Talar Dome Osteochondral Lesions: Pre- and Postoperative Imaging.

We suggest a similar approach to evaluating osteochondral lesions of the talar dome both pre- and postoperatively. This review addresses the etiology, natural history, and treatment of talar dome osteochondral lesions with an emphasis on imaging appearances. High-resolution magnetic resonance imaging, ideally combining a small field-of-view surface coil with ankle traction, optimizes visibility of most of the clinically relevant features both pre- and postoperatively.

Screening for laterally deviated plantar pressure during stance using the Cumberland ankle instability tool and anthropometric measures.

This study developed a method that predicts laterally deviated plantar pressure during stance by lower limb anthropometrics and self-reported ability to stop an ankle which has started to roll over. Thirty-two males ran on a treadmill for 2 minutes at 11 km/h. Foot pressure data were collected by a pressure insole system for classifying the participants as medial or lateral strikers. Cumberland Ankle Instability Tool score, Tegner Activity Scale score, foot arch height, active and passive ankle and knee range of motion, bi-malleolar width, foot length, foot width and calf circumference were measured. Binary logistic regressions were performed to produce a model which estimated if an individual showed laterally deviated foot pressure during stance. The model utilized the score of Cumberland Ankle Instability Tool Question 8, active and passive knee joint external rotation, height, body mass and bimalleolar width (explained variance of 47.3%, p = 0.037), producing a sensitivity of 71.4% and a specificity of 54.5%. A validation trial on another 15 runners reported a 73.3% accuracy in prediction if they are medial or lateral strikes.

Arthroscopic Lateral Soft Tissue Release for Hallux Valgus.

Release of the tight lateral soft tissue is an important procedure during surgery for hallux valgus. The authors describe an arthroscopic assisted lateral soft tissue release technique that is minimally invasive and easy to perform, while also providing precise visualization of the released structures.

Controlled trial to compare the Achilles tendon load during running in flatfeet participants using a customized arch support orthoses vs an orthotic heel lift.

BACKGROUND: Achilles tendinopathy is one of the most common overuse injuries in running, and forefoot pronation, seen in flatfeet participants, has been proposed to cause additional loading across the Achilles tendon. Foot orthoses are one of the common and effective conservative treatment prescribed for Achilles tendinopathy, it works by correcting the biomechanical malalignment and reducing tendon load. Previous studies have shown reduction of Achilles Tendon load (ATL) during running by using customized arch support orthosis (CASO) or an orthotic heel lift (HL). However, there are still little biomechanical evidence and comparative studies to guide orthotic prescriptions for Achilles tendinopathy management. Therefore, this study seeks to investigate the two currently employed orthotic treatment options for Achilles tendinopathy: CASO and HL for the reduction of ATL and Achilles tendon loading rate (ATLR) in recreational runners with flatfeet. METHODS: Twelve participants were recruited and run along the runway in the laboratory for three conditions: (1) without orthoses, (2) with CASO (3) with HL. Kinematic and kinetic data were recorded by 3D motion capturing system and force platform. Ankle joint moments and ATL were computed and compared within the three conditions. RESULTS: Participants who ran with CASO (p = 0.001, d = 0.43) or HL (p = 0.001, d = 0.48) associated with a significant reduction in ATL when compared to without orthotics while there was no significant difference between the two types of orthoses, the mean peak ATL of CASO was slightly lower than HL. Regarding the ATLR, both orthoses, CASO (p = 0.003, d = 0.93) and HL (p = 0.004, d = 0.78), exhibited significant lower value than the control but similarly, no significant difference was noted between them in which the use of CASO yielded a slightly lower loading rate than that of HL. CONCLUSIONS: Both CASO and HL were able to cause a significant reduction in peak ATL and ATLR comparing to without orthotics condition. There were subtle but no statistically significant differences in the biomechanical effects between the two types of orthoses. The findings help to quantify the effect of CASO and HL on load reduction of Achilles tendon and suggests that foot orthoses may serve to prevent the incidence of Achilles tendon pathologies. TRIAL REGISTRATION: NCT04003870 on clinicaltrials.gov 1 July 2019.

