Cannulated screws versus nitinol staple for tarsometatarsal fusion: A cadaveric biomechanical comparison model.

BACKGROUND: The objective of this study was to evaluate the biomechanical stability of a medially placed nitinol staple compared to two crossed-screws in the first TMT-1 joint fusion in a cadaveric cyclic loading model. METHODS: Seven matched pairs (N = 7) of lower limb cadaveric specimens were utilized. TMT-1 joints from each donor were fixed with a medially placed nitinol staple or dorsally placed two 3.5 mm partially threaded cannulated crossed-screws. Specimens were tested in a 4-point bending setting with increasing cyclic forces. RESULTS: The mean plantar gapping was not significantly different between the two groups at any loading stage below 200 N. Specimens fixed with a nitinol staple failed at a mean load of 305 ± 57 N. Conversely, those fixed with crossed-screws failed at 373 ± 86 N. (P = .09). CONCLUSION: There was no statistical difference between a medially placed nitinol staple and dorsally placed crossed-screws in failure loads and plantar gapping under cyclic loads at the TMT-1 joint, however, the staple fixation was much more variable. LEVEL OF EVIDENCE: Level V, basic science study, biomechanics.

Locked intramedullary nailing provides superior functional outcomes and lower complication rates than plate fixation of distal fibula fractures. A systematic review and meta-analysis of comparative studies.

PURPOSE: This study aims to provide an updated systematic review and meta-analysis of comparative studies on the outcomes and complications of locked IMNs in comparison to ORIF using plates and screws, while avoiding limitations of similar published reviews. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, two independent team members electronically searched MEDLINE (PubMed), EMBASE, Google Scholar, SCOPUS, and Cochrane databases throughout May 2021 using the following keywords with their synonyms: "Ankle fracture fixation" AND "Open reduction and internal fixation", "locked intramedullary nail", or "complications". The primary outcomes were (1) functional outcomes, (2) complications, and (3) reoperation, while the secondary outcomes were: (1) union rate, and (2) cost. INCLUSION CRITERIA: comparative studies on outcomes and complications of plate open reduction and internal fixation (ORIF) vs. locked intramedullary nailing (IMN) of ankle fractures reporting at least one of the following parameters: functional outcomes, complications (infection, dehiscence, reoperation etc.), union, and cost. Studies reporting on non-locked intramedullary fibular nails were also excluded. RESULTS: After the removal of duplicates, a total of 1461 studies were identified. After screening those records, 63 studies remained for full-text assessment. Out of those, four comparative studies with a total of 262 ankle fractures met the inclusion criteria for this meta-analysis. The mean 12 months postoperative Olerud and Molander Ankle Scores (OMAS) were reported by two studies, with a statistically significant difference in favor of IMNs (MD= 6.72, CI: 3.77-9.67, p<0.001, I2= 94%). In the ORIF group, the overall complication rate was 39/134 (29.1%) vs. 10/128 (7.8%) in the IMN group, with a statistically significant difference in favor of the IMN group (RR=3.23, CI:1.71-6.11, p<0.001, I2=34%). In the ORIF group, the overall infection rate was 11/134 (8.2%), while there were no infections in the IMN group, with a statistically significant difference in favor of the IMN group (RR=8.05, CI:1.51-42.82, p=0.01, I2=0%). In the ORIF group, the overall reoperation rate was 10/134 (7.5%) while the overall reoperation rate was 6/128 (4.7%) in the IMN group, with no statistically significant difference between groups (RR=1.49, CI: 0.60-3.70, p = 0.39, I2=0%). CONCLUSION: Locked intramedullary nail fixation of distal fibula fractures could provide superior functional outcomes and lower complication rates in comparison to open reduction and plate fixation. Despite the high incidence of ankle fractures, the number of high-quality comparative studies remains limited in literature, especially on newer locked fibular nails, and large multicentric clinical trials are required before recommending locked IMNs as the new standard of care in distal fibula fractures.

Demographic Distribution of Foot and Ankle Surgeries Among Orthopaedic Surgeons and Podiatrists: A 10-Year Database Retrospective Study.

