , Qualidade de Vida , Método Simples-Cego , Velocidade de Caminhada
6.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 47(1): 79-85, 2022 Jan 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-35545366

RESUMO

OBJECTIVES: To summarize our experience with the sural neurofasciocutaneous flap for reconstructing the soft tissue defects over the forefoot distal to the connecting line of midpoints in the metatarsal bones, and to compare the outcomes between the flap for resurfacing the defects distal and proximal to the connecting line. METHODS: The clinical data of 425 sural neurofasciocutaneous flaps for repairing the soft tissue defects in the middle and lower leg, ankle, and foot between Apr. 2002 and Apr. 2020 were reviewed. Based on the connecting line of midpoints of the metatarsals, the sural neurofasciocutaneous flaps were divided into a forefoot group (flaps with furthest edges distal to the connecting line) and a peri-ankle group (flaps with the furthest edges proximal to the connecting line). RESULTS: The partial necrosis rate in the forefoot group (14.5%, 10/69) was significantly higher than that in the peri-ankle group (7.0%, 25/356), with significant difference (P<0.05). Using the flap alone or in combination with a simple salvage treatment, the ratio of successful coverages of the defects was 98.6% (68/69) in the forefoot group, and 97.8% (348/356) in the peri-ankle group, respectively, with no statistical difference (P>0.05). CONCLUSIONS: The sural neurofasciocutaneous flap is a better choice for covering the soft tissue defects over the forefoot distal to the connecting line of midpoints of the metatarsal bones. The survival reliability of the sural neurofasciocutaneous flap reconstructing the soft tissue defect proximal to the connecting line is superior to that of the flap reconstructing the defect distal to the connecting line.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Tornozelo/cirurgia , Humanos , Reprodutibilidade dos Testes , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos
7.
J Bodyw Mov Ther ; 30: 53-59, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35500979

RESUMO

BACKGROUND: Reduced ankle dorsiflexion is associated with lower limb injury and dysfunction, with static stretching mostly used to increase ankle range of motion. Foam rolling is an alternative intervention, shown to immediately increase ankle range of motion, while the long-term application has conflicting evidence. AIMS: To assess the effects of single and multiple foam rolling interventions on ankle dorsiflexion range of motion in healthy adults and appraise the methodological quality of the included studies. DESIGN: Systematic literature review. METHODS: Five electronic databases were systematically searched to identify randomised controlled trials reporting the effects of foam rolling on ankle dorsiflexion. Data was extracted from studies that met the inclusion criteria and independently appraised by each reviewer using the PEDro scale. RESULTS: Thirty-two articles were identified; six studies included foam rolling compared to other interventions on ankle dorsiflexion range of motion. Five of the six studies reported a significant increase (p < 0.05) in ankle dorsiflexion within groups compared to baseline measurements, after a single foam rolling intervention. One study found a significant within group increase in long-term effects after foam rolling on ankle dorsiflexion over seven weeks. The mean PEDro score for all studies was 6/10 indicating a high-quality level of evidence. CONCLUSION: There is strong evidence suggesting that foam rolling may be effective in increasing range of motion in a healthy adult population in the short term up to 30 min; however, definitive conclusions on long-term effects cannot be drawn due to a lack of evidence, with further research recommended.


Assuntos
Tornozelo , Exercícios de Alongamento Muscular , Adulto , Articulação do Tornozelo , Humanos , Extremidade Inferior , Amplitude de Movimento Articular
8.
Med Eng Phys ; 103: 103789, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35500990

RESUMO

Restoration of ankle kinematic functions is the major objective following total ankle arthroplasty (TAA). However, the clinical results of traditional ankle implants are still unsatisfactory. Anatomic ankle implant may provide better ankle kinematic functions and load distribution. In this study, the biomechanical performances between two potential anatomic ankle implants and a commercial INBONE II implant were compared using a previously developed patient-specific musculoskeletal multibody dynamics model during walking. Furthermore, the effects of the different height differences between the medial and lateral borders on the ankle biomechanics and kinematics were also investigated. Significant improvements in kinematic functions especially in internal-external rotation and inversion-eversion, and in load balance between the medial and lateral contacts of the two anatomic ankle implants were observed, as compared to the INBONE II ankle implant. The design of anatomic ankle implant with the medial peak higher than the lateral peak had better performance in restoring the internal-external rotation and balancing the medial and lateral contact forces. The kinematics and loads were not sensitive to the height difference for the anatomic ankle implant with medial border higher than lateral border. The anatomic articular surface design of artificial ankle implant can provide better tibiotalar joint kinematics and loading, therefore, anatomic ankle implant should be considered in the future implant design and surgical procedures.


