Radiographic Evaluation of Intermetatarsal Angle Correction Following First MTP Joint Arthrodesis for Severe Hallux Valgus.

Background: Arthrodesis is a standard operative treatment for symptomatic arthritis of the first metatarsophalangeal (MTP) joint. Patients with degenerative joint disease (DJD), severe hallux valgus, and metatarsus primus varus may also require fusion of the first MTP joint. An important question in the latter group of patients is whether a proximal first metatarsal osteotomy is required, in addition to the first MTP joint fusion.

Radiographic correction of stage III posterior tibial tendon dysfunction with a modified triple arthrodesis.

Background: The literature supports fusion as the surgical treatment of choice for stage III posterior tibial tendon dysfunction (PTTD). The present study reports the radiographic correction following a modified triple arthrodesis (fusions of the subtalar, talonavicular, and first tarsometatarsal joints) in patients with stage III PTTD.

Methods: An institutional review board-approved retrospective study was performed to assess the radiographic outcome of a modified triple arthrodesis in 21 patients (22 feet).

Lateral ankle radiographs: do we really understand what we are seeing?

Objectives: To evaluate the validity of using lateral intraoperative fluoroscopic imaging to assess the reduction of the tibial plafond articular surface, two hypotheses were tested: 1) the distal tibial subchondral shadow on the lateral ankle radiograph is created equally by the medial, central, and lateral portions of the distal tibia; and (2) displacement of a 5-mm width osteochondral fragment is consistently recognizable on lateral fluoroscopic imaging.

Methods: Six human fresh-frozen tibial plafond cadaveric specimens were sagitally sectioned in 5-mm increments after removal of the anterior soft tissue and stabilization of the position of the ankle through external fixation. To test the first hypothesis, a perfect lateral radiograph was taken after sectioning the specimens.

Midline posterior approach to the ankle and hindfoot.

Background: The posterior approach to the ankle and hindfoot can be used for fixation of fractures, fusions, or osteotomies and is especially useful in patients with poor soft tissue anteriorly, medially, or laterally. However, a high rate of wound complications has been reported with standard posterolateral and posteromedial approaches. Because of local wound problems with the standard approaches, we have used a midline posterior approach and a longitudinal midline splitting of the Achilles tendon.

Operative outcome of partial plantar fasciectomy and neurolysis to the nerve of the abductor digiti minimi muscle for recalcitrant plantar fasciitis.

A retrospective review was conducted of 23 patients (26 feet) to assess operative outcome of partial plantar fasciectomy and neurolysis to the nerve of the abductor digiti minimi muscle for recalcitrant plantar fasciitis. Nonsurgical treatment was implemented in all patients with no relief of symptoms (average 20.8 months) prior to surgery.

Diabetic neuroarthropathy (Charcot joints): the importance of recognizing chronic sensory deficits in the treatment of acute foot and ankle fractures in diabetic patients.

Patients with diabetic neuropathy are at a higher risk of developing complications, especially Charcot arthropathy. Early diagnosis and intervention is the key to optimizing outcome. Therefore, diabetic patients with a lower extremity injury should be screened with sensory testing using a 5.