Endoscopy-Assisted Hallux Valgus Correction Provides Sustainable Long-Term >10-Year Outcomes.

PURPOSE: This study aims to review the long-term efficacy of the endoscopy-assisted distal soft-tissue procedure (EDSTP) and to see whether operative correction can be maintained for >10 years. METHODS: All hallux valgus cases undergoing EDSTP from 2000 to 2006 were recruited. Preoperative, postoperative, and 10-year follow-up x-rays were analyzed. A pain score from the preoperative and >10-year follow-up was recorded. The American Orthopaedic Foot and Ankle Society (AOFAS) hallux score and Foot and Ankle Outcome Score (FAOS) were measured at the >10-year follow-up. RESULTS: A total of 85 cases met the inclusion criteria with an EDSTP performed between January 2000 and December 2006 and had a follow-up of >10 years. Hallux valgus angle corrected from 25.8° to 11.2° (P < .001), 1,2 intermetatarsal angle (1,2 IMA) improved from 13.5° to 9.5° (P < .001), and the tibial sesamoid position changed from 4 to 1 (P < .001). Pain improved from preoperative 6.5/10 to 0.5/10 (P < .001). AOFAS score was 93.5/100 at >10-year follow-up, and the FAOS was good in all 5 subcategories (range, 72.6-89.3). CONCLUSIONS: Our results show that the EDSTP has good early postoperative results that are maintained for >10 years. It provides good long-term radiological correction, in addition to lasting pain relief and great foot function, using only 5 incisions. LEVEL OF EVIDENCE: Level IV, case series.

Prevalence of dance-related injuries and associated risk factors among children and young Chinese dance practitioners.

While Chinese dance is a popular dance genre among Chinese teenagers and adults, little is known regarding the prevalence of dance-related injuries or factors associated with such injuries among Chinese dance practitioners. The current cross-sectional study aimed to determine the prevalence of dance-related injuries and their associated risk factors among young Chinese dance practitioners in Hong Kong. Online surveys were distributed to dancers through local dance associations, while paper-based surveys were distributed to young Chinese dance performers during the 54th School Dance Festival in Hong Kong. Self-reported hours of dancing, injuries in the last 12 months, injury sites, and related factors were collected. The injury rate, 12-month prevalence of dance-related injuries were determined. Risk factors for common dance injuries were analyzed using separate multivariate regression models. A total of 175 children (aged 10-14 years) and 118 young (aged 15-24 years) Chinese dance practitioners provided their dance injury information. Young dancers had a significantly higher injury rate (6.5 injuries vs 4.6 injuries/1000 dance hours) and 12-month prevalence (52.5% vs 19.4%) than their child counterparts. The most commonly injured sites were the knee (children:7.4%; young:15.3%), lower back (children: 4.6%; young: 9.5%), and ankles (children: 5.1%; young: 16.9%). Age was a significant independent risk factor for dance-related injuries to the upper back, lower back, and pelvis/buttock (odds ratios ranging from 1.2 to 1.3/additional years). Additionally, height was a significant independent risk factor for lower limb injury (odds ratios ranging from 1.0-1.1/additional centimeter). Collectively, young Chinese dance practitioners are more vulnerable to dance-related injuries than are child dancers. Older age increases the risk of trunk injuries, whereas taller dancers are more likely to sustain lower-limb injuries. Future research should determine the mechanisms underlying dance-related injuries among these dancers.

Comparison of Dance-Related Foot and Ankle Injuries Among Pre-Professional Ballet, Contemporary, and Chinese Dancers.

