The Use of Hexapod External Fixation in the Management of Charcot Foot and Ankle Deformities.

Charcot neuroarthropathy (CN) and its sequela is a disabling pathology in the foot and ankle. The 2-stage computer hexapod-assisted technique is an effective tool to address midfoot Charcot and ankle-hindfoot deformities to restore function and decrease the risk of amputation secondary to ulceration and infection. Although this is not the only technique available, it is an excellent option in cases with significant angular deformity or subluxation, need to reduce shortening of the foot, and in the presence of soft tissue defects, with or without concurrent soft tissue or bone infection.

Mechanical Axis Method to Determine First Intermetatarsal Angle and Tibial Sesamoid Position.

Utilizing the mechanical axis can decrease load on the joint and be beneficial when analyzing bony deformities and planning surgical correction with osteotomies. The aim of this study was to identify the normal mechanical axes of the first and second metatarsals and use them to obtain the first/second mechanical intermetatarsal angle (mIMA). The mechanical axis of the first metatarsal was used to obtain the mechanical tibial sesamoid position (mTSP), which provides a mechanical relationship with the sesamoid apparatus.

Load to Failure of the Ankle Joint Complex After Fusion of the Subtalar and Talonavicular Joints: A Cadaveric Study.

Recent literature has proposed that restriction of joints in the rearfoot secondary to coalitions may lead to increased risk for severe ankle fracture after trauma. There is a paucity of literature regarding the rigidity of the ankle joint after arthrodesis of the subtalar and talonavicular joints. In this study, load-to-failure testing of cadaveric ankle joints with and without fusion of the subtalar and talonavicular joints was performed to determine if clinically relevant fracture patterns could be reproduced.

Radiographic Outcomes of a Percutaneous, Reproducible Distal Metatarsal Osteotomy for Mild and Moderate Bunions: A Multicenter Study.

Hallux valgus is a prevalent condition. Many open surgical methods of correction have been described. We performed a percutaneous, extra-articular distal metatarsal osteotomy for mild to moderate bunion deformity.

Interobserver Analysis of Standard Foot and Ankle Radiographic Angles.

Standard foot and ankle radiographs have long been studied and averages formulated in an attempt to provide a common framework for understanding the relationships of the foot and ankle, not only for surgical planning but also to determine normal versus abnormal relationships. The authors describe 8 angles measured on 100 patients by up to 18 observers (4 attending physicians, 12 residents, and 2 students). This study validates the previously documented normal angles using a significantly larger observer group as well as a greater number of analyzed angles.

Current health and economic burden of chronic diabetic osteomyelitis.

Introduction: Diabetic foot ulcer (DFU) prevalence is as high as 25% and 40-80% of DFUs become infected (DFI). About 20% of infected ulcers will spread to bone causing diabetic foot osteomyelitis (DFO). DFU costs Medicare $9-13 billion/year.

Midfoot Charcot Reconstruction.

Midfoot Charcot joints are complex problems that are most commonly seen in patients with peripheral neuropathy secondary to diabetes. The goal of management is to prevent pedal collapse, which can lead to ulceration; infection; and in some cases, amputation. Principles of surgical management should be centered on respecting the soft tissue, obtaining correction, maintaining correction, and supplementing with orthobiologics to achieve healing.

Lengthen, Alignment, and Beam Technique for Midfoot Charcot Neuroarthropathy.

Charcot neuroarthropathy is a disabling pathology in the foot and ankle. Midfoot Charcot is most common and results in progressive deformity. We describe a 2-step approach to surgical reconstruction, referred to as the lengthen, alignment, and beam technique.

The Gradual and Acute Correction of Equinus Using External Fixation.

Equinus is one of the most common deformities noted in foot and ankle biomechanics that, at times, if not identified and managed properly may lead to significant lower extremity pathology. With that being said, this deformity is also one that may be both underdiagnosed and undertreated. Treatment for equinus can range from conservative therapy to more aggressive surgical therapy.

Minimally Invasive Bunion Correction.

Hallux valgus is a common condition that results in lateral deviation of the hallux and medial deviation of the metatarsal. When conservative management fails, surgical management is often necessary. More than 150 procedures have been described, and most recommend an open approach.

Subchondroplasty: Treatment of Bone Marrow Lesions in the Lower Extremity.

Bone marrow lesions are associated with pain, disease progression, and cartilage loss in inflammatory and noninflammatory conditions, and are related to mechanical loading and subchondral stress. Treatment, particularly in the foot and ankle, is challenging. In the subchondroplasty procedure, flowable, synthetic, calcium phosphate bone filler is injected into the defect region, improving subchondral bone integrity and allowing remodeling back into healthy cancellous bone.