Assuntos
Tornozelo , Artroplastia de Substituição do Tornozelo , Tornozelo/cirurgia , Articulação do Tornozelo/cirurgia , Fenômenos Biomecânicos , Humanos , Próteses e Implantes
9.
Biomed Res Int ; 2022: 6234561, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35496050

RESUMO

Background: This study is aimed at exploring the prognostic value of preoperative lymphocyte-to-monocyte ratio (LMR), an index of systemic inflammation before operation, in ankle lateral ligament repair (ALLR). Methods: A total of 213 I-III degrees injuries of lateral ankle ligament patients received ALLR and were followed up for more than 2 years. Univariate and multivariable linear regression analysis was used to determine the relationship between preoperative LMR and postoperative recovery. The evaluations of postoperative recovery include American Orthopaedic Foot and Ankle Society (AOFAS) score, Karlsson-Peter ankle score (KPAS), Cumberland Ankle Instability Tool (CAIT) score, Visual Analog Scale (VAS) score, and range of motion (ROM). The prognostic value of preoperative LMR was measured by receiver operating characteristic (ROC) curve. Results: 178 patients (178 ankles) were followed up successfully, with a follow-up of 2.82 ± 1.54 years. Overall, the mean AOFAS, KPAS, CAIT and VAS scores, and ankle varus angle were significantly improved at the final follow-up. Univariate and multiple linear regression analysis showed that preoperative LMR was the only independent factor associated with postoperative function, ROM, and pain. The preoperative LMR of patients with poor recovery was significantly lower than that of patients with good recovery. Based on the ROC analysis, the cutoff value of preoperative LMR was 3.824. The clinical outcomes of patients with preoperative LMR < 3.824 were significantly lower than that of patients with preoperative LMR ≥ 3.824. The corresponding specificity and sensitivity were 84.6% and 71.4%. Conclusion: The clinical outcomes of open or arthroscopic repair for ATFL injury are satisfactory. As a marker of systemic inflammation, preoperative LMR can be used as a prognostic indicator for ALLR.


Assuntos
Instabilidade Articular , Ligamentos Laterais do Tornozelo , Tornozelo , Artroscopia , Humanos , Inflamação , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/cirurgia , Linfócitos , Monócitos
10.
Ned Tijdschr Geneeskd ; 1662022 03 24.
Artigo em Holandês | MEDLINE | ID: mdl-35499595

RESUMO

A 13-year-old girl presented to the traumatology outpatient clinic with a painful right ankle after an inversion trauma. She was unable to bear weight on the right foot. Additional radiographic imaging and CT-scan revealed a Tillaux fracture of the right ankle. As the fracture fragment was displaced 8 mm, open reduction and screw fixation was performed to restore the anatomy of the ankle joint.


Assuntos
Traumatismos do Tornozelo , Fraturas da Tíbia , Adolescente , Tornozelo , Traumatismos do Tornozelo/complicações , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Fraturas da Tíbia/cirurgia
11.
Medicine (Baltimore) ; 101(17): e29230, 2022 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-35512083

RESUMO

ABSTRACT: The goniometer is the gold-standard measurement tool of ankle range of motion (ROM). However, several studies have questioned its inter- and intra-rater reliability. Therefore, we conducted this validation study to assess the reliability of a different tool, named Equinometer, as a measurement device of ankle ROM in addition to comparing the reproducibility of their results.Sixteen healthy individuals were included. They underwent both goniometer and Equinometer measurements in knee extension and 90° knee flexion (Silfverskjöld Test). Three raters reported the values of dorsiflexion (DF) and plantarflexion (PF) in each session using both measurement tools. Intra-rater reliability was assessed between 2 raters on another study group of 24 participants. Intraclass correlation coefficients were used to determine the reliability of the used device.The age of study subjects ranged from 22 to 85 years. Fifty percent were males, and the right ankle joint was the most examined side (68.75%). In terms of DF and PF during knee extension and flexion, our analysis revealed that the measurements recorded by the Equinometer were equivalent to the goniometer. Of note, the intra-rater reliability of the Equinometer was excellent for both DF and PF assessment during both knee flexion and extension (Intraclass correlation coefficient ranged from 0.90 to 0.98), with minimal mean differences from goniometer measurements. Subgroup analysis based on age did not reveal any significant differences (P > .05).Given the high intra-rater correlations of the Equinometer, we suggest that it is reliable and precise in recording ankle ROM in outpatient clinics, particularly to obtain reproductive, comparable and unbiased data from different observers.