BACKGROUND: Foot and ankle injuries have been noted as the most common in dancers. However, the variability of injury epidemiology across different dance genres has not been clearly evaluated. Herein, this study aimed to evaluate the prevalence and incidence of foot and ankle problems in pre-professional ballet, contemporary, and Chinese dancers.
Methods: Participants (N = 54) were recruited from a local dance institution that offered a formal undergraduate dance program. Demographic characteristics and specifics of foot and ankle pain during dancing were collected through an online self-reporting survey from September 2018 to June 2019. Descriptive statistical analyses, including injury incidence and risk rates, were conducted.
Results: The overall response rate was 69.3%, with a total of 88 subjects eligible for analysis of which the results from 54 subjects were ultimately analyzed. The incidence of foot and ankle pain during the academic year of 2018 to 2019 was highest in contemporary dancers (0.38 per 1,000 dance hours) when compared to that of ballet (0.32 per 1,000 dance hours) and Chinese dancers (0.22 per 1,000 dance hours). Prevalence of foot and ankle pain within the same year was 84% in ballet dancers, 79% in Chinese dancers, and 70% in contemporary dancers. Ballet dancers were six times more likely to suffer from pain in the Achilles region than Chinese and contemporary dancers (p < 0.01). Chinese dancers were found to experience more forefoot and midfoot problems compared to ballet and contemporary dancers (p < 0.05).
Conclusion: This study illustrated that foot and ankle pain is highly prevalent among pre-profes- sional dancers. Ballet was associated with the highest prevalence of foot-ankle pain while contemporary dance was associated with the highest incidence. There were significant differences of foot and ankle pain among dance genres and anatomical subregions, which suggests a need for targeted genre-specific injury prevention programs in hopes of preventing potentially career-ending injuries in dancers.

APKASS Consensus Statement on Chronic Syndesmosis Injury, Part 1: Clinical Manifestation, Radiologic Examination, Diagnosis Criteria, Classification, and Nonoperative Treatment.

BACKGROUND: Clinical manifestation, radiologic examination, diagnostic criteria, classification, and nonoperative treatment strategies regarding chronic syndesmosis injury remain unclear. PURPOSE: An international group of experts representing the fields of sports injuries in the foot and ankle area were invited to collaboratively advance toward consensus opinions based on the best available evidence regarding chronic syndesmosis injuries. All were members of the Asia-Pacific Knee, Arthroscopy and Sports Medicine Society (APKASS). STUDY DESIGN: Consensus statement. METHODS: From November to December 2020, a total of 111 international experts on sports medicine or ankle surgery participated in a 2-stage Delphi process that included an anonymous online survey and an online meeting. A total of 13 items with 38 statements were drafted by 13 core authors. Of these, 4 items with 15 clinical questions and statements were related to the clinical manifestation, radiologic examination, diagnostic criteria, classification, and nonoperative treatment strategies for chronic syndesmosis injury and are presented here. Each statement was individually presented and discussed, followed by a general vote. The strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; unanimous, 100%. RESULTS: Of the 15 questions and statements, 5 reached unanimous support and 10 achieved strong consensus. CONCLUSION: This APKASS consensus statement, developed by international experts in the field, will assist surgeons and physical therapists with diagnosis, classification, and nonoperative treatment strategies for chronic syndesmosis injury.

APKASS Consensus Statement on Chronic Syndesmosis Injury, Part 3: Fusion Techniques, Comorbidity Treatments, Postoperative Rehabilitation, and Return-to-Sport Indications.

