Peroneal Tendinopathy in Chronic Lateral Ankle Instability / 대한스포츠의학회지

In patients complained of lateral ankle pain, the peroneal tendinopathy is frequently overlooked because relatively rare. In this study, types of lesion, frequency, and clinical results were analyzed in patients with peroneal tendinopathy associated in chronic ankle instability. This study reviewed the result of 22 patients. The average age was 35.1 years with an average follow-up of 20.1 months. Modified Brostrom procedure was done and peroneal tendon was explored. Peroneal tendinopathy was composed of 9 tear, 2 dislocation, 4 tendinitis, 7 low-lying muscle belly, 1 peroneal quartus. Depending on the type of peroneal tendinopathies, tubularization, groove deepening and retinaculum repair, and debridement were done. All patients had a history of repeated sprains, positive anterior drawer test, lateral ankle pain. After the last follow-up, the visual analogue scale score and American Orthopaedic Foot and Ankle Society score were evaluated. Also, almost of all patients were satisfied and anterior drawer test was improved. If the patients have chronic ankle instability and pain around the retromalleolar area, we keep in mind that the lesions are peroneal tendinopathy.

Reliability of MRI Findings of Peroneal Tendinopathy in Patients with Lateral Chronic Ankle Instability

BACKGROUND: Patients with chronic lateral ankle instability also have peroneal tendinopathy often. However, preoperative MRIs of these patients are vague in many cases. Our study was performed to see the reliability of MRI findings of peroneal tendinopathy in patients with chronic lateral ankle instability. METHODS: MRI images for 82 patients who had chronic lateral ankle instability, and had received surgical treatment between March 2006 and November 2009 were compared with impressions from operating rooms. The mean age of patients was 36.4 years (range, 15 to 64 years), 82 ankles were studied, and patients with rheumatoid diseases were excluded from the study. RESULTS: Of the 82 cases, 26 were true positives, 38 true negatives, 13 false positives and 5 false negatives. Of 39 cases of peroneal tendinopathy diagnosed from MRI, 14 had peroneal tendon partial tears, 15 tenosynovitis, 3 dislocations, 17 low-lying muscle bellies, and 6 peroneus quartus muscles. Of 31 cases of peroneal tendinopathy observed in surgery 11 had peroneal tendon partial tears, 4 tenosynovitis, 5 dislocations, 12 low-lying muscle belliess, and 1 peroneus quartus muscle. Sensitivity and specificity of peroneal tendinopathy were 83.9% and 74.5%, respectively. Positive predictive value was 66.7%. Negative predictive value was 88.4%. Accuracy rate was 78.0%. CONCLUSIONS: MRI is a useful diagnostic tool for detecting peroneal tendinopathy in patients with chronic lateral ankle instability. However, MRI is vague in many cases. Therefore, a thorough delicate physical examination and careful observation is needed.

Predisposing Factors and Treatment for the Fifth Proximal Metatarsal Fracture / 대한족부족관절학회지

PURPOSE: To evaluate clinical results of the 5th proximal metatarsal intraarticular fracture (Zone I) with displacement treated operatively and to evaluate predisposing factors of the 5th proximal metatarsal fracture (Zone I). MATERIALS AND METHODS: 11 patients treated for the 5th proximal metatarsal fracture (Zone I) operatively and 10 patients treated conservatively between Jan 2003 and Dec 2005, were followed for more than one year. Functions were graded by AOFAS foot scoring system and union time and postoperative complications were also evaluated. Calcaneal pitch angle was also evaluated. RESULTS: Clinically there were no much difference in results. Clinical points were 94.5 in the operative group and 92.3 in the conservative group. At the last follow-up, the radiographic results showed union in all cases. During the follow-up period, there were no significant complications. But in the conservative group, displaced fracture with calcaneal pitch angle over 30 degree tends to show delayed union and time to loss of pain tends to be prolonged. CONCLUSION: Calcaneal pitch angle is thought to predisposing factor for 5th metatarsal base fracture. Operative treatment is viable option for the 5th proximal metatarsal intraarticular fracture with displacement and with calcaneal pitch angle over 30 degree. In cases of cavovarus foot deformity, we think operative treatment should be considered with deliberation and long term follow-up study for peroneal tendinopathy should be needed.