BACKGROUND: Foot and ankle surgeries in the United States (US) are currently performed by orthopaedic surgeons or podiatrists with specialty surgical training. With the trend in healthcare now placing increased emphasis on quality and standardizing patient care, this study aimed to characterize the distribution, volume, and trends of certain foot and ankle surgeries performed in the US by both orthopaedic surgeons and podiatrists. MATERIALS AND METHODS: A retrospective analysis was performed using the Marketscan Claims Database (Truven Health Analytics, Ann Arbor, Michigan) which covers most privately insured patients under the age of 65 in the USA from 2005 to 2014. We searched current procedural terminology (CPT) codes for total ankle replacement (TAR), triple arthrodesis, hallux valgus correction, pilon fracture open reduction and internal fixation (ORIF), calcaneus fracture ORIF, and ankle fracture ORIF. We recorded the timing and nature of procedures along with various features associated with the surgeon and the geographic location of the treatment facility. RESULTS: We found that the number of foot and ankle procedures performed annually is steadily increasing. Orthopaedic surgeons are the main treating surgeon for common foot and ankle traumatic conditions or complex hind foot cases like TAR. On the other hand, our study showed that podiatrists perform almost 9 out of 10 hallux valgus correction surgeries. DISCUSSION: Our study showed the trends in surgical volumes and differences between surgical podiatrists and orthopaedic surgeons and the evolution of these volumes over a ten year period and differences in surgical repertoire between orthopaedists and podiatrists.Levels of Evidence: Level IV: Case series, Clinical research.

Achilles tendon moment arm changes with total ankle arthroplasty.

Prior research on total ankle arthroplasty (TAA) has focused on improvements in pain and function following the surgical treatment of ankle arthritis, but its effect on ankle joint mechanics has received relatively little attention. The plantarflexion moment arm of the Achilles tendon is a critical determinant of ankle function with the potential to be altered by TAA. Here we investigate the effect of TAA on Achilles tendon moment arm assessed using two methods. Standing sagittal-plane radiographs were obtained for ten patients presurgery and postsurgery, from which anterior-posterior distance between the posterior calcaneus and the center of the talar dome was measured. Ultrasound imaging and three-dimensional (3D) motion capture were used to obtain moment arm pre- and post-TAA. The absolute changes in moment arm pre- to post-TAA were significantly different from zero for both methods (9.6 mm from ultrasound and 4.6% of the calcaneus length from radiographs). Only 46% of the variance in postoperative 3D Achilles tendon moment arm was explained by the preoperative value (r2 = 0.460; p = .031), while pre- and post-TAA values from radiographs were not correlated (r2 = 0.192, p = .206). While we did not find significant mean differences in Achilles tendon moment arm between pre- and post-TAA, we did find absolute changes in 3D moment arm that were significantly different from zero and these changes were partially explained by a change in location of the talar dome as indicated by measurements from radiographs (r2 = 0.497, p = .023).

Effects of variations in Dwyer calcaneal osteotomy determined by three-dimensional printed patient-specific modeling.

Dwyer (lateral calcaneal closing wedge) osteotomy is commonly used in surgical correction of heel varus deformity. The purpose of this study was to determine the effect of wedge size and angle of osteotomy on deformity correction using preoperative imaging analysis with three-dimensional (3D) printed modeling. Seven patients diagnosed with pes cavovarus deformity who underwent Dwyer calcaneal osteotomy were identified retrospectively. Preoperative computed tomogrphy scans were used to create 3D printed models of the foot. After18 variations of osteotomy and fixation performed for each foot, Harris heel and Saltzman images were obtained. The angle between the tibia-talus axis and calcaneal-tuber axis was measured and compared to pre-osteotomy state. Change in the calcaneal lengths was also analyzed. The average degree correction of deformity per mm of bone resected was 3.8 ± 0.2 degrees in the Harris Heel view and 2.7 ± 0.8 degrees in the Saltzman view. A significant increase in correction was obtained with 10 mm compared with 5 mm wide wedges (P < .001). The difference in correction was not statistically significant between 30 and 45 degree cuts or osteotomy distance from the posterior calcaneal tuberosity, but a 45 degree sagittal angle resulted in less calcaneal shortening compared to 30 degrees (P = .02). A clinically driven method using patient-specific 3D models for determining effects of calcaneal osteotomy variables in correcting hindfoot alignment was developed. In summary, the amount of wedge resected impacts hindfoot alignment more than location and sagittal angle of the cut. Calcaneal shortening depends on sagittal angle of the cut.

Distal fibula osteotomies improve tibiotalar joint compression: A biomechanical study in a cadaveric model.

