Endoscopically Assisted Percutaneous Harvesting of the Flexor Hallucis Tendon in Zone 2: An Anatomical Study.

Background: Flexor hallucis longus (FHL) transfer is a well-established method for treating chronic Achilles tendon ruptures and tendinopathy. Harvesting of the FHL tendon in zone 2 results in greater length but is also associated with an increased risk of injury to the medial plantar nerve and requires an additional plantar incision. Because of the anatomic proximity of the FHL tendon to the tibial neurovascular bundle in zone 2, the purpose of this study was to investigate the risk of vascular or nerve injury with arthroscopic assisted percutaneous tenotomy in zone 2 of the FHL tendon.

First Metatarsal Rotation After Scarf Osteotomy for Hallux Valgus.

Background: Recurrence after surgical correction of hallux valgus may be related to coronal rotation of the first metatarsal. The scarf osteotomy is a commonly used procedure for correcting hallux valgus but has limited ability to correct rotation. Using weight-bearing computed tomography (WBCT), we aimed to measure the coronal rotation of the first metatarsal before and after a scarf osteotomy, and correlate these to clinical outcome scores.

Anatomy of the Sural Nerve in the Posterolateral Approach to the Ankle: A Cadaveric Study.

Sural nerve injury may occur during the posterolateral approach to the ankle during fracture fixation. We aimed to map its location in a posterolateral approach in cadaveric specimens. A posterolateral approach was used in 28 cadaver legs with the incision made halfway between the medial border of the fibula and the lateral border of Achilles tendon, extending proximally from the tip of the lateral malleolus.

Predictors of metalwork failure and nonunion after hindfoot Charcot reconstruction.

Aims: Surgical reconstruction of deformed Charcot feet carries a high risk of nonunion, metalwork failure, and deformity recurrence. The primary aim of this study was to identify the factors contributing to these complications following hindfoot Charcot reconstructions.

Methods: We retrospectively analyzed patients who underwent hindfoot Charcot reconstruction with an intramedullary nail between January 2007 and December 2019 in our unit.

Side-to-Side Difference of Metatarsal Rotation in Normal Individuals.

Background: A previous study defined the normal first metatarsal pronation angle (MPA) as <16 degrees and normal α angle as <18 degrees. The primary purpose of this study was to assess the side-to-side variation in first metatarsal pronation between feet in normal individuals.

Methods: MPA and α angles were measured on standardized coronal weightbearing computed tomography slices.

Percutaneous subtalar joint screw fixation of comminuted calcaneal fractures: a salvage procedure.

Introduction: Malunited comminuted calcaneal fractures result in poor function due subtalar joint arthritis and altered biomechanics. We aimed to assess whether percutaneous subtalar joint screws after fracture reduction provide good outcomes for these difficult injuries.

Methods: We retrospectively analysed 15 comminuted calcaneal fractures (in 14 patients) treated with percutaneous subtalar screw fixation.

Imaging Findings and First Metatarsal Rotation in Hallux Valgus.

Background: Failure to identify and correct malrotation of the first metatarsal may lead to recurrent hallux valgus deformity. We aimed to identify the proportion of hallux valgus patients with increased first metatarsal pronation using weightbearing computed tomography (WBCT) and to identify the relationship with conventional radiographic measurements.

Methods: WBCT scans were analyzed for 102 feet with a hallux valgus angle (HVA) and intermetatarsal angle (IMA) greater than or equal to 16 and 9 degrees, respectively.

The Value of SPECT-CT in Diagnosing Complex Non-Arthritic and Non-Neoplastic Conditions of the Foot and Ankle.

Introduction: There is little information on the value of using single photon emission computerized tomography-computed tomography (SPECT-CT) in non-arthritic and non-neoplastic conditions of the foot and ankle (F&A). The vast majority of studies have investigated the role of SPECT-CT in degenerative conditions, bony pathology, and neoplastic conditions. The diagnostic value of SPECT-CT in purely non-arthritic and non-neoplastic conditions, in the absence of other conclusive radiological findings, is yet to be clarified.

A unique case of bilateral triceps avulsion fracture in a patient with pseudohypoparathyroidism.

Triceps tendon ruptures and avulsions are rare injuries and are often associated with systemic diseases. This paper illustrates the unique case of a 20-year-old female patient with pseudohypoparathyroidism, who sustained bilateral triceps avulsion fractures after a fall. She underwent suture anchor fixation, augmented with tension band suture as double row repair with excellent post-operative results.

Repeatability of Weightbearing Computed Tomography Measurement of First Metatarsal Alignment and Rotation.

Background: Weightbearing computed tomography (WBCT) can be used to assess alignment and rotation of the first metatarsal. It is unknown whether these measures remain consistent on sequential WBCTs in the same patient when a patient's standing position may be different. The aim of this study was to establish the repeatability (test-retest) of measurements of first metatarsal alignment and rotation in patients without forefoot pathology on WBCT.

Assessing the Rotation of the First Metatarsal on Computed Tomography Scans: A Systematic Literature Review.

Background: Hallux valgus is a multiplanar deformity that is often treated on the basis of 2-dimensional (2D) parameters and radiographs. Recurrence rates after surgical correction remain high, and failure to correct pronation of the metatarsal is increasingly stipulated as being part of the problem. Multiple methods of assessing metatarsal pronation have been proposed.

The Assessment of First Metatarsal Rotation in the Normal Adult Population Using Weightbearing Computed Tomography.

Background: The importance of the rotational profile of the first metatarsal is increasingly recognized in the surgical planning of hallux valgus. However, rotation in the normal population has only been measured in small series. We aimed to identify the normal range of first metatarsal rotation in a large series using weightbearing computed tomography (WBCT).

Comparison of Mechanical Axis of the Limb Versus Anatomical Axis of the Tibia for Assessment of Tibiotalar Alignment in End-Stage Ankle Arthritis.

Background: Coronal plane ankle joint alignment is typically assessed using the tibiotalar angle (TTA), which relies on the anatomical axis of the tibia (AAT) and the articular surface of the talus as landmarks. Often, the AAT differs from the mechanical axis of the lower limb (MAL). We set out to test our hypothesis that the TTA using the MAL would differ from the TTA measured using the AAT in patients with ankle osteoarthritis.

Bone Cysts and Osteolysis in Ankle Replacement.

Background: Total ankle replacements (TARs) have higher rates of osteolysis than hip or knee replacements. It is unclear whether this is a pathologic immunologic process in response to wear debris, or expansion of pre-existing osteoarthritic bone cysts. We aimed to determine the incidence of bone cysts in patients with end-stage ankle arthritis prior to surgery and review the literature on bone cysts and osteolysis in relation to TAR.

Paediatric calcaneal fractures: A guide to management based on a review of the literature.

Introduction: Calcaneal fractures are rare in children. These fractures are often misdiagnosed as a consequence of their subtle clinical and radiographic presentation. The purpose of this paper was to identify prognostic factors on the basis of type of fracture, age and treatment.

Mechanical and anatomical axis of the lower limb in total ankle arthroplasty.

Introduction: Inadequate correction of mechanical alignment may lead to failure of Total Ankle Replacements (TAR). The mechanical axis of the lower limb (MAL), the mechanical axis of the tibia (MAT) and the anatomical axis of the tibia (AAT) are three well described coronal plane measurements using plain radiography. The assumption is that the MAL, MAT and AAT are equivalent.

Should the Tibiotalar Angle Be Measured Using an AP or Mortise Radiograph? Does It Matter?

Understanding the tibiotalar angle (TTA) is key to planning for deformity correction. The TTA is an important radiographic tool to determine alignment or malalignment of the ankle and hindfoot. Two methods of measuring the TTA have been described: the midline TTA (MTTA) and the lateral TTA (LTTA).

Role of Rotation in Total Ankle Replacement.

Background: The importance of total ankle replacement (TAR) implant orientation in the axial plane is poorly understood with major variation in surgical technique of implants on the market. Our aim was to better understand the axial rotational profile of patients undergoing TAR.

Methods: In 157 standardized computed tomography (CT) scans of patients with end-stage ankle arthritis planning to undergo primary TAR surgery, we measured the relationship between the knee posterior condylar axis, the tibial tuberosity, the transmalleolar axis (TMA), and the tibiotalar angle.

Turf toe: A clinical update.

Turf toe is a condition that describes injury to the plantar metatarsophalangeal-sesamoid complex of the great toe.It is a relatively rare and debilitating condition, particularly seen in American footballers after the introduction of harder, artificial 'turf' surfaces.Turf toe represents a significant injury to the hallux and requires a high index of suspicion.

A simple measure to improve the rates of thromboprophylaxis prescription post surgical fixation of neck of femur fractures in a district general hospital.

Neck of femur (NOF) fractures are a major public health concern because of the ageing population and higher incidence of fragility fractures. NOF fractures are associated with high mortality and morbidity rates, and there is a high risk of venous thromboembolism (VTE) after hip fractures (Ref 1). Therefore thromboprophylaxis is vital.