Biomechanical Evaluation of Different Fixation Methods for Percutaneous Extracapsular Transverse Cervical Metatarsal Osteotomy in a Hallux Valgus Sawbone Model.

Background: There is limited literature available that provide information about fixation methods for minimally invasive hallux valgus osteotomies. Our objective was to evaluate the strength of different fixation methods for a percutaneous extracapsular transverse cervical metatarsal (PTCM) osteotomy in a sawbone model.

Methods: Thirty solid foam sawbone foot models were used.

Neuropathic Deformities of the Lesser Toes.

Neuropathic deformities of the lesser toes refer to a variety of neuromuscular disorders in which a stiff lesser toe deformity is encountered. Claw toes, hammer toes, and mallet toes can be found. Each deformity is better described as which joint of a particular toe is in a flexed or extended position.

Evidence-Based Treatment Algorithm for Freiberg Disease.

Freiberg disease is a type of osteonecrosis of the metatarsal head that predominantly occurs in young females and adolescents, although it may occur at any age. The pathophysiology is multifactorial and may involve trauma, altered foot biomechanics, systemic disorders, and arterial insufficiency. The most typical location is the second metatarsal head, but Freiberg disease may also occur in other lesser toes.

Acute Deltoid Injury in Ankle Fractures: A Biomechanical Analysis of Different Repair Constructs.

Background: The importance of the deltoid ligament in the congruency and coupling of the tibiotalar joint is well known. The current trend is to repair it in cases of acute injuries in the context of ankle fractures; however, there is limited information on how it should be reconstructed. The objective of this study was to compare different deltoid ligament repair types in an ankle fracture cadaveric model.

The double posteromedial portals endoscopy for posterior ankle impingement syndrome in athletes.

Background: Posterior ankle impingement syndrome (PAIS) may result from flexor hallucis longus tendinopathy, compression of the posterior process of the talus from the presence of an os trigonum, soft-tissue impingement, or a combination of these. Posterior extra-articular endoscopy performed with the patient supine through the double posteromedial portals, with excision of adhesions, excision of the posterior process of the talus or an os trigonum, and decompression of the tendon of the flexor hallucis longus (FHL), can be used in athletes with PAIS.

Methods: Thirty-four athletes with PAIS in whom conservative management had failed underwent posterior ankle endoscopy in the supine position using the double posteromedial portals.

Biomechanical Cadaveric Evaluation of the Role of Medial Column Instability in Hallux Valgus Deformity.

Background: Medial column instability is a frequent finding in patients with flatfeet and hallux valgus, within others. The etiology of hallux valgus is multifactorial, and medial ray axial rotation has been mentioned as having an individual role. Our objective was to design a novel cadaveric foot model where we could re-create through progressive medial column ligament damage some components of a hallux valgus deformity.

Correction of Sagittal Plane Deformity of the Distal Tibia.

Distal tibia sagittal plane deformities are a frequent finding in tibial malunions (antecurvatum or recurvatum) or ankle posttraumatic arthritis (anterior or posterior ankle arthritis). They should be evaluated in all deformities using long leg and tibia radiographs. Measuring the anterior distal tibia angle is necessary to evaluate the deformity severity.

Correlation between indirect radiographic parameters of first metatarsal rotation in hallux valgus and values on weight-bearing computed tomography.

Purpose: To verify if indirect radiographic signs of first metatarsal pronation, determined by the head round sign, correspond to weight-bearing computed tomography (WBCT) measurements.

Methods: In this case-control retrospective study, we analyzed 26 hallux valgus (HV) feet and 20 controls through conventional radiograph (CR) and WBCT images. Two blinded orthopaedic foot and ankle surgeons performed the measurements.

Validity and Reliability of a New Radiological Method to Estimate Medial Column Internal Rotation in Hallux Valgus Using Foot Weight-Bearing X-Ray.

Background: Medial column internal rotation in hallux valgus (HV) can be measured using weight-bearing computed tomography (WBCT). Anteroposterior weight-bearing foot radiographs' (WBXR) ability to estimate medial column internal rotation in HV was evaluated comparing these measurements with those obtained from WBCT.

Methods: Three observers evaluated WBCT and WBXR of 33 HV feet twice.

Current Concepts in Treatment of Ligament Incompetence in the Acquired Flatfoot.

Flatfoot deformity consists of a loss of medial arch, hindfoot valgus, and forefoot abduction. Historically considered a posterior tendon insufficiency, multiple ligament damage and subsequent incompetence explain the different clinical presentations with varying degrees of deformity. When surgery is deemed necessary, depending on the apex of the deformity, skeletal and soft tissue procedures are considered to keep motion and restore function.

Metatarsal Pronation in Hallux Valgus Deformity: A Review.

Hallux valgus deformity is a multiplanar deformity, where the rotational component has been recognized over the past 5 to 10 years and given considerable importance. Years ago, a rounded shape of the lateral edge of the first metatarsal head was identified as an important factor to detect after surgery because a less rounded metatarsal head was associated to less recurrence. More recently, pronation of the metatarsal bone was identified as the cause for the rounded appearance of the metatarsal head, and therefore, supination stress was found to be useful to achieve a better correction of the deformity.

Comparison of Suture-Augmented Ligamentplasty to Transarticular Screws in a Lisfranc Cadaveric Model.

