Tendon transfer options in managing the adult flexible flatfoot.

Patients undergoing surgery for posterior tibial tendon dysfunction may require tendon transfer. The flexor digitorum longus is most commonly transferred, although the flexor hallucis longus and peroneus brevis have also been described in the literature. This article discusses the advantages and disadvantages of the different tendons, the surgical techniques used to perform them, and their results in the literature, concentrating principally on studies in which additional bone procedures were not performed.

Porous tantalum stimulates the proliferation and osteogenesis of osteoblasts from elderly female patients.

Porous tantalum (Ta) implants have been successful in various orthopedic procedures for patients with compromised bone-forming abilities. Previous studies demonstrated that human osteoblast (HOB) cultures from older female patients produced less bone on implant materials in vitro compared to HOBs from age-matched male and younger female patients. In this study, the responses of HOBs from younger (< 45) and older (> 60 years old) female patients were compared on Ta, titanium fiber mesh (TFM) and tissue culture plastic.

Implications for the anatomy of the flexor hallucis brevis insertion.

Background: Excessive hallux proximal phalangeal base removal during first MTP resection arthroplasty, implant arthroplasty, or amputation can compromise the flexor hallucis brevis (FHB) insertion leading to first MTP joint plantarflexion weakness, cock-up toe deformity, and altered forefoot loading.

Material And Methods: The insertional anatomy of the FHB tendon was measured in 30 fresh frozen cadaver specimens. The FHB was then cyclically loaded and bone sequentially removed from the proximal phalangeal base until specimen failure occurred.

Foot and ankle experience in orthopedic residency: an update.

Background: In 2003, a limited survey regarding the number of dedicated foot and ankle faculty and foot and ankle rotations at orthopaedic surgery residency programs was published. The purpose of this paper was to update the results of that previous survey and provide additional, more in-depth information.

Materials And Methods: A survey questionnaire was emailed to the program directors and chairpersons of the 150 ACGME-accredited orthopaedic residency training programs in the United States.

Therapeutic touch stimulates the proliferation of human cells in culture.

Objectives: Our objective was to assess the effect of Therapeutic Touch (TT) on the proliferation of normal human cells in culture compared to sham and no treatment. Several proliferation techniques were used to confirm the results, and the effect of multiple 10-minute TT treatments was studied.

Design: Fibroblasts, tendon cells (tenocytes), and bone cells (osteoblasts) were treated with TT, sham, or untreated for 2 weeks, and then assessed for [(3)H]-thymidine incorporation into the DNA, and immunocytochemical staining for proliferating cell nuclear antigen (PCNA).

The in vitro response of human osteoblasts to polyetheretherketone (PEEK) substrates compared to commercially pure titanium.

Polyetheretherketone (PEEK) is used as an alternative to titanium in medical devices. Previous in vitro studies examining PEEK have differed in their choice of polymer variant [PEEK or carbon-fiber reinforced PEEK (CFR-PEEK)], source of polymer (some of which are no longer available or for implantation) and cell type. While all studies demonstrated favorable cytocompatibility of the PEEK material, no studies are available which reflect the current state of the art of the material.

Management of hindfoot disease in rheumatoid arthritis.

There is a wide variety of hindfoot disease seen in patients with rheumatoid arthritis. Initial treatment is conservative including optimizing medical management to control the disease process. Should symptoms persist, surgical treatment may be performed, although there is an increased complication rate related to both the disease and the side effects of the medications used to treat it.

Cyclic loading of Achilles tendon repairs: a comparison of polyester and polyblend suture.

Background: Early functional rehabilitation is widely used after open suture repair of the Achilles tendon. To our knowledge, no previous studies have assessed gap formation from cyclic loading and subsequent failure loads of simulated Achilles tendon repairs. A synthetic (polyblend) suture has been introduced for tendon repairs with reportedly greater strength than polyester suture.

An in vitro study comparing the use of suture anchors and drill hole fixation for flexor digitorum longus transfer to the navicular.

Background: The surgical management of posterior tibial tendon dysfunction often includes transfer of the flexor digitorum longus (FDL) tendon through a tunnel in the navicular. Fixation often is obtained by sewing the tendon back onto itself. The purpose of this study was to compare this standard method of fixation with suture anchor fixation, a technique that may be associated with less surgical morbidity, because it requires the harvesting of less tendon length.

Treatment of the missed Lisfranc injury.

Lisfranc joint injuries may be missed at the time of occurrence potentially leading to persistent instability, deformity, or arthritis. In the absence of significant residual arthritis or fixed deformity, delayed open reduction and internal fixation with or without reconstruction of the Lisfranc ligament may be performed. An alternative is reduction and primary arthrodesis of the relatively immobile medial tarsometatarsal (TMT) joints.

The effect of triceps surae contracture force on plantar foot pressure distribution.

Background: Triceps surae contractures have been associated with foot and ankle pathology. Achilles tendon contractures have been shown to shift plantar foot pressure from the heel to the forefoot. The purpose of this study was to determine whether isolated gastrocnemius contractures had similar effects and to assess the effects of gastrocnemius or soleus contracture on midfoot plantar pressure.

Transforming growth factor-beta 1 (TGF-beta1) prevents the age-dependent decrease in bone formation in human osteoblast/implant cultures.

Titanium implants have been extensively used in orthopedic surgery and dentistry. Most of the patients who receive such implants are elderly with a compromised ability to heal and form new bone. By using an in vitro osteoblast/implant culture system, the potency of TGF-beta1 in enhancing mineralization of human osteoblast cultures from elderly subjects was investigated in this study.

Ligamentous Lisfranc joint injuries: a biomechanical comparison of dorsal plate and transarticular screw fixation.

Background: The current treatment of displaced ligamentous injuries of the tarsometatarsal (TMT) joints is open reduction and rigid fixation using transarticular screws. This technique causes further articular surface damage that theoretically may increase the risk of arthritis. Should the screws break, hardware removal is difficult.

Posterior heel pain (retrocalcaneal bursitis, insertional and noninsertional Achilles tendinopathy).

The majority of patients with Achilles tendinopathy respond to nonoperative treatment. In patients with refractory symptoms, surgery can be considered. If paratenonitis is present, the paratenon is partially excised, and adhesions are released.

Foot and ankle experience in orthopaedic residency.

Background: Dedicated orthopaedic residency training in the musculoskeletal discipline of foot and ankle is an important contribution to the development of a well-rounded orthopaedic surgeon. Current residency training guidelines are vague and do not require specific experience or proficiency in this discipline.

Methods: A one-page questionnaire on commitment to foot and ankle education in American Orthopaedic Surgery residency training programs was completed by all 148 program directors.

Adolescent osteochondral lesion of the talus. Ankle arthroscopy in pediatric patients.

Osteochondral lesions of the talus can be difficult to diagnose and can result in a significant functional limitation in young, active patients. New imaging modalities have improved the diagnosis and staging of these lesions. In general, nonoperative treatment results in poorer outcomes compared with operative treatment, and arthroscopic treatment has results similar to open treatment.

Different faces of the triple arthrodesis.

Patients with severe pes planovalgus or cavovarus foot deformities who fail conservative treatment may require a triple arthrodesis. Modifying the triple arthrodesis to include extended bone wedge resections allows for improved correction. The goal of each procedure is to obtain a less painful, plantigrade foot, and to improve function.