BACKGROUND: Successful tibiotalar joint fusion relies on adequate compression. Compression following joint preparation may be affected by the extent to which the fibula holds the joint out to anatomical length. The purpose of this study was to evaluate the effect of various distal fibula osteotomies on tibiotalar joint compression. METHODS: Eight adult cadaveric lower extremity specimens with an intact ankle joint and syndesmotic complex were evaluated. The ankle joint cartilage was denuded to subchondral bone. The fibula was surgically modified with three progressing procedures including an oblique fibula osteotomy, 1 cm resection, and distal fibula resection. A transducer was utilized to measure tibiotalar joint force, contact area, and peak pressure values while compressive forces of 30 N, 50 N, and 100 N were applied to the proximal tibia/fibula. FINDINGS: Distal fibula resection significantly increased tibiotalar joint force, contact area, and peak pressure the most of all fibula conditions tested compared to intact fibula control (p < .05). Tibiotalar joint force and peak pressures were significantly increased with a distal fibula oblique osteotomy, 1 cm resection, and complete resection under both 30 and 50 N applied compressive force (p < .05). INTERPRETATION: Complete distal fibular resection results in higher tibiotalar joint force, contact area, and peak pressure which may improve clinical rates of successful ankle fusion.

Proximal Interphalangeal Arthrodesis of Lesser Toes Utilizing K-Wires Versus Expanding Implants: Comparative Biomechanical Cadaveric Study.

BACKGROUND:: Lesser toe proximal interphalangeal (PIP) joint arthrodesis is one of the most common foot and ankle elective procedures often using K-wires for fixation. K-wire associated complications led to development of intramedullary fixation devices. We hypothesized that X Fuse (Stryker) and Smart Toe (Stryker) would provide stronger and stiffer fixation than K-wire fixation. METHODS:: 12 cadaveric second toe pairs were used. In one group, K-wires stabilized 6 PIP joints, and 6 contralateral PIP joints were fixed with X Fuse. A second group used K-wires to stabilize 6 PIP joints, and 6 contralateral PIP joints were fixed with Smart Toe. Specimens were loaded cyclically with extension bending using 2-N step increases (10 cycles per step). Load to failure and initial stiffness were assessed. Statistical analysis used paired t tests. RESULTS:: K-wire average failure force, 91.0 N (SD 28.3), was significantly greater than X Fuse, 63.3 N (SD 12.9) ( P < .01). K-wire average failure force, 102.3 N (SD 17.7), was also significantly greater than Smart Toe, 53.3 N (SD 18.7) ( P < .01). K-wire initial stiffness 21.3 N/mm (SD 5.7) was greater than Smart Toe 14.4 N/mm (SD 9.3) ( P = .02). K-wire failure resulted from bending of K-wire or breaching cortical bone. X Fuse typically failed by implant pullout. Smart Toe failure resulted from breaching cortical bone. CONCLUSION:: K-wires may provide stiffer and stronger constructs in extension bending than the X Fuse or Smart Toe system. This cadaver study assessed stability of the fusion site at time zero after surgery. CLINICAL RELEVANCE:: Our findings provide new data supporting biomechanical stability of K-wires for lesser toe PIP arthrodesis, at least in this clinically relevant mode of cyclic loading.

Avoiding Pitfalls of Tibiotalocalcaneal Nail Malposition With Internal Rotation Axial Heel View.

Background. Tibiotalocalcaneal (TTC) nails are often used for complex hind foot arthrodesis and deformity correction. The natural valgus alignment of the hindfoot creates a challenge to optimum placement of the guidewire and eventual nail with a straight or valgus-curved nail. Methods. Five fresh frozen cadavers were used for placement of a TTC guidewire with standard anterior-posterior (AP), lateral, and Harris axial heel views as a reference for proper placement. The limb was then rotated 15°, 30°, and 45° both internally and externally to evaluate the perceived amount of osseous purchase within the calcaneus. The TTC nail was then inserted and dissection was performed to demonstrate proximity of the nail to the sustentaculum tali and neurovascular structures. Results. A 30° internal rotation Harris axial heel view demonstrated the most accurate representation of osseous purchase within the calcaneus with the guidewire and nail placement. When the guidewire was placed with standard imaging the nail was often ultimately placed in close proximity to the sustentaculum tali and neurovascular structures. Conclusion. Careful placement of the guidewire prior to reaming and nail placement should be undertaken to avoid neurovascular injury and to increase osseous purchase. For optimal guidewire placement, the authors suggest using appropriate anatomic landmarks and using a 30° internally rotated Harris axial heel view to verify correct placement. Levels of Evidence: Level V: Expert opinion.