Assuntos
Articulação do Tornozelo , Paralisia Cerebral , Adulto , Idoso , Idoso de 80 Anos ou mais , Tornozelo , Paralisia Cerebral/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Reprodutibilidade dos Testes , Adulto Jovem
12.
Acta Orthop Belg ; 88(1): 121-125, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35512162

RESUMO

Management of symptomatic osteoarthritis (OA) of the ankle in patients with haemophilia can be challenging. Arthroscopic ankle arthrodesis has been shown in non-haemophiliac patients to provide similar or superior rates of fusion to open ankle fusion. However, the literature regarding ankle arthrodesis in patients with haemophilia is limited. Our aim was to compare the rate of successful fusion between open and arthroscopic assisted ankle arthrodesis in patients with haemophilia. A retrospective study was performed. All patients with haemophilia who underwent ankle arthrodesis at our centre were included. Outcomes including peri- and post-operative complications, and lengths of stay were extracted from patients' records. Radiographs were reviewed for signs of successful arthrodesis. Seventeen arthrodesis procedures were performed in 13 patients between 1980 and 2017. Nine procedures were performed arthroscopically and eight were open. Ten patients were diagnosed with haemophilia A and three with haemophilia B. The success rates of arthroscopic and open tibiotalar arthrodesis were 100% and 87.5% respectively. Four complications occurred. In the open technique group, there was one non-union. The same patient also developed subsequent haematoma after revision surgery. One patient developed a superficial wound infection which resolved with antibiotics. In the arthroscopic group, one patient developed a pseudoarthrosis of the distal tibiofibular joint which required a revision procedure. The results of this study suggest that arthroscopic ankle fusion for haemophilia- associated arthropathy is a viable option, with the rate of successful fusion being comparable to open procedures.


Assuntos
Hemofilia A , Osteoartrite , Tornozelo , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Artrodese/métodos , Artroscopia , Hemofilia A/complicações , Hemofilia A/cirurgia , Humanos , Osteoartrite/complicações , Osteoartrite/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
13.
Eur Rev Med Pharmacol Sci ; 26(8): 2944-2948, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35503638

RESUMO

OBJECTIVE: The aim of the present study was to retrospectively compare the outcomes of two minimally invasive surgical techniques in patients with isolated anterior talofibular ligament (ATFL) lesion suffering from chronic ankle instability (CAI). PATIENTS AND METHODS: Thirty-six patients with ATFL lesion suffering from CAI were treated at our department from 2010 to 2017 and retrospectively reviewed after an average time of 4 years (2 to 9 years). Eighteen patients underwent a four-step operative protocol, including: synovectomy, debridement of ATFL lesion borders, capsular shrinkage, and 21-day immobilization and non-weightbearing. Eighteen patients underwent arthroscopic Broström procedure. Patients were assessed pre-operatively and at follow-up with American Orthopedic Foot & Ankle Society Score (AOFAS) scale, Karlsson-Peterson score, Tegner activity level, and objective examination comprehending range of motion, anterior drawer test, and talar tilt test. Wilcoxon test was utilized to compare the pre-operative and follow-up status. The Mann-Whitney U test was used to make comparisons between the two surgical techniques. Statistical significance was established at p < 0.05. RESULTS: Mean overall AOFAS, Karlsson-Peterson and Tegner scores significantly increased at follow-up compared to pre-operatory status (p < 0.05). However, no statistically significant differences concerning mean AOFAS score (90.2 in the four-step group vs. 89.2 in the Broström arthroscopic group), mean Karlsson-Peterson score (88.1 and 85.9 respectively), and median Tegner activity level (6.0 vs. 5.5) were reported between the two groups (p = n.s.). The complications in the arthroscopic four-step treatment group included damage to the superficial branch of the peroneal nerve in one case. The complications in the arthroscopic Broström included nerve injury in one case and persistent local pain nearby suture knot in one case. CONCLUSIONS: Both arthroscopic Broström and a four-step operative procedure including synovectomy, debridement of ATFL lesion borders, capsular shrinkage and immobilization, improved functional outcomes in patients with ATFL lesion suffering from CAI.


