Total Ankle Arthroplasty in Young Patients.

With continuing advancements in total ankle arthroplasty (TAA), it is quickly becoming the procedure of choice for older patients with end-stage ankle arthritis. Multiple studies have been conducted on younger patients who have undergone TAA with promising results, but is it the procedure of choice? Considerations of TAA versus ankle arthrodesis, TAA implant longevity, outcomes of revision TAA, and whether patients should be offered an arthrodesis with plans for conversion to arthroplasty may help elucidate whether pursuing ankle arthroplasty in a younger, more active population is the correct approach for surgeons.

Patient-Reported Outcomes of Primary Total Ankle Arthroplasty in Patients Aged <50 Years.

Background: Compared to more prevalent arthritic conditions, ankle arthritis is complicated by an earlier age of onset. Recently published data demonstrates excellent survivorship and complication rates in short-/midterm follow-up of younger patients who received a primary total ankle arthroplasty (TAA). Additionally, older TAA patients display comparable reported outcomes relative to hip/knee arthroplasty.

Taylor Spatial Frame in Treatment of Equinus Deformity.

Background: An equinus deformity interferes with activities of daily living. Correction of the deformity ranges from conservative (heel cord stretching, orthotics) to surgical treatment (Baumann, Strayer, Achilles lengthening, soft tissue releases). Severe contractures increase surgical intervention with extensive dissections to release soft tissues.

A Consensus Statement on the Surgical Treatment of Charcot-Marie-Tooth Disease.

Background: Charcot-Marie-Tooth (CMT) disease is a hereditary motor-sensory neuropathy that is often associated with a cavovarus foot deformity. Limited evidence exists for the orthopedic management of these patients. Our goal was to develop consensus guidelines based upon the clinical experiences and practices of an expert group of foot and ankle surgeons.

Adding deltoid ligament repair in ankle fracture treatment: Is it necessary? A systematic review.

Background: Deltoid ligament injuries are typically caused by supination-external rotation or pronation injury. Numerous ligament reconstruction techniques have been proposed; however, clear indications for operative repair have not yet been well established in the literature.

Methods: We reviewed primary research articles comparing ORIF treatment for ankle fracture with versus without deltoid ligament repair.

Malalignment Correction of the Lower Limb Before, During, and After Total Ankle Arthroplasty.

One of the main challenges in ankle replacement is correction of any deformities in the operative limb. Deformity can be found proximal and distal to the ankle joint as well as in the ankle joint. There are static and dynamic deformities that can create unbalanced ankle joints causing early and often catastrophic failure.

Osteomyelitis of the foot and ankle: diagnosis, epidemiology, and treatment.

Osteomyelitis of the foot and ankle is a common, potentially devastating condition with diagnostic and treatment challenges. Understanding the epidemiology and pathogenesis of osteomyelitis can raise clinical suspicion and guide testing and treatments. History and physical examination, laboratory studies, vascular studies, histologic and microbiologic analyses, and various imaging modalities contribute to diagnosis and treatment.

Complications after tendon transfers in the foot and ankle using bioabsorbable screws.

Background: Tendon transfers are commonly used for correction of pathology or deformity of the foot and ankle. Bioabsorbable implants have been developed as an alternative to metal interference screws. The purpose of this study was to document complications following tendon transfers of the foot and ankle using bioabsorbable poly-L-lactide interference screws.

Calcaneal fractures: indirect reduction and external fixation.

Background: The current treatment of displaced intra-articular calcaneal fractures has been surgical fixation. The objective of this study was to evaluate the use of indirect reduction with Ilizarov external fixation as a viable alternative in the surgical treatment of certain calcaneal fractures.

Methods: Thirty-one patients with 33 fractures of the calcaneus (Sanders types II, III, and IV) were treated using small wire circular external fixation.

Excess post-exercise oxygen consumption following continuous and interval cycling exercise.

The purpose of this investigation was to examine the effect of interval (INT) and continuous (CON) cycle exercise on excess post-exercise oxygen consumption (EPOC). Twelve males first completed a graded exercise test for VO2max and then the two exercise challenges in random order on separate days approximately 1 wk apart. The INT challenge consisted of seven 2 min work intervals at 90% VO2max, each followed by 3 min of relief at 30% VO2max.

Calculation of the opening wedge for a low tibial osteotomy.

