Noninsertional Achilles Tendinopathy Pathologic Background and Clinical Examination.

The term tendinopathy includes a series of pathologies, all of which have a combination of pain, swelling, and impaired performance. The terms tendinosis, tendinitis and peritendinitis are all within the main heading of tendinopathy; this terminology provides a more accurate understanding of the condition and highlights the uniformity of clinical findings while distinguishing the individual histopathological findings of each condition. Understanding the clinical features and the underlying histopathology leads to a more accurate clinical diagnosis and subsequent treatment selection.

Imaging Techniques and Indications.

This article evaluates the utility of radiography, ultrasonography, and MRI in diagnosing Achilles tendon injuries. It reviews the pertinent anatomy of the Achilles and associated structures, and signs of disorder with each imaging technique. The economics of use ultrasonography and MRI are discussed.

Anatomic, Vascular, and Mechanical Overview of the Achilles Tendon.

The Achilles tendon is the strongest and thickest tendon in the body and is subjected to unique forces during the activities of living. A variety of pathologic processes have been identified causing clinical symptoms in patients of all ages. A detailed understanding of Achilles anatomy is necessary to understand the pathologic process that are seen in the tendon.

Charcot Collapse: Does Collapse Pattern Dictate Osseous Metabolism?

Unlabelled: Charcot fracture pattern (FP) and Charcot dislocation pattern (DP) are 2 distinct collapse patterns identified in Charcot neuroarthropathy of the foot and ankle. These patterns are believed to demonstrate relative differences in central bone mineral density (BMD), which has been theoretically extrapolated to describe local BMD. To assess variation in local bone composition of FP and DP patients, 10 patients, 5 DP and 5 FP were recruited.

Comparison of Transverse and Coronal Plane Stability at the First Tarsal-Metatarsal Joint With Multiple Screw Orientations.

Unlabelled: Intercuneiform instability has been recognized as a potential cause of hallux valgus recurrence following tarsal-metatarsal joint (TMTJ) fusion. Recommendations have been made for additional screw placement between the metatarsals and/or the cuneiforms to improve stability. The screw orientation that provides the best stability has not been documented.

Comparison of the Mechanical Characteristics of a Universal Small Biplane Plating Technique Without Compression Screw and Single Anatomic Plate With Compression Screw.

To better understand the mechanical characteristics of biplane locked plating in small bone fixation, the present study compared the stability under cyclic cantilever loading of a 2-plate locked biplane (BPP) construct without interfragmentary compression with that of a single-plate locked construct with an additional interfragmentary screw (SPS) using surrogate bone models simulating Lapidus arthrodesis. In static ultimate plantar bending, the BPP construct failed at significantly greater load than did the SPS construct (556.2 ± 37.

Evaluation of dorsal Lisfranc ligament deformation with load using ultrasound imaging.

Background: Research findings have linked dorsal Lisfranc ligament (dLL) rupture to complete Lisfranc ligament complex rupture; identifying deformation characteristics of the dorsal Lisfranc ligament alone may be helpful in diagnosing complete ligament rupture. The goal of the present study was to assess the deformation characteristics of the asymptomatic dLL using physiologically relevant stress/loads in a clinical setting and to discern normative dLL parameters.

Methods: Unilateral dLL measurements were taken from 50 healthy volunteers, using sonographic imaging under three different stress/load conditions.

Quantitative Analysis of the Degree of Frontal Rotation Required to Anatomically Align the First Metatarsal Phalangeal Joint During Modified Tarsal-Metatarsal Arthrodesis Without Capsular Balancing.

The data from 35 consecutive patients with hallux valgus undergoing triplane arthrodesis at the first tarsal metatarsal joint were studied to determine the amount of first metatarsal frontal plane rotation (supination) needed to anatomically align the first metatarsal phalangeal joint on an anterior posterior radiograph without soft tissue balancing at the first metatarsal phalangeal joint. Radiographs were measured both pre- and postoperatively to assess the 1-2 intermetatarsal angle, hallux abductus angle, and tibial sesamoid position (TSP). The mean amount of varus (supination) rotation performed during correction was 22.

A retrospective review of the effect of metatarsus adductus on healing time in the fifth metatarsal jones fracture.

Purpose: The fifth metatarsal Jones fracture is a unique injury. Previous studies have identified possible biomechanical risk factors related to this fracture, as well as potential subsequent effects on bone healing complications. The purpose of this retrospective study was to determine the effect of metatarsus adductus (MAA) on bone healing in patients following intramedullary screw fixation of the Jones fracture.

Comparison of Complications for Internal and External Fixation for Charcot Reconstruction: A Systematic Review.

The surgical reconstruction of Charcot deformity can be a challenge for foot and ankle surgeons. Consensus is lacking among surgeons regarding the best method of surgical fixation to be used in reconstruction, and clear strong evidence is also lacking in published studies. We undertook a systematic review of electronic databases and other relevant sources in an attempt to better understand the complications and outcomes associated with internal and external fixation for Charcot foot and ankle reconstruction.

Illustration of Cost Saving Implications of Lower Extremity Nerve Decompression to Prevent Recurrence of Diabetic Foot Ulceration.

The US diabetic foot ulcer (DFU) incidence is 3-4% of 22.3 million diagnosed diabetes cases plus 6.3 million undiagnosed, 858 000 cases total.

Complications of metatarsal suture techniques for bunion correction: a systematic review of the literature.

To better understand the safety of suture techniques to reduce the intermetatarsal angle in patients with hallux valgus deformity, we undertook a systematic review of the complications associated with the use of this technique. The suture procedures of 197 patients were analyzed for complications. The number of complications in the total group (n = 197) at a pooled mean follow-up period of 23.