Antibiotic Use and Kirschner Wire Fixation in Forefoot Surgery: A National Survey.

In foot and ankle patients, the use of Kirschner wires is common, and the population in the typical foot and ankle practice has higher rates of comorbidities associated with infection. This study assessed national trends regarding the use of postoperative prophylactic antibiotic therapy in patients undergoing foot and ankle surgery treated with percutaneous Kirschner wires. Attending physicians at foot and ankle fellowships were mailed a questionnaire that included 3 clinical vignettes containing questions on the use of postoperative antibiotics in patients treated with percutaneous Kirschner wires. A total of 112 physicians were identified; 64 physicians (57%) returned the survey. In the first case of a nondiabetic patient, 16 physicians (25%) indicated they would place the patient on postoperative antibiotics for an average of 9.4 days with an average duration of Kirschner wire fixation of 35.1 days. In the second case of a non-neuropathic diabetic patient, 18 surgeons (28%) indicated they would place the patient on postoperative antibiotics for an average of 13.8 days with an average duration of Kirschner wire fixation of 35.4 days. In the third case of a diabetic patient with neuropathy, 19 physicians (32%) indicated they would place the patient on postoperative antibiotics for an average of 14.5 days with an average duration of Kirschner wire fixation of 36.7 days. Few attending physicians at orthopedic foot and ankle fellowships placed their patients treated with percutaneous Kirschner wires on postoperative antibiotic prophylaxis, even in diabetic patients for whom an increased risk of infection has been documented. [Orthopedics. 2017; 40(4):e594-e597.].

Biomechanical consequences of adding plantar fascia release to metatarsal osteotomies: Changes in forefoot plantar pressures.

Destruction of the normal metatarsal arch by a long metatarsal is often a cause for metatarsalgia. When surgery is warranted, distal oblique, or proximal dorsiflexion osteotomies of the long metatarsal bones are commonly used. The plantar fascia has anatomical connection to all metatarsal heads. There is controversial scientific evidence on the effect of plantar fascia release on forefoot biomechanics. In this cadaveric biomechanical study, we hypothesized that plantar fascia release would augment the plantar metatarsal pressure decreasing effects of two common second metatarsal osteotomy techniques. Six matched pairs of foot and ankle specimens were mounted on a pressure mat loading platform. Two randomly assigned surgery groups, which had received either distal oblique, or proximal dorsiflexion osteotomy of the second metatarsal, were evaluated before and after plantar fasciectomy. Specimens were loaded up to a ground reaction force of 400 N at varying Achilles tendon forces. Average pressures, peak pressures, and contact areas were analyzed. Supporting our hypothesis, average pressures under the second metatarsal during 600 N Achilles load were decreased by plantar fascia release following proximal osteotomy (p < 0.05). However contrary to our hypothesis, peak pressures under the second metatarsal were significantly increased by plantar fascia release following modified distal osteotomy, under multiple Achilles loading conditions (p < 0.05). Plantar fasciotomy should not be added to distal metatarsal osteotomy in the treatment of metatarsalgia. If proximal dorsiflexion osteotomy would be preferred, plantar fasciotomy should be approached cautiously not to disturb the forefoot biomechanics. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:800-804, 2017.

Repair of Chronic Tibialis Anterior Tendon Rupture With a Major Defect Using Gracilis Allograft.

