Forefoot Success.

The goal of this chapter is to familiarize orthopaedic surgeons with the latest information pertaining to typical problems of the forefoot. Painful and deforming problems of the forefoot are surprisingly common. The understanding of forefoot deformity and pathology has evolved considerably over the past decade.

Mid-Term Prospective Clinical and Radiographic Outcomes of a Modern Fixed-Bearing Total Ankle Arthroplasty.

The early outcomes of the Salto Talaris® Total Ankle Prosthesis have been promising, but information on its mid-term outcomes is still sparse. The purpose of this study was to evaluate the mid-term clinical and radiographic outcomes of this implant among a prospective cohort of patients who underwent total ankle replacement for various etiologies. Forty-six patients (50 ankles) were consecutively enrolled in the study.

Distribution of segmental foot kinematics in patients with degenerative joint disease of the ankle.

Degenerative joint disease (DJD) of the ankle is a debilitating chronic disease associated with severe pain and dysfunction resulting in antalgic gait alteration. Little information is available about segmental foot and ankle motion distribution during gait in ankle osteoarthritis. The aim of the current study was to dynamically characterize segmental foot and ankle kinematics of patients with severe ankle arthrosis requiring total ankle replacement.

Correlation of Postoperative Position of the Sesamoids After Chevron Osteotomy With Outcome.

Background: Postoperative incomplete reduction of the sesamoids has been identified as a potential risk factor for hallux valgus recurrence after proximal osteotomy. However, it is not known whether the postoperative sesamoid position is a risk factor in hallux valgus correction via distal chevron osteotomy with or without dorsal webspace release (DWSR).

Methods: In this retrospective study, 169 patients who underwent distal chevron osteotomy with or without DWSR were reviewed.

Hammertoe correction with k-wire fixation.

Background: Kirschner wire (K-wire) fixation for correction of hammertoe deformity is a common, low-cost method for fixation of hammertoes after proximal interphalangeal (PIP) arthroplasty or fusion. Complications of this procedure include pin-tract infection, pin migration, pin bending or breakage, and recurrence of deformity. The investigators reviewed a large experience using K-wire stabilization for hammertoe correction.

Sagittal subtalar and talocrural joint assessment with weight-bearing fluoroscopy during barefoot ambulation.

Background: Identifying talar position during ambulation has proved difficult as the talus lacks palpable landmarks for skin marker placement and more invasive methodologies such as bone pins are not practical for most clinical subjects. A fluoroscopic motion system was used to track the talus and calcaneus, allowing kinematic analysis of the talocrural and subtalar joints.

Methods: Thirteen male subjects (mean age 22.

Microbiology of explanted suture segments from infected and noninfected surgical patients.

Sutures under selective host/environmental factors can potentiate postoperative surgical site infection (SSI). The present investigation characterized microbial recovery and biofilm formation from explanted absorbable (AB) and nonabsorbable (NAB) sutures from infected and noninfected sites. AB and NAB sutures were harvested from noninfected (70.

Multisegmental foot and ankle motion analysis after hallux valgus surgery.

Background: Gait changes in patients with hallux valgus, including altered kinematic and temporal-spatial parameters, have been documented in the literature. Although operative treatment can yield favorable clinical and radiographic results, restoration of normal gait in this population remains unclear. Segmental kinematic changes within the foot and ankle during ambulation after operative correction of hallux valgus have not been reported.

Gait abnormality following amputation in diabetic patients.

Amputations of the lower extremity may result from several etiologic factors. Most amputations performed in the United States result from a dysvascular limb. A majority of the population with vascular impairment comprises people with diabetes.

Motion of the multisegmental foot in hallux valgus.

Background: Hallux valgus is a common condition characterized by lateral deviation of the large toe and medial deviation of the first metatarsal. While some gait analyses of patients with hallux valgus have been performed using plantar pressures, very little is known about the kinematics of gait in this population. The purpose of this study was to evaluate triplanar kinematics in patients with hallux valgus using a multisegmental foot model.

Hallux rigidus: surgical treatment with the crescentic oblique basilar resection arthroplasty (COBRA).