BACKGROUND: Questions regarding surgical fusion techniques, postoperative treatment, and indications for return to sport after chronic syndesmosis injury or its comorbidities remain unanswered. PURPOSE: An international group of experts representing the field of injuries in the foot and ankle area was invited to collaboratively advance toward consensus opinions based on the best available evidence regarding chronic syndesmosis injury. All were members of the Asia-Pacific Knee, Arthroscopy and Sports Medicine Society (APKASS). STUDY DESIGN: Consensus statement. METHODS: From November to December 2020, a total of 111 international experts on sports medicine or ankle surgery participated in a 2-stage Delphi process that included an anonymous online survey and an online meeting. A total of 13 items with 38 statements were drafted by 13 core authors. Of these, 4 items with 6 clinical questions and statements were related to surgical fusion techniques, comorbidity treatments, postoperative rehabilitation, and return-to-sports indications and are presented here. Each statement was individually presented and discussed, followed by a general vote. The strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; and unanimous, 100%. RESULTS: Of the 6 questions and statements, 5 achieved unanimous support and 1 reached strong consensus. CONCLUSION: This APKASS consensus statement, developed by international experts in the field, will assist surgeons and physical therapists with surgical and postoperative treatment strategies for chronic syndesmosis injury.

APKASS Consensus Statement on Chronic Syndesmosis Injury, Part 2: Indications for Surgical Treatment, Arthroscopic or Open Debridement, and Reconstruction Techniques of Suture Button and Screw Fixation.

BACKGROUND: The indications for surgical treatment of chronic syndesmosis injury are challenging for many orthopaedic clinicians, as there is no international consensus on the optimal management of these injuries. PURPOSE: An international group of experts representing the field of sports injuries in the foot and ankle area was invited to collaboratively advance toward consensus opinions based on the best available evidence regarding chronic syndesmosis injury. All were members of the Asia-Pacific Knee, Arthroscopy and Sports Medicine Society (APKASS). STUDY DESIGN: Consensus statement. METHODS: From November to December 2020, a total of 111 international experts on sports medicine or ankle surgery participated in a 2-stage Delphi process that included an anonymous online survey and an online meeting. A total of 13 items with 38 statements were drafted by 13 core authors. Of these, 9 items with 17 clinical questions and statements were related to indications for surgical treatment, arthroscopic versus open debridement, and suture button versus screw fixation reconstruction techniques and are presented here. Each statement was individually presented and discussed, followed by a general vote. The strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; and unanimous, 100%. RESULTS: Of the 17 questions and statements, 4 achieved unanimous support, 11 reached strong consensus, and 2 reached consensus. CONCLUSION: This APKASS consensus statement, developed by international experts in the field, will assist surgeons and physical therapists with surgical indications and techniques for chronic syndesmosis injury.

Randomised control trial on the optimal duration of non-weight-bearing walking after hallux valgus surgery.

INTRODUCTION: Hallux valgus surgery is one of the most commonly performed operations in Orthopaedics. Multiple surgical techniques have been described including arthrodesis, osteotomies and soft tissue procedures. The endoscopic-assisted distal soft tissue procedure is one of the minimally invasive surgical options with a good long-term outcome. The rehabilitation protocol for this soft tissue procedure consists of 6-weeks of non-weight bearing walking. This prolonged period of non-weight-bearing walking may ensure a good stabilization of the alignment but is difficult for the patient from a social-economical perspective. In addition, earlier mobilisation has other theoretical advantages including less atrophy and better range of motion. The objective of this trial is to investigate the effect of an earlier weight-bearing regime at 2-weeks post-surgery. METHODS: Randomised control trial of patients undergoing the endoscopic-assisted distal soft tissue procedure. Allocation and randomization of subjects were performed immediately after completion of surgery to avoid intra-operative biases. The control group underwent the usual protocol of 6-weeks of non-weight-bearing walking while the intervention group underwent 2-weeks of post-operative non-weight-bearing walking. Foot function was measured using the Foot and Ankle Outcome Score (FAOS) at the baseline, 12-week post-surgery and 26-weeks post-surgery. The hallux valgus angle, 1,2 inter-metatarsal angle and tibial sesamoid position were also measured during those time-points. RESULTS: A total of 51 participants completed the study, 29 in the control group and 22 in the early weight-bearing group. 1 patient form the early weight-bearing group was complicated with hallux varus requiring revision surgery. All the patients had significantly improved radiological angles and foot function in both the control and early weight-bearing group. At the 12-week time point, the radiological angles were the same for both groups but foot function was significantly better in the early weightbearing group. DISCUSSION: Early postoperative weight-bearing did not lead to pre-mature implant failures or increased recurrence rates. It actually resulted in fewer symptoms like stiffness, lessened pain, better performance in daily activities and a better quality of life. CONCLUSION: Early weight-bearing walking at 2-week after distal soft tissue reconstruction of hallux valgus is not only safe, it may help accelerate the rehabilitation process and allow patients to return their usual life faster.The translational potential of this article: Being a clinical trial, our results are directly translatable to hallux valgus patients. The results of this study show that a shortened non-weight bearing duration after hallux valgus surgery improves foot function at 12 weeks while not affecting recurrence risks.