Biomechanical Comparison of Intramedullary Beaming and Plantar Plating Methods for Stabilizing the Medial Column of the Foot: An In Vitro Study.

Charcot neuroarthropathy often results in a rocker-bottom foot deformity, which leads to ulceration, infection, and amputation. Surgical techniques to reconstruct the medial column include intramedullary beaming and plantar plating, with disagreement regarding which approach provides a stronger construct with superior stability and fixation. The objective of the present cadaveric study was to compare the construct rigidity and strength of beaming and plantar plating of the medial column of 5 paired bilateral feet.

The Evolution of Limb Deformity: What Has Changed over the Past Ten Years?

Limb deformity correction has been widely discussed in orthopedic literature with an increasing interest in technologically based surgical strategies. However, principles described by Ilizarov and Paley still form the basis of these newly developing surgical systems. The recent advances and increased use of computers and mobile devices in the medical arena, along with the application of dynamic hexapod external fixation, have allowed for easier and more convenient strategies, leading to a greater outreach and more confidence in the newer surgeon when faced with addressing a patient with a limb deformity.

Guided Growth With Temporary Hemiepiphysiodesis to Treat Ankle Valgus in a Skeletally Immature Individual: A Case Report.

Guided growth is useful in correcting pediatric angular deformities. Ankle valgus is a coronal plane deformity and is often seen in skeletally immature patients with congenital or acquired lower extremity pathologic features. Temporary hemiepiphysiodesis with a percutaneous transphyseal medial malleolar screw is a surgical treatment capable of correcting the angular deformity and can offer effective correction.

The Mechanical Axis of the First Ray: A Radiographic Assessment in Hallux Abducto Valgus Evaluation.

The present report describes a new method of hallux abducto valgus deformity correction planning using the mechanical axis of the medial column (mechanical axis planning). This method of radiographic evaluation identifies an ideal position for the first metatarsal after correction and is useful regardless of the surgical procedure chosen. We retrospectively reviewed 200 radiographs to identify a "normal" value for the mechanical axis angle.

Tibiocalcaneal arthrodesis in the high-risk foot.

The present case series outlines the history and surgical treatment of 6 patients who underwent tibiocalcaneal arthrodesis from April 2002 to May 2012, all with external fixation as the primary or secondary fixation. Surgical intervention was performed by the same surgeon at the same facility. The indication for surgery was a nonbraceable Charcot deformity in 5 (83.

Medial Column Arthrodesis Using an Anatomic Distal Fibular Locking Plate.

The medial column fusion is performed for a multitude of etiologies, including peritalar subluxation deformity, Charcot arthropathy, trauma, post-traumatic degenerative joint disease, and rheumatoid arthritis. Various surgical techniques have been described for medial column arthrodesis. We describe a new fixation method using an anatomic distal fibular locking plate for medial column arthrodesis.

Posterior approach for subtalar joint distraction arthrodesis by compact external fixation: a technique guide.

Subtalar joint arthrodesis is a commonly used surgical procedure for the management of rearfoot pathologic features. We present a technique guide for a posterior incisional approach to subtalar joint arthrodesis for correction of a calcaneal deformity secondary to calcaneal fracture malunion. This technique uses a monolateral external fixation device for controlled distraction and intercallary allograft placement.

Rating systems for evaluation of functional ankle instability: prospective evaluation in a cohort of patients treated with monopolar capacitive-coupled radiofrequency.

Unlabelled: Evaluation of patient outcomes should include the use of validated scoring systems to determine disease-specific outcomes. Many scoring systems are being used for disorders of the ankle joint. However, not all instruments are capable of detecting changes associated with functional ankle instability (FAI), since their focus is toward pathological entities with greater impact on individual's physical and mental well-being.

Intramedullary foot fixation for midfoot Charcot neuroarthropathy.

Midfoot Charcot collapse commonly occurs through the tarsometatarsal and/or midtarsal joints, which creates the characteristic "rocker bottom" deformity. Intramedullary metatarsal fixation spanning the tarsus into the talus and/or calcaneus is a recently developed method for addressing unstable midfoot Charcot deformity. The intramedullary foot fixation technique has various advantages when addressing midfoot Charcot deformity in the neuropathic patient.

Pilot trial of biovance collagen-based wound covering for diabetic ulcers.

Background: Diabetes mellitus affects more than 194 million people worldwide, resulting in nearly 40,000 limb amputations per year, secondary to infected ulcerations, peripheral neuropathy, and inadequate vascular status. Diabetic foot ulcers have an underlying metabolic etiology that contributes to a nonhealing ulcer. Biovance (Celgene Cellular Therapeutics, Morris, New Jersey) is a wound covering produced from decellularized, dehydrated human amniotic membrane.