ABSTRACT
BACKGROUND: Subtle cavovarus foot is a condition that can lead to significant foot pain and disability. We review the results of our treatment algorithm at medium-term followup. MATERIALS AND METHODS: Thirty-five consecutive patients with lateral based symptoms due to an underlying congenital subtle cavovarus foot type were surgically corrected. Various procedures were utilized, including some combination of the following: lateral displacement calcaneus osteotomy, peroneus longus to brevis transfer, dorsiflexion first metatarsal osteotomy, and Achilles tendon lengthening. Twenty-three patients, with 29 feet, returned for followup examination. The mean patient age at the time of surgery was 43.4 years, and the mean followup to date was 4.4 years. RESULTS: The mean AOFAS ankle hindfoot score preoperatively was 45, and postoperatively was 90. Radiographically, the medial cuneiform to floor height changed from 3.5 cm preoperatively to 3.0 cm postoperatively. The talo-first metatarsal angle improved 7.5 degrees postoperatively. There were no nonunions. No patients to date have gone on to fusions or revisions. Ten feet (34%) required hardware removal. All patients had resolution of their symptoms following hardware removal. CONCLUSION: The surgical management for the subtle cavovarus foot based on the proposed treatment algorithm provided symptomatic relief, longstanding correction, and high patient satisfaction.
Subject(s)
Algorithms , Foot Deformities/surgery , Outcome Assessment, Health Care , Adolescent , Adult , Aged , Female , Follow-Up Studies , Foot Deformities/diagnostic imaging , Humans , Male , Middle Aged , Orthopedic Procedures , Patient Satisfaction , RadiographyABSTRACT
Anterior calcaneal osteotomy (ACO) with extension bone graft is commonly employed in the treatment of symptomatic supple, hypermobile flatfoot in adolescent as well as adult (>or= 18 years of age) patients. Although autogenous bone graft has been considered the gold standard, allogenic bone is widely used for this procedure because it is readily available, requires no additional procedure for procurement and has incorporation rates similar to autogenous bone graft. There is increasing agreement among surgeons that the union rates with allograft bone are comparable with that observed with autograft bone when used in the ACO. We reviewed the medical records of 51 consecutive patients who had undergone 53 ACO with allogenic bone graft for the repair of flatfoot deformity in an effort to further evaluate outcomes associated with the use of allogenic bone graft. All of the patients had at least 12 months of follow-up. The mean time to graft incorporation was 9.10 +/- 1.54 weeks for adolescents and 9.81 +/- 2.13 weeks for adults (P = .0149), The incidence of graft incorporation (bone union) was 100% and 90% (P = .1391) in the adolescent and adult groups, respectively. Complications included lateral column pain, sinus tarsitis, nonunion, calcaneocuboid capsulitis, complex regional pain syndrome, incisional dehiscence, and sural neuritis; and all of the complications occurred in the adult group. The results support the understanding that ACO with allogenic bone graft is a reasonable alternative to autograft bone graft in the treatment of flexible flatfoot in adolescent and adult patients.
Subject(s)
Bone Transplantation , Calcaneus/surgery , Flatfoot/surgery , Osteotomy , Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Retrospective Studies , Transplantation, Homologous , Treatment OutcomeABSTRACT
UNLABELLED: Ankle equinus can result from congenital, traumatic, neurological, and pathological etiologies. Corrective methods have been described in the literature using a combination of soft tissue releases or osseous procedures with reported complications. We present a case report of a patient with a post-traumatic fixed equinus deformity of 28 degrees at maximum dorsiflexion, treated successfully through gradual correction using a modified constrained external fixator. The patient maintained a rectus foot and was able to perform all daily activities at the final follow-up. Fixed equinus deformities can be difficult to manage. Gradual correction with an external fixator is a reasonable treatment option. LEVEL OF CLINICAL EVIDENCE: 4.
Subject(s)
Equinus Deformity/surgery , External Fixators , Accidents, Traffic , Adult , Equinus Deformity/etiology , Equipment Design , Female , HumansABSTRACT
We present a case report about traumatic dislocation of the first metatarsophalangeal joint and patterns of injury. We are unaware of previous reports in the literature describing this unusual variant.
Subject(s)
Joint Dislocations/complications , Joint Dislocations/diagnosis , Metatarsophalangeal Joint/injuries , Sesamoid Bones/injuries , Tibial Fractures/complications , Tibial Fractures/diagnosis , Adult , Female , Humans , Joint Dislocations/therapy , Tibial Fractures/therapyABSTRACT
Triple arthrodesis is often the procedure of choice for end-stage adult-acquired flatfoot. The benefits of triple arthrodesis include resolution of symptoms, hindfoot realignment, and stability. This article reviews the operative technique, realignment