Stonefish envenomation with acute carpal tunnel syndrome.

Stonefish envenomation is a common marine sting. Although stonefish injuries are commonly sustained during maritime activities, this local delicacy can also be considered a regional occupational hazard for chefs. The availability and consumption of stonefish in local restaurants has increased the risk of acute carpal tunnel syndrome after a stonefish injury. This case report describes acute carpal tunnel syndrome following stonefish envenomation. An excellent recovery was achieved after surgical decompression of the carpal tunnel syndrome. Standard management of stonefish injuries should therefore take into account the possibility that this orthopaedic emergency may complicate the injury.

Reliability and validity analysis of the open-source Chinese Foot and Ankle Outcome Score (FAOS).

AIM: Develop the first reliable and validated open-source outcome scoring system in the Chinese language for foot and ankle problems. METHODS: Translation of the English FAOS into Chinese following regular protocols. First, two forward-translations were created separately, these were then combined into a preliminary version by an expert committee, and was subsequently back-translated into English. The process was repeated until the original and back translations were congruent. This version was then field tested on actual patients who provided feedback for modification. The final Chinese FAOS version was then tested for reliability and validity. Reliability analysis was performed on 20 subjects while validity analysis was performed on 50 subjects. Tools used to validate the Chinese FAOS were the SF36 and Pain Numeric Rating Scale (NRS). Internal consistency between the FAOS subgroups was measured using Cronbach's alpha. Spearman's correlation was calculated between each subgroup in the FAOS, SF36 and NRS. RESULTS: The Chinese FAOS passed both reliability and validity testing; meaning it is reliable, internally consistent and correlates positively with the SF36 and the NRS. DISCUSSION AND CONCLUSIONS: The Chinese FAOS is a free, open-source scoring system that can be used to provide a relatively standardised outcome measure for foot and ankle studies.

5-year results of the 1.5cm incision Achilles tendon repair.

BACKGROUND: To study a hypothesis that the cost-effective 1.5cm medial incision Achilles tendon repair technique will provide good functional outcomes which are maintained for over 5 years. METHOD: Prospective study of 12 consecutive cases with a minimal 5-year follow-up were recruited from April 2008 to November 2010. Cases whom were mentally incompetent or those which required concomitant procedures were excluded. Outcomes measures included the numeric pain rating scale, motor power strength, range of motion, functional scoring using the AOFAS hindfoot score and patient's self-assessment using the Foot and Ankle Outcome Score (FAOS). RESULT: No re-ruptures or sural nerve injured were identified after a minimal 5-year follow-up. Pain was minimal at 0.5/10, calf power was 5/5 and ankle range was good (plantarflexion: 38°/dorsiflexion: 21°). The AOFAS hindfoot score was 97.4 and all 5 sub-categories of the Foot and Ankle Outcome Score (FAOS) were good. CONCLUSION: The 1.5cm medial incision repair of the Achilles tendon is an economically sound surgical technique, with minimal complications, which gives good medium length functional outcomes. LEVEL OF EVIDENCE: IV.