Background: Medial opening wedge distal tibial osteotomy, a relatively new technique for treatment of intermediate ankle joint arthritis, is a technically demanding procedure that requires preoperative planning to determine the size of the wedge that will restore anatomic alignment of the joint surface. The purpose of this study was to facilitate the preoperative planning process for distal tibial osteotomy by determining angular correction obtained with various wedge heights.

Methods: Measurements of the distal tibia were taken from cadaver specimens to develop a database of average distal tibial widths.

Joint distraction for the treatment of ankle osteoarthritis.

Joint distraction has demonstrated substantial promise in the treatment of tibiotalar arthritis. Its minimally invasive nature, combined with the fact that it does not seem to "burn any bridges," lends considerable clinical appeal. Even if joint distraction provides only temporary relief and clinical results slowly deteriorate over time, more definitive and committed procedures potentially can be forestalled for a considerable period of time.

Malleolar fracture after total ankle arthroplasty: a comparison of two designs.

There has been a resurgence in the treatment of end-stage tibiotalar arthritis with prosthetic replacement. This procedure has highlighted numerous complications including malleolar fracture. We wanted to determine the clinical relevance of malleolar fracture with the two most commonly used implants in the United States.

Peripheral nerve entrapments.

Peripheral nerve entrapment is a rare, but important, cause of foot and ankle pain that often is underdiagnosed and mistreated. A peripheral nerve may become entrapped anywhere along its course, but certain anatomic locations are characteristic. Clinically,nerve entrapment is divided into three stages: in stage I patients feel rest pain and intermittent paresthesias which are worse at night; in stage II, continued nerve compression leads to paresthesias, numbness, and, occasionally, muscle weakness that does not disappear during the day, and in stage III, patients describe constant pain, muscle atrophy, and permanent sensory loss.

Tendon transfer fixation: comparing a tendon to tendon technique vs. bioabsorbable interference-fit screw fixation.

Tendon transfer techniques in the foot and ankle are used for tendon ruptures, deformities, and instabilities. This fresh cadaver study compares the tendon fixation strength in 10 paired specimens by performing a tendon to tendon fixation technique or using 7 x 20-25 mm bioabsorbable interference-fit screw tendon fixation technique. Load at failure of the tendon to tendon fixation method averaged 279N (Standard Deviation 81N) and the bioabsorbable screw 148N (Standard Deviation 72N) [p = 0.

Tendon transfer fixation in the foot and ankle: a biomechanical study evaluating two sizes of pilot holes for bioabsorbable screws.

The purpose of this study was to compare the initial fixation strengths of bioabsorbable screws for tendon transfers in the foot and ankle when the pilot hole size varied. A 7 x 20 mm screw was used with 5.5 mm and 6.

Evaluation of compression in intramedullary hindfoot arthrodesis.

Compression was evaluated in an intramedullary hindfoot arthrodesis cadaver model using an external fixator and a "second generation" intramedullary compression nail. Four cadaver specimens were used. Four trials were done with each specimen.

The use of external fixation in arthrodesis and salvage of the foot and ankle.

External fixation arthrodesis provides a tremendous salvage alternative to previously unsalvageable complex ankle and hindfoot pathology. Options for bone transport and soft tissue correction add versatility to the procedure while reducing risk and increasing the potential for healing without complications. Judicious use of an experienced plastic surgeon is not only helpful, but recommended.

Continuous lateral sciatic blocks for acute postoperative pain management after major ankle and foot surgery.

Unlabelled: We developed a continuous lateral sciatic nerve infusion technique for postoperative analgesia.

Methods: A 10-cm insulated Tuohy needle connected to a nerve stimulator was introduced posteriorly between the biceps femoris and vastus lateralis groove 10 cm cephalad from the tip of the patella. After proper positioning of the insulated needle, a 20-gauge catheter was placed in proximity to the sciatic nerve.

Insertional Achilles tendinosis: surgical treatment through a central tendon splitting approach.

Twenty-two heels in 21 patients treated surgically for a primary diagnosis of insertional Achilles tendinosis were reviewed on the basis of preoperative and postoperative examinations, office records, and a comprehensive questionnaire administered to each subject. Each patient underwent surgical treatment using a midline-posterior skin incision combined with a central tendon splitting approach for debridement, retrocalcaneal bursectomy, and removal of the calcaneal bursal projection as necessary. The findings at surgery revealed involvement of the middle third of the insertion in 21 of 22 cases with only one patient manifesting isolated lateral involvement.