The treatment of advanced hallux rigidus in an older, more sedentary population with poor bone stock or comorbidities that may make corrective osteotomy, fusion, and implant fixation more problematic has frequently been an issue for orthopedic surgeons. The traditional Keller resection arthroplasty has not fared well because of various problems. Crescentic oblique basilar resection arthroplasty is a viable surgical treatment alternative for older, more sedentary patients who have advanced hallux rigidus with or without hallux valgus.

Surgical reconstruction of posterior tibial tendon dysfunction: prospective comparison of flexor digitorum longus substitution combined with lateral column lengthening or medial displacement calcaneal osteotomy.

Posterior tibial tendon dysfunction (PTTD) may require surgical intervention when nonoperative measures fail. Different methods of bony reconstruction may supplement tendon substitution. This study compares two types of bony procedures used to reinforce reconstruction of the posterior tibial tendon-the lateral column lengthening (LCL), and the medial displacement calcaneal osteotomy (MDCO).

Midfoot and forefoot issues cavovarus foot: assessment and treatment issues.

This chapter addresses the etiology and diagnosis of forefoot and midfoot cavovarus deformities, the relevant anatomy and biomechanics, and specific procedures for correction of the forefoot and midfoot. Associated hindfoot and ankle procedures will be referenced; however, their specifics will be reserved for other chapters.

Kinematic changes of the foot and ankle in patients with systemic rheumatoid arthritis and forefoot deformity.

Minimal published data exist characterizing the effect of rheumatoid arthritis of the forefoot (RA) on multi-segmental gait kinematics. The purpose of this study was to examine specific changes in segmental foot motion in patients with RA as compared to persons without foot/ankle pathology. This was a cross-sectional, descriptive study consisting of 22 preoperative adult patients (29 feet) diagnosed with RA and 25 adult patients with no known foot pathology (Control).

Preoperative gait characterization of patients with ankle arthrosis.

The purpose of this study was to evaluate the kinematic changes that occur about the foot and ankle during gait in patients with degenerative joint disease (DJD). By comparing a normal adult population with what was found in the DJD population we determined how the motion of theses groups differed, thereby characterizing how this pathology affects foot and ankle motion. A 15-camera Vicon Motion Analysis System was used in conjunction with weight bearing radiographs to obtain three-dimensional motion of the foot and ankle during ambulation.

Arthrodesis of the first metatarsophalangeal joint.

Arthrodesis of the first metatarsophalangeal joint is indicated in patients with symptomatic arthrodesis or advanced hallux valgus deformities that are unresponsive to nonsurgical treatment. Several fixation techniques have been described, including intefragmentary compression screws and/or dorsal plate fixation. Using these modern fixation techniques, the rate of fusion is between 94% to 98%, with high patient satisfaction.

Glomus tumor of the hallux: case presentation and review of the literature.

Glomus tumor is an unusual benign neoplasm of the extremity. Although it is most commonly found as a painful subungual lesion in the digits of the hand, the diagnosis has been reported at various sites throughout the lower extremity. Presented is a glomus tumor of the hallux with correlative imaging and surgical findings, including a review of the literature.

Validation of a multisegment foot and ankle kinematic model for pediatric gait.

This paper reports the development, accuracy, reliability, and validation protocol of a four-segment pediatric foot and ankle model. The four rigid body segments include: 1) tibia and fibula; 2) hindfoot--talus, navicular, and calcaneus; 3) forefoot--cuboid, cuneiforms, and metatarsals; and 4) hallux. A series of Euler rotations compute relative angles between segments.

Imaging of the navicular.

This article presented a rational approach to imaging of navicular pathology. The indications, techniques, and limitations of conventional radiographic imaging were discussed. In addition, the role of advanced imaging techniques, including MRI, CT, and NMI, in the diagnosis of navicular pathology was presented.

Medial-sided bony procedures: why, what, and how?

The adult acquired flat foot deformity is a common clinical entity; rupture or incompetence of the posterior tibial tendon is a frequent cause. The natural history is characterized by progressively worsening deformity and early recognition is important. Nonoperative treatment can alleviate symptoms and control progression in nearly all stages of the disease.