Foot and ankle problems in dancers.

The dancer's foot and ankle are subjected to high forces and unusual stresses in training and performance. Injuries are common in dancers, and the foot and ankle are particularly vulnerable. Ankle sprains, ankle impingement syndromes, flexor hallucis longus tendonitis, cuboid subluxation, stress fractures, midfoot injuries, heel pain, and first metatarsophalangeal joint problems including hallux valgus, hallux rigidus, and sesamoid injuries will be reviewed.

Hallux valgus in dancers: a closer look at dance technique and its impact on dancers' feet.

Hallux valgus is a common deformity of the forefoot. There is no doubt that some dancers develop hallux valgus, but the question remains as to whether dancers are at greater risk than the general population for developing this deformity. Review of the literature reveals on-going debate regarding risk factors for hallux valgus, which may include increasing age, female gender, genetic predisposition, constrictive shoe wear, first ray hypermobility, foot architecture, tight Achilles tendon, and first metatarsal length.

Effects of unloading on knee articular cartilage T1rho and T2 magnetic resonance imaging relaxation times: a case series.

Study Design: Case series.

Background: It has been shown in rodent and canine models that cartilage composition is significantly altered in response to long-term unloading. To date, however, no in vivo human studies have investigated this topic.

Biomechanical analysis of stresses to the fifth metatarsal bone during sports maneuvers: implications for fifth metatarsal fractures.

Fifth metatarsal stress fractures are an increasing problem in elite and recreational athletic populations. One possible mechanism of injury is the many bending moments applied to the fifth metatarsal during dynamic sports maneuvers involving rapid changes in direction and speed. A potentially important bending moment is loading of the base versus the head of the fifth metatarsal, which tends to cause a bending moment along the bone.

Anterior impingement syndrome in dancers.

Anterior impingement is a common problem in dancers occurring primarily secondary to the repetitive forced ankle dorsiflexion inherent in ballet. Symptoms generally occur progressively and may respond to conservative treatment including addressing biomechanical faults that contribute to the problem. As impingement progresses, movements essential to ballet may become impossible and arthroscopic ankle surgery is often effective for both diagnosis and treatment, allowing athletes to return to dance.

Regional foot pressure during running, cutting, jumping, and landing.

Background: Evaluating shoes during sport-related movements may provide a better assessment of plantar loads associated with repetitive injury and provide more specific data for comparing shoe cushioning characteristics.

Hypothesis: Accelerating, cutting, and jumping pressures will be higher than in straight running, differentiating regional shoe cushioning performance in sport-specific movements.

Study Design: Controlled laboratory study.

Foot and ankle injuries in dance.

Although dancers develop overuse injuries common in other athletes, they are also susceptible to unique injuries. This article reviews common foot and ankle problems seen in dancers and provides some basic diagnosis and treatment strategies.

Perioperative medication management for the patient with rheumatoid arthritis.

The treatment of rheumatoid arthritis has improved dramatically in recent years with the advent of the latest generation of disease-modifying antirheumatic drugs. Despite these advances, in some patients inflammation is not diminished sufficiently to prevent irreversible musculoskeletal damage, thus requiring surgical intervention to reduce pain and improve function. In these cases, the orthopaedic surgeon frequently encounters patients on a drug regimen consisting of nonsteroidal anti-inflammatory drugs, glucocorticoids, methotrexate, and biologic agents (disease-modifying antirheumatic drugs).

Alternative to the modified jones procedure: outcomes of the flexor hallucis longus (FHL) tendon transfer procedure for correction of clawed hallux.

Background: The modified Jones procedure is the traditional operative procedure for correction of a clawed hallux, although the deformity may be caused by overpull of one of three different muscles. In this study we present the radiographic and functional outcomes of flexor hallucis longus (FHL) tendon transfer as treatment for clawed hallux. The transfer is performed by drawing two thirds of the FHL tendon up through a drill hole in the proximal phalanx and then suturing it medially back to the remaining third.

Reliability of the Foot Function Index:: A report of the AOFAS Outcomes Committee.

Background: There currently is no widely used, validated, self-administered instrument for measuring musculoskeletal functional status in individuals with nonsystemic foot disorders. The purpose of this paper was to report on the assessment of reliability of one of these instruments. We wanted to determine if the Foot Function Index (FFI), which has been validated in rheumatoid patients without fixed foot deformity or prior foot surgery, would be reliable for a population of patients with foot complaints without systemic disease.

Issues of importance to patients seeking care from members of the AOFAS: a preliminary report of the outcomes committee of the AOFAS.

Background: The purpose of this multi-center study was to examine the outcomes of importance for patients seeking treatment for foot and ankle disorders. An improved understanding of patient outcome preferences will assist surgeons in improving patient satisfaction.

Methods: An open-ended priority function questionnaire was administered to 235 patients presenting as new patients to five different outpatient locations.

Stability of Lisfranc joints in ballet pointe position.

Background: Ballerinas develop stress fractures at the second metatarsal base associated with dancing en pointe. The purpose of this study was to evaluate the relative importance of the pointe shoe and the tarsometatarsal ligaments in Lisfranc joint stability en pointe.

Methods: Eleven cadaver feet were dressed with pointe shoes, loaded in foot flat with ligaments intact, and loaded en pointe before and after sequential sectioning of the dorsal, interosseous, and plantar ligaments between the first and second metatarsals and cuneiforms.

Impact of educational intervention on confidence and competence in the performance of a simple surgical task.

Background: Many complex new procedures involve a learning curve, and patients treated by individuals who are new to a procedure may have more complications than those treated by a practitioner who has performed the intervention more frequently. Still, at some point on the learning curve, each individual must decide that he or she is qualified to perform a procedure, presumably on the basis of his or her level of confidence, background, education, and skill. To evaluate the interrelationship of these factors, we designed a study in which we assessed the performance of a simulated knee joint injection.

An association between functional second metatarsal length and midfoot arthrosis.

Background: Primary tarsometatarsal arthrosis is relatively uncommon. The etiology of osteoarthritis in the foot is poorly understood, and it is possible that mechanical or anatomic factors play a role.

Methods: We compared the relative length of the metatarsals in patients with idiopathic arthrosis of the midfoot with that in a group of controls without arthrosis.

The effect of walking speed on center of mass displacement.

The movement of the center of mass (COM) during human walking has been hypothesized to follow a sinusoidal pattern in the vertical and mediolateral directions. The vertical COM displacement has been shown to increase with velocity, but little is known about the mediolateral movement of the COM. In our evaluation of the mediolateral COM displacement at several walking speeds, 10 normal subjects walked at their self-selected speed and then at 0.

The efficacy of two methods of ankle immobilization in reducing gastrocnemius, soleus, and peroneal muscle activity during stance phase of gait.

Background: Immobilization to limit muscle activity is a common therapeutic and posttreatment event. There are potential time and resource savings if a prefabricated boot can replace a custom applied cast. The purpose of this study was to determine if muscle activity reduction is similar using a fiberglass cast versus a prefabricated (Aircast FoamWalker) boot.

Ordering and interpreting rheumatologic laboratory tests.

Many mechanical and systemic conditions can cause joint pain and synovitis. When rheumatologic illness is suspected, the initial evaluation begins with an accurate history, physical examination, and selective use of confirmatory testing, which can help avoid common pitfalls inherent in serologic evaluation. Tests for erythrocyte sedimentation rate, C-reactive protein level, rheumatoid factor, antinuclear antibodies, anticardiolipin antibodies and lupus anticoagulant, HLA-B27, uric acid level, and Lyme disease, either alone or in combination, may support certain diagnoses.