Assuntos
Instabilidade Articular , Ligamentos Laterais do Tornozelo , Tornozelo , Articulação do Tornozelo/cirurgia , Artroscopia , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/lesões , Ligamentos Laterais do Tornozelo/cirurgia , Estudos Retrospectivos
14.
J Pediatr Orthop ; 42(5): e448-e452, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35405728

RESUMO

BACKGROUND: This paper aims to report on the last 5 years of relevant research on pediatric foot and ankle pathology with specific focus on clubfoot, congenital vertical talus, toe walking, tarsal coalitions, pes planovalgus with or without accessory navicular, foot and ankle trauma, and talar dome osteochondritis dessicans. METHODS: The Browzine platform was used to review the table of contents for all papers published in the following target journals related to the treatment of pediatric foot and ankle conditions. Search results were further refined to include clinical trials and randomized controlled trials published from March 1, 2015 to November 15, 2021. RESULTS: A total of 73 papers were selected for review based on new findings and significant contributions in treatment of clubfoot, congenital vertical talus, toe walking, tarsal coalitions, pes planovalgus with or without accessory navicular, foot and ankle trauma, and talar dome osteochondritis dessicans. Also included were several papers that did not fit into any of these categories but provided new insight into specific foot and ankle pathologies. CONCLUSIONS: Treatment strategies for children with foot and ankle pathology are continually evolving. We review many of the most recent publications with the goal of improving understanding of these pathologies and highlighting current best practices. LEVEL OF EVIDENCE: Level III.


Assuntos
Pé Torto Equinovaro , Pé Chato , Osteocondrite Dissecante , Coalizão Tarsal , Tornozelo , Criança , Doenças do Pé , Humanos , Ossos do Tarso/anormalidades
15.
Clin Podiatr Med Surg ; 39(2): 233-272, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35365325

RESUMO

The correction of the deformed arthritic foot and ankle is a complicated and somewhat controversial topic. After conservative methods fail, there is a wide range of possible bony procedures and arthrodesis that maybe performed. The appropriate work up and understanding of the pathomechanics is vital to the correct choice of procedures to correct these deformities. Once the work up and procedure selection is done, the operation must also be technically performed well and with efficiency, as most often the condition is corrected with a variety of procedures. This article discusses some of the most common procedures necessary to fully correct deformity of the midfoot, hindfoot, and ankle. This article will also discuss the authors' technique and pearls.


Assuntos
Tornozelo , , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Artrodese/métodos , Humanos , Extremidade Inferior
16.
Clin Podiatr Med Surg ; 39(2): 273-293, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35365326

RESUMO

Total ankle replacement (TAR) continues to increase in popularity as a motion-preserving option to ankle arthrodesis. TAR is indicated for primary, posttraumatic and inflammatory arthropathies as an alternative procedure to tibiotalar arthrodesis. Proper patient selection is paramount to a successful outcome in TAR. Contraindications to TAR include the presence of neuropathy, active infection, severe peripheral arterial disease, inadequate bone stock, and severe uncorrectable coronal plane deformity. This article is a brief overview of techniques and PEARLS on how to address a well-aligned ankle joint, varus deformity as well as valgus deformities as well as the authors' experience with single versus staging coronal plane deformities.


Assuntos
Artrite , Artroplastia de Substituição do Tornozelo , Tornozelo/cirurgia , Articulação do Tornozelo/anormalidades , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Artrite/cirurgia , Artroplastia de Substituição do Tornozelo/métodos , Humanos , Amplitude de Movimento Articular
17.
Clin Podiatr Med Surg ; 39(2): 307-319, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35365328

RESUMO

A review of the literature regarding the evaluation and management of osteomyelitis and discussion on clinical, radiographic, laboratory, and pathologic findings with both acute and chronic cases is presented. Cases illustrate the complexities that can typically present at an academic setting, which often require a stepwise approach and interdisciplinary collaboration. Surgical pearls and ancillary treatment of osteomyelitis highlight the technical challenges and surgeons' preferences.


Assuntos
Diabetes Mellitus , Pé Diabético , Osteomielite , Amputação , Tornozelo , Articulação do Tornozelo , Pé Diabético/complicações , Pé Diabético/cirurgia , Humanos , Osteomielite/diagnóstico por imagem , Osteomielite/cirurgia
18.
Clin Podiatr Med Surg ; 39(2): 331-341, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35365330

RESUMO

Charcot neuroarthropathy (CN) of the foot/ankle is a devastating complication that can occur in neuropathic patients. It is a progressive and destructive process that is characterized by acute fractures, dislocations, and joint destruction that will lead to foot and/or ankle deformities. Early diagnosis is imperative, and early treatment may be advantageous, but the condition is not reversible. There is no cure for CN but only treatment recommendations. Ultimate goals of care should include providing a stable limb for ambulation and no ulcerations.