Is our current paradigm for evaluation and management of the bunion deformity flawed? A discussion of procedure philosophy relative to anatomy.

Of the >100 procedures that have been proposed to treat hallux valgus or the "bunion" deformity, most have focused on correction through metatarsal osteotomies at various levels combined with soft tissue balancing procedures at the first metatarsophalangeal joint. This paradigm of metatarsal osteotomy and soft tissue balancing has been so commonplace, any argument for a fundamental change to the approach becomes uncomfortable and seems unwarranted to most foot and ankle surgeons. However, the simple fact that so many procedures exist, with so many modifications of these procedures, can be interpreted as a failure of our basic paradigm of metatarsal osteotomy and soft tissue balancing.

Mechanical comparison of cortical screw fixation versus locking plate fixation in first metatarsal base osteotomy.

The oblique closing base wedge osteotomy has been used for surgical treatment of moderate to severe hallux valgus deformities with an intermetatarsal angle typically greater than 15°. Several postoperative complications have been identified that relate to failure of the fixation construct used to fixate the osteotomy, especially when that construct has been subjected to a vertical load. We performed a mechanical analysis comparing 2 constructs used to fixate oblique osteotomies of the first metatarsal using composite first metatarsals.

Reduction of the intermetatarsal angle after first metatarsal phalangeal joint arthrodesis: a systematic review.

Arthrodesis of the first metatarsophalangeal joint (MTPJ) has commonly been used for the treatment of a variety of first MTPJ disorders, including hallux valgus. We undertook a systematic review of the electronic databases and other relevant sources to identify material relating to the reduction of the first intermetatarsal angle (IMA) after first MTPJ arthrodesis. Fifteen studies with a total of 701 first MTPJ arthrodesis procedures were identified that met the inclusion criteria.

Observed changes in radiographic measurements of the first ray after frontal and transverse plane rotation of the hallux: does the hallux drive the metatarsal in a bunion deformity?

It is well known that the pathologic positions of the hallux and the first metatarsal in a bunion deformity are multiplanar. It is not universally understood whether the pathologic changes in the hallux or first metatarsal drive the deformity. We have observed that frontal plane rotation of the hallux can result in concurrent positional changes proximally in the first metatarsal in hallux abducto valgus.

Technique for minimally invasive reduction of calcaneal fractures using small bilateral external fixation.

Soft tissue complications are well known after extensile exposure of the calcaneus for open reduction internal fixation of fractures. A variety of recommendations have been proposed to reduce soft tissue healing issues and infection. Despite these recommendations, some surgeons believe that soft tissue complication rates have remained unacceptably high with lateral extensile incisions.

Observed changes in radiographic measurements of the first ray after frontal plane rotation of the first metatarsal in a cadaveric foot model.

We observed the changes in the angular measurements commonly used in the evaluation of the first metatarsal and first metatarsophalangeal joint in cadaveric specimens before and after frontal plane rotation of the first metatarsal. Measurements of the first and second intermetatarsal angle (IMA), hallux abductus angle, proximal articular set angle, and tibial sesamoid position (TSP) were taken after varying degrees of varus and valgus rotation of the first metatarsal. Standard dorsoplantar radiographs were taken at 0°, 10°, 20°, and 30° of valgus rotation of the first metatarsal and repeated at 10°, 20°, and 30° varus rotation of the first metatarsal.

Incidence of surgical site infection in the foot and ankle with early exposure and showering of surgical sites: a prospective observation.

The incidence of postoperative surgical site infection (SSI) reported in the published data for foot and ankle surgery has been 1.0% to 5.3%.

Ultrasound assessment of dorsal lisfranc ligament strain under clinically relevant loads.

Background: Pure Lisfranc ligament injuries have a varied clinical presentation, making them difficult to diagnose. This study seeks to understand in vivo strain characteristics of the dorsal Lisfranc ligament under clinically relevant stress loads and foot orientations measured by ultrasound.

Methods: Randomized ultrasound imaging trials were performed on 50 asymptomatic feet of 20-to-32-year-old individuals who were free of lower-extremity abnormalities.

Clarification of the anatomic definition of the bunion deformity.

Evolution of the terminology applied to the bunion deformity has progressed in parallel with our changing understanding of the deformity itself. Along this path of progression have been multiple terms, sometimes with multiple meanings. Hallux valgus and metatarsus primus varus are 2 of the most common terms for the deformity.

Reduction of intermetatarsal angle after first metatarsophalangeal joint arthrodesis in patients with hallux valgus.

We present a radiographic review of 94 patients who underwent first metatarsophalangeal joint arthrodesis. The main focus of our review was to assess the change in the intermetatarsal angle (IMA). The change in the IMA was measured for the entire group and for 2 subgroups (IMA 11° to 15° and IMA >15°).

Observed changes in first metatarsal and medial cuneiform positions after first metatarsophalangeal joint arthrodesis.

The first intermetatarsal angle (IMA) is known to decrease after first metatarsophalangeal joint arthrodesis, although the exact mechanism by which this decrease occurs is not known. We measured the first IMA and obliquity of the medial cuneiform on anteroposterior weightbearing preoperative and postoperative radiographs in 86 feet and analyzed the statistical correlation between the IMA and the medial cuneiform angle. A change in the first IMA after first metatarsophalangeal joint fusion showed a strong positive correlation with a change in cuneiform obliquity (p < .

Effectiveness of a locking plate in preserving midcalcaneal length and positional outcome after Evans calcaneal osteotomy: a retrospective pilot study.

When using the Evans calcaneal osteotomy for repair of a calcaneovalgus deformity, lengthening of the lateral column of the foot is the method by which the procedure acts to correct the deformity. Therefore, maintaining the length is a priority. In our experience, substantial length is lost soon after surgery using the traditional nonfixated procedure.