BACKGROUND: Tibialis anterior tendon (TAT) rupture is an uncommon injury, however, it can cause substantial deficit. Diagnosis is often delayed due to lack of initial symptoms; yet loss of function over time typically causes the patient to present for treatment. This delay usually ends up with major defects creating a great technical challenge for the operating surgeon. We present a novel technique and operative algorithm for the management of chronic TAT ruptures with a major gap after a delayed diagnosis not otherwise correctable with currently described techniques in the literature. This technique has been performed in 4 cases without any complications with fairly successful functional outcomes. METHODS: For the reconstruction of chronic TAT rupture with an average delay of nine weeks after initial injury and gap of greater than 10 cm, a thorough operative algorithm was implemented in 4 patients using a double bundle gracilis allograft. Patients were then kept nonweightbearing for 6 weeks followed by weightbearing as tolerated. They began physical therapy with a focus on ankle exercises and gradual return to normal activity at 8 weeks, with resistance training exercises allowed at 12 weeks. RESULTS: At a mean follow-up time of 24.5 months, all patients reported significant pain relief with normal gait pattern. There were no reported intra- or postoperative complications. The average Foot and Ankle Ability Measure score increased to 90 from 27.5 in the postoperative period. All patients were able to return their previous activity levels. CONCLUSIONS: Gracilis allograft reconstruction as used in this study is a viable and reproducible alternative to primary repair with postoperative results being favorable without using complex tendon transfer techniques or autograft use necessitating the functional sacrifice of transferred or excised tendon. To the best of our knowledge, this is the first study demonstrating a successful technique and operative algorithm of gracilis allograft reconstruction of the TAT with a substantial deficit of greater than 10 cm with favorable results. LEVELS OF EVIDENCE: Level IV: Operative algorithm with case series.

Comparison of Proximal and Distal Oblique Second Metatarsal Osteotomies with Varying Achilles Tendon Tension: Biomechanical Study in a Cadaver Model.

BACKGROUND: The optimal surgery for reducing pressure under the second metatarsal head to treat metatarsalgia is unknown. We tested our hypothesis that a proximal oblique dorsiflexion osteotomy of the second metatarsal would decrease second-metatarsal plantar pressures in a cadaver model with varying Achilles tendon tension. We also tested the plantar pressure effects of two popular techniques of distal oblique osteotomy. METHODS: Twelve fresh-frozen feet from six cadavers were randomly assigned to either the distal osteotomy group (a classic distal oblique osteotomy followed by a modified distal oblique osteotomy) or proximal metatarsal osteotomy group. Each specimen was tested intact and then after the osteotomy or osteotomies. The feet were loaded with 0, 300, and 600 N of Achilles tendon tension and a 400-N ground reaction force. Plantar pressures were measured by a pressure sensitive mat and analyzed in sections located under each metatarsal. RESULTS: The proximal metatarsal osteotomy significantly reduced average pressures beneath the second metatarsal head during both 300 and 600 N of Achilles tendon loading by an average of 19.4 and 29.7 kPa, respectively (p < 0.05). The modified distal oblique osteotomy significantly decreased these pressures during 600 N of Achilles tendon loading, by a mean of 20.2 kPa, which was to a lesser extent than the proximal metatarsal osteotomy. Interestingly, the classic distal oblique osteotomy was not found to have significant effects on pressures beneath the second metatarsal head. CONCLUSIONS: The proximal oblique dorsiflexion metatarsal osteotomy may be the most effective procedure for decreasing plantar pressures under the second metatarsal. The modified distal oblique osteotomy may be the second most effective. CLINICAL RELEVANCE: The findings of this biomechanical study help shed light on which of the common second metatarsal osteotomies are best for decreasing plantar pressures.

Algorithm for Severe Hallux Valgus Associated With Metatarsus Adductus.

BACKGROUND: Radiographic angles, such as the intermetatarsal angle, hallux valgus angle, and distal metatarsal articular angle, are commonly used to help guide operative planning for soft tissue and osseous treatment options for hallux valgus. Hallux valgus treatment in the setting of associated metatarsus adductus is less common and not well described. The presence of metatarsus adductus reduces the gap between the first and second metatarsals. Consequently, it complicates the measurement of the first-second intermetatarsal angle and can limit the area available for transposition of the first metatarsal head. A compensatory pronation is also created, which must be compensated for. We present 4 cases of patients that had hallux valgus with severe metatarsus adductus treated operatively, as well as a treatment algorithm. METHODS: For concomitant correction of both the metatarsus adductus and the hallux valgus, a thorough surgical treatment algorithm was implemented to address the hallux, lesser toe deformities, and pes planus deformity. Postoperatively, the patients were kept non-weight bearing for 6 weeks, followed by gradual weight bearing in a protective boot. Physical therapy was instituted at the start of weight bearing to encourage a return to activities of daily living. RESULTS: At follow-up, patients reported significant relief of their pain symptoms with a narrower and improved appearance of the foot. No recurrence was noted. One patient used a medial arch support but was otherwise symptom free. Radiographic measurements improved on postoperative radiographs. CONCLUSIONS: For the treatment of hallux valgus with metatarsus adductus, the second and third metatarsals may need to be addressed for the first metatarsal to be laterally transposed adequately. Overall, this comprehensive approach addresses the hindfoot, midfoot, and forefoot for patients with hallux valgus associated with metatarsus adductus, with successful results.