Assuntos
Tornozelo , Artropatia Neurogênica , Tornozelo/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Artropatia Neurogênica/diagnóstico por imagem , Artropatia Neurogênica/cirurgia , Humanos
19.
BMC Musculoskelet Disord ; 23(1): 321, 2022 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-35379211

RESUMO

BACKGROUND: For knee osteoarthritis (OA) treatment, it is important to correct the lower limb alignment including the foot. However, in the upright position, lower limb alignment is generally assessed from the body surface or radiographs, and it is a challenge to capture the exact characteristics of three-dimensional lower limb alignment. The purpose of the study was to measure lower limb alignment in patients with knee OA using upright computed tomography (CT) and radiography, and to identify features of knee joint deformity. METHODS: A total of 45 limbs in 25 patients with knee OA were enrolled. The subjects underwent both upright CT and radiography for the whole lower limb in the standing position. The joint angles were calculated on both images. The degree of knee OA was classified according to Kellgren-Lawrence (KL) grade by referring to radiography, which is mainly based on the degree of articular cartilage loss and severity of osteophytes, and the characteristics or correlation between knee and ankle joint in each group was investigated. RESULTS: In KL-I, there was an association between varus of the knee joint and internal rotation of the talocrural joint (r = 0.76, P < 0.05). In KL-II, there was an association between varus of the knee joint and eversion of the subtalar joint (r = 0.63, P < 0.05) and talocrural joint (r = - 0.65, P < 0.05). In KL-III, there was an association between varus of the knee joint and internal rotation of the subtalar joint (r = - 0.62, P < 0.05), and in KL-IV, there was an association between varus of the knee joint and internal rotation of the subtalar joint (r = - 0.58, P < 0.05). CONCLUSIONS: The lower limb alignment of patients with knee OA in the standing position was found that as knee OA worsened, it became apparent that compensatory knee joint alignment depended on the ankle joint rather than the subtalar joint. The results may help in the rehabilitation of patients with knee OA, since the ankle joint alignment has a significant impact on the knee joint during coarse movements involving load.


Assuntos
Articulação do Tornozelo , Mau Alinhamento Ósseo , Tornozelo , Articulação do Tornozelo/diagnóstico por imagem , Mau Alinhamento Ósseo/diagnóstico por imagem , Humanos , Articulação do Joelho/diagnóstico por imagem , Extremidade Inferior , Posição Ortostática , Tomografia Computadorizada por Raios X
20.
BMC Musculoskelet Disord ; 23(1): 317, 2022 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-35379212

RESUMO

BACKGROUND: Ankle fractures are a common injury and the main cause of post-traumatic ankle arthritis. The prevalence of obesity is increasing worldwide, and this population is known to have poorer short and midterm outcomes after ankle fractures. Our objective is to assess long-term patient-reported outcomes in patients with operatively treated ankle fractures, and the effect of BMI on these results using the new and validated patient-reported outcome questionnaire, the Manchester Oxford foot and ankle questionnaire (MOXFQ). METHODS: We performed a retrospective review of all ankle fractures treated operatively in a ten-year period from 2002-2012. The MOXFQ and SF-12 were sent to all patients and were obtained, on average, 11.1 years after surgery (range 5.3-16.2 years). RESULTS: Two thousand fifty-five ankle fractures were reviewed, of which 478 (34%) patients completed the questionnaires. The mean age was 48.1 ± 15.5 years, 52% were men and the mean BMI was 26.1 ± 4.5 kg/m2. Of the 478, 47% were of normal weight, 36% were overweight, and 17% were obese. Overall, 2.1% were type A, 69.9% B, and 24.9% type C fractures. There were no significant differences in the type of fracture between the BMI groups. Comparing obese and non-obese patients, there were large differences in MOXFQ pain (33 ± 29 vs. 18.7 ± 22.1, effect size 0.55), and function scores (27.3 ± 29 vs. 12.5 ± 21.1, effect size 0.58). No differences in complications and reoperations rates were observed. The BMI value at surgery correlated more strongly with the MOXFQ pain score than the BMI at follow-up (Spearman's Rho 0.283 vs. 0.185, respectively). CONCLUSION: These findings reveal that obese patients have significant worse long-term outcomes, namely increased pain, poorer function, and greater impairment in everyday life after an operatively treated ankle fracture. Moreover, pain and function linearly declined with increasing BMI. Our findings appear to indicate that increased BMI at surgery is an important contributor to adverse outcome in the operative management of rotational ankle fractures. LEVEL OF EVIDENCE: III.


Assuntos
Fraturas do Tornozelo , Adulto , Tornozelo , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/epidemiologia , Fraturas do Tornozelo/cirurgia , Articulação do Tornozelo/cirurgia , Índice de Massa Corporal , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade
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