Background: Lisfranc injuries represent a spectrum of trauma from high-energy lesions, with significant instability of the midfoot, to low-energy lesions, with subtle subluxations or instability without gross displacement. Recently, treatment options that allow for physiologic fixation of this multiplanar joint are being evaluated. The purpose of this study was to analyze the stability of a cadaveric Lisfranc injury model fixed with a novel suture-augmented neoligamentplasty in comparison with a traditional transarticular screw fixation construct.

The Use of a Triplanar Metatarsal Rotational Osteotomy to Correct Hallux Valgus Deformities.

Proximal rotational metatarsal osteotomy (PROMO) is a technique that allows the surgeon to correct the varus and pronation of the first metatarsal that is observed in most patients with hallux valgus deformity. Persistent metatarsal pronation is a recognized recurrence factor for operatively treated hallux valgus. The indication for this technique is a mild-moderate hallux valgus deformity (i.

Mini-Open Achilles Tendon Rupture Repair.

Background: We present a mini-open Achilles tendon rupture repair technique, which does not open the paratenon and avoids the sural nerve. We perform it to recover the normal working length of the gastrocnemius-soleus complex musculotendinous unit as well as possible, trying to avoid soft-tissue complications.

Description: This repair is performed via a 3-cm-long incision that is placed 4 cm proximal to the Achilles tendon gap.

Role of Coronal Plane Malalignment in Hallux Valgus Correction.

Coronal malalignment is an important deformity parameter in hallux valgus feet. Approximately 90% of patients with hallux valgus have some degree of metatarsal pronation. In operated hallux valgus, persistent metatarsal pronation is an independent deformity relapse factor.

Biomechanical Evaluation With a Novel Cadaveric Model Using Supination and Pronation Testing of a Lisfranc Ligament Injury.

Background: Lisfranc joint injuries can be due to direct or indirect trauma and while the precise mechanisms are unknown, twisting or axial force through the foot is a suspected contributor. Cadaveric models are a useful way to evaluate injury patterns and models of fixation, but a frequent limitation is the amount of joint displacement after injury. The purpose of this study was to test a cadaveric model that includes axial load, foot plantarflexion and pronation-supination motion, which could re-create bone diastasis similar to what is seen in subtle Lisfranc injuries.

Incidence of and Functional Significance of Floating Toe After Weil Osteotomy.

Background: The most frequent complication after Weil osteotomies is a floating toe deformity, but there are no reports about its effect on the patient. In this study, we analyzed the consequences of floating toe deformities after the performance of a modified Weil osteotomy (MWO) or a modified Weil osteotomy with interphalangeal fixation (MWOIF).

Methods: We performed a retrospective review with a prospective follow-up of 50 patients (98% women, 120 rays) who underwent MWO (65 rays) or MWOIF (55 rays), with a mean age of 54 ± 12 years and a minimum follow-up of 4 years (mean of 6 years).

Proximal and Distal Failure Site Analysis in Percutaneous Achilles Tendon Rupture Repair.

Background: Different techniques have been described for percutaneous Achilles tendon rupture repair, but no biomechanical evaluation has been performed separately for proximal and distal suturing techniques. The purpose of this study was to biomechanically analyze proximal versus distal percutaneous Achilles suture configurations during cyclic loading and load to failure.

Methods: A simulated, midsubstance rupture was created 6 cm proximal to the calcaneal insertion in fresh-frozen cadaveric Achilles tendons.

Achilles tendoscopy for non insertional Achilles tendinopathy. A case series study.

Background: Achilles non-insertional tendinopathy is usually treated with conservative means. If resistant to a rehabilitation protocol surgical treatment could be proposed. The aim of this research is to report the mid-term clinical results of endoscopic assisted surgery for patients suffering from recalcitrant painful non-insertional Achilles tendinopathy.

AOFAS Position Statement Regarding Patient-Reported Outcome Measures.

Outcome measures evaluate various aspects of patient health, and when appropriately utilized can provide valuable information in both clinical practice and research settings. The orthopedic community has placed increasing emphasis on patient-reported outcome measures, recognizing their value for understanding patients' perspectives of treatment outcomes. Patient-reported outcomes are information directly reported by patients regarding their perceptions of health, quality of life, or functional status without interpretation by healthcare providers.

Subtalar Arthroscopic Fusion.

Arthroscopic subtalar fusion is an excellent approach to subtalar pathologic condition where conservative treatment has failed and a fusion has been indicated. Formal contraindications include excessive malalignment and bone loss. The posterior arthroscopic approach is analyzed in this article, including indications, surgical technique, surgical tips, and complications.

Arthroereisis: What Have We Learned?

One of the most common orthopedic problems in the authors' practice is flatfoot and, although it is most commonly treated conservatively, there is still lack of consensus about the type of surgical treatment that is best recommended in a specific patient. Keeping in mind that medial soft tissue reconstruction alone has not proved enough as an isolated procedure and that osteotomies and arthrodesis are considered more invasive surgery, arthroereisis is a quick, easy, and reproducible technique that seems to have good results without major complications in the correct patient. Indications, biomechanical principles, and technique are described in this article.

Cross-cultural adaptation and validation of the VISA-A questionnaire for Chilean Spanish-speaking patients.

Background: The purpose of this study is to translate, culturally adapt, and validate the VISA-A questionnaire for Chilean Spanish speakers with Achilles tendinopathy (AT), which has been originally developed for English-speaking population.

Methods: According to the guidelines published by Beaton et al., the questionnaire was translated and culturally adapted to Chilean patients in six steps: initial translation, synthesis of the translation, back translation, expert committee review, test of the pre-final version (cohort n = 35), and development of VISA-A-CH.