Ankle arthritis: review of diagnosis and operative management.

The diagnostic and therapeutic options for ankle arthritis are reviewed. The current standard of care for nonoperative options include the use of nonsteroidal antiinflammatory drugs, corticosteroid injections, orthotics, and ankle braces. Other modalities lack high-quality research studies to delineate their appropriateness and effectiveness. The gold standard for operative intervention in end-stage degenerative arthritis remains arthrodesis, but evidence for the superiority in functional outcomes of total ankle arthroplasty is increasing. The next few years will enable more informed decisions and, with more prospective high-quality studies, the most appropriate patient population for total ankle arthroplasty can be identified.

An unusual case of chronic lateral foot pain following ankle inversion injury: osteoid osteoma of the tarsal cuboid bone.

Osteoid osteomas are common benign tumors normally seen in the femur, tibia, and spine. They rarely are seen in the foot. We present an unusual case of osteoid osteoma of the cuboid in a 26-year-old man. This was initially thought to be an ankle sprain, as its first presentation was after a sporting injury. It was then treated as an infection before the true diagnosis--that of osteoid osteoma--was obtained.

Giant cell tumor of the distal phalanx of the great toe: a case report.

UNLABELLED: Giant cell tumors are rarely seen in the foot. They can cause a significant amount of pain and deformity due to their aggressive and recurrent nature. We present the unusual case of a giant cell tumor of the distal phalanx of the hallux in a 39-year-old man. LEVELS OF EVIDENCE: Therapeutic Level IV, Case Report.

Extensor retinaculum augmentation reinforces anterior talofibular ligament repair.

Repair of the anterior talofibular ligament often is augmented with the inferior extensor retinaculum because it is thought to reinforce the primary ligament repair. The additional dissection and suturing extend the duration of surgery, and not all surgeons routinely include inferior extensor retinaculum augmentation in anterior talofibular ligament repairs. To determine whether there is a reasonable basis for this surgery, we ascertained the degree to which inferior extensor retinaculum augmentation reinforced the primary anterior talofibular ligament repair. Matched pairs of cadaveric ankles had controlled inversion while monitoring resistance to inversion, first with the anterior talofibular ligament sectioned, then with primary anterior talofibular ligament repair alone or with inferior extensor retinaculum augmentation. The resistance to ankle inversion was greater at 5 degrees, 10 degrees, 15 degrees, 20 degrees, and 25 degrees rotation in ankles that had inferior extensor retinaculum augmentation. Anterior talofibular ligament failure occurred at similar inversion angles in both treatment groups, but the primary anterior talofibular ligament repair required more torque to fail in the augmented group. With these ankle loading conditions, inferior extensor retinaculum augmentation provided protection to the primary anterior talofibular ligament repair, indicating that broader clinical use of augmentation may be warranted.

The functional outcome of displaced intra-articular calcaneal fractures: a comparison between isolated cases and polytrauma patients.

This study was conducted to analyze the functional outcome of displaced intra-articular calcaneal fractures in polytrauma patients and isolated cases, and to make a comparison between them. Twenty-eight patients (12 women and 16 men) with an average age of 37 (range, 13 to 60) who had 35 displaced intra-articular calcaneal fractures were included in this study. Among these, 17 fractures were due to polytrauma and 18 were due to isolated trauma. According to Sanders CT classification, 19 fractures (54.3%) were classified as type II, 10 fractures (28.5%) as type III and six fractures (17.2%) as type IV. The treatment consisted of operative and closed methods. The average follow-up time was 38 months (range, 18 to 83 months). The functional outcome was evaluated using Maryland Foot Score and there were three (17%) excellent, nine (52.9%) good and five (29.5%) fair results in polytrauma patients Seven (38.8%) excellent, 10 (55.6%) good and one (5.6%) fair results were seen in isolated cases. When compared with isolated cases, the functional outcome of displaced intra-articular calcaneal fractures in polytrauma patients was worse. With the findings available, it appears that foot trauma is usually ignored and should be treated without delay as for other system injuries in polytrauma patients.