Operative management of Charcot neuropathy of the foot and ankle: A retrospective cohort study of long-term outcomes.

Treatment of Charcot neuroarthropathy (CN) of the foot and ankle remains challenging for both patients and surgeons. Nonoperative treatment with cast/orthosis immobilization has long been the main treatment, but surgical intervention has gained interest to improve poor long-term outcomes. Few long-term outcome studies exist on operative management of CN.

Surgical Outcomes in Charcot Arthropathy.

Treatment of Charcot neuroarthropathy (CN) of the foot and ankle remains challenging for both patients and surgeons. Nonoperative treatment with cast/orthosis immobilization has long been the mainstay of treatment, but surgical intervention has gained interest to improve poor long-term outcomes. A review of existing data on the operative management of CN demonstrates the potential benefits but also the continued risks associated with treatment.

The chevron bunionectomy for moderate to severe hallux valgus deformity: Effects of procedural factors on hallux valgus correction.

Background: Effects of procedural factors on chevron bunionectomy outcomes were studied.

Methods: Included were 109 feet with distal chevron osteotomy and preoperative intermetatarsal angle (IMA) greater than 15 degrees. IMA and hallux valgus angles (HVA), release type, fixation, second-digit procedures, and risk factors were evaluated.

Cost Analysis and Reimbursement of Weightbearing Computed Tomography.

Background: Weightbearing computed tomography (WBCT) is becoming a valuable tool in the evaluation of foot and ankle pathology. Currently, cost analyses of WBCT scanners in private practice are lacking in the literature. This study evaluated the costs of acquisition, utilization, and reimbursements for a WBCT at a tertiary referral center, information of particular interest to practices considering obtaining such equipment.

Efficacy of Postoperative Oral Antibiotics in Foot and Ankle Surgery.

Background: Preoperative oral antibiotic use in patients undergoing foot and ankle surgery is standard practice, but no consensus has been reached regarding the efficacy of postoperative oral antibiotics. The purpose of this study was to determine whether postoperative oral antibiotics reduce the rate of surgical site infections (SSIs) in patients, with and without comorbidities, undergoing foot and ankle surgery.

Methods: A retrospective chart review was conducted identifying patients who underwent foot and ankle surgery by 4 fellowship-trained, foot and ankle orthopaedic surgeons between January 1, 2015, and January 1, 2019.

Volume and Variability of Foot and Ankle Case Exposure During Orthopaedic Residency: 2014-2019.

Background: Exposure to a comprehensive breadth and volume of surgical cases is a fundamental component of orthopaedic education, though standardization of case exposures across residency programs is limited to a small amount of required case minimums. Significant variability in exposure to subspecialty cases, such as foot and ankle surgeries, can create distinctly different residency experiences.

Methods: Accreditation Council for Graduate Medical Education (ACGME) surgical case logs from 2014 to 2019 for leg/ankle and foot/toes were examined following the 2013 implementation of case minimums.

The Weekend Warrior: Common Foot and Ankle Injuries in Recreational Athletes.

Weekend warriors are recreational athletes who compress their physical activity into 1-2 weekly exercise sessions. The characteristic combination of general deconditioning and excessive activity can predispose these individuals to a multitude of foot and ankle injuries. The purpose of this review is to highlight the etiology and management of common foot and ankle injuries in recreational athletes.

Understanding Penicillin Allergy, Cross-reactivity, and Antibiotic Selection in the Preoperative Setting.

Penicillin allergies are reported by 8% to 15% of the US population, but up to 95% of these allergies do not correspond to a true allergy when tested. Recent studies have demonstrated that having a penicillin allergy label (PAL) results in a 50% increased odds of surgical site infection among patients reporting a penicillin allergy entirely attributable to the use of a beta-lactam alternative antibiotic (primarily clindamycin or vancomycin). This study provides a review of the prevalence of PAL, the cross-reactivity with cefazolin, immunogenic components of cefazolin and penicillin, and current guidelines for preoperative antibiotic selection in patients with PALs.

Analysis of Wheeled Knee Walker Use following Foot and Ankle Surgery or Injury.

To determine patient satisfaction and safety with wheeled knee walkers, we performed a retrospective, observational, and descriptive study. Inclusion criteria were age ≥18 years, unilateral foot or ankle surgery, non-weightbearing status, and being given the option of using the knee walker. Surveys were sent to eligible patients, and chart review included only those patients who returned surveys.

Race and Insurance Status Association With Receiving Orthopedic Surgeon-Prescribed Foot Orthoses.

Background: This study looked at the effect of patient demographics, insurance status, education, and patient opinion on whether various orthotic footwear prescribed for a variety of diagnoses were received by the patient. The study also assessed the effect of the orthoses on relief of symptoms.

Methods: Chart review documented patient demographics, diagnoses, and medical comorbidities.

"Locked-Lateral" Calcaneal Fracture-Dislocation Treated with Primary Subtalar Fusion: A Case Report.

Case Report: A 65-year-old man presented with pain in his left ankle. After a delay, he presented to the orthopaedic clinic where computed tomography scan revealed an intra-articular, locked-lateral calcaneal fracture with dislocation of the peroneal tendons.

Conclusions: This combination of injuries can produce subtle signs, such as an atypical double-density sign and varus talar tilt, on plain radiographs; however, the consequences of delayed treatment can be catastrophic.

Smoking Effects in Foot and Ankle Surgery: An Evidence-Based Review.

Background: The purpose of this article was to review the basic science pertaining to the harmful effects of cigarette smoke, summarize recent clinical outcome studies, and examine the benefits of smoking cessation and the efficacy of current smoking cessation strategies.

Methods: The literature concerning basic science, clinical outcomes, and smoking cessation was reviewed; over half (56%) of the 52 articles reviewed were published in the last 5 years.

Results: Smoking is associated with low bone mineral density, delayed fracture union, peri-implant bone loss, and implant failure.

Preoperative Risk Factors for Complications in Elective Ankle and Hindfoot Reconstruction.

Background: The purpose of this study was to examine medical, social, and psychological factors associated with complications and reoperation after foot and ankle reconstruction.

Methods: A retrospective chart review was conducted of 132 patients (135 feet; 139 operative cases) who had elective foot and ankle reconstruction. Medical, social, and psychological variables were documented.

Orthopedic Surgical Options for Joint Cartilage Repair and Restoration.

The limited natural capacity for articular cartilage to regenerate has led to a continuously broadening array of surgical interventions. Used once patients' symptoms are not relieved by nonoperative management, these share the goals of joint preservation and restoration. Techniques include bone marrow stimulation, whole-tissue transplantation, and cell-based strategies, each with its own variations.

Psychosocial Risk Factors for Postoperative Pain in Ankle and Hindfoot Reconstruction.

Background: The purpose of this study was to examine factors associated with pain after elective ankle and hindfoot reconstruction.

Methods: Patients who underwent major ankle or hindfoot reconstruction over a 3-year period were identified. Retrospective chart review determined patient demographics, comorbidities, surgeries, tobacco, alcohol, and narcotic use, chronic pain, and mood disorders.

Effect of Obesity on Outcomes of Forefoot Surgery.

Background: Forefoot surgery typically is elective, so it is important to define risk factors to educate patients on potential complications. The purpose of this study was to determine if obesity is an independent risk factor that contributes to increased complication rates after forefoot surgery.

Methods: Through a retrospective review of records, 633 patients were identified who had forefoot surgery at one institution between 2008 and 2010.

Business and Practice Management Knowledge Deficiencies in Graduating Orthopedic Residents.

We conducted a study to determine the general level of knowledge that orthopedic residents have on business and practice management topics at graduation and to evaluate the level of knowledge that practicing orthopedic surgeons need in order to function effectively in a medical practice. Residency graduates from a single training program were asked to complete a survey that gathered demographic information and had surgeons rate their understanding of 9 general business and practice management skills and the importance of these skills in their current practice situation. The amount of necessary business knowledge they lacked at graduation was defined as a functional knowledge deficiency (FKD) and was calculated as the difference between the reported importance of a topic in current practice and the level of understanding of that topic at graduation (larger FKD indicates greater deficiency).

Cigarette smoking increases complication rate in forefoot surgery.

Background: Cigarette smoking is known to increase perioperative complication rates, but no study to date has examined its effect specifically in forefoot surgery. The purpose of this study was to determine whether cigarette smoking increased complications after forefoot surgery.

Methods: The records of 602 patients who had forefoot surgery between 2008 and 2010, and for whom smoking status was known, were reviewed.

The effects of conventional physical therapy and eccentric strengthening for insertional achilles tendinopathy.

Study Design: Single-blind, randomized, clinical trial.

Background: The effect of eccentric training for mid-portion Achilles tendinopathy is well documented; however, its effect on insertional Achilles tendinopathy is inconclusive. The primary purpose of this study was to investigate the effect of eccentric training on pain and function for individuals with insertional Achilles tendinopathy.

The recurrent Morton neuroma: what now?

Interdigital neuromas are a common cause of forefoot pain, and approximately 80% of patients require surgical excision for symptom relief. Although 50% to 85% of patients obtain relief after primary excision, symptoms may recur because of an incorrect diagnosis, inadequate resection, or adherence of pressure on a nerve stump neuroma. The symptom relief rate after reoperation is similar to that after primary excision.

Discordance in current procedural terminology coding for foot and ankle procedures between residents and attending surgeons.

Objective: Because of the importance of current procedural terminology (CPT) coding in both resident education evaluation and practice management, this study was undertaken to evaluate the correlation and interrater reliability between residents and attending physicians in CPT coding for orthopedic foot and ankle surgeries as well as to determine attending surgeons' and residents' familiarity with and confidence in the coding process.

Methods: CPT codes from resident case logs were compared with those submitted by attending surgeons, and Pearson's correlation coefficient and interrater reliability were calculated to examine coding congruency. An online survey was also used to examine attending surgeon and resident perceptions and habits regarding CPT codes and the coding process.

Current concept review: vitamin D and stress fractures.

Critical review of the available evidence indicates that a relationship exists between sufficient vitamin D status and stress fractures, although genetic and environmental factors are involved as well. Patients at high risk for stress fracture should be educated on protective training techniques and the potential benefits of supplementation with combined calcium and vitamin D, particularly if increased exercise is planned during winter or spring months, when vitamin D stores are at their lowest. The amount of vitamin D intake required is highly variable depending on many factors including sun exposure, and therefore many recommendations have been made for daily vitamin D intake requirements.

Evaluation of the hallux morbidity of single-incision flexor hallucis longus tendon transfer.

Background: Achilles tendinosis and chronic Achilles tendon ruptures are relatively frequently encountered by orthopaedic surgeons. One treatment for patients who fail to respond to conservative management involves augmentation of the repair with transfer of the flexor hallucis longus (FHL), using either a single-incision or double-incision technique. Despite the frequency of this procedure, little is known about the associated donor morbidity.

Long-term evaluation of interdigital neuroma treated by surgical excision.

Background: We examined a large cohort of patients who had interdigital neurectomy and evaluated their clinical outcomes by using a previously developed scoring system as well as a visual analog scale (VAS). In addition, we wanted to identify risk factors that may lead to poorer outcomes.

Materials And Methods: A retrospective review identified 232 patients who had neuroma excision between 1994 and 2004, after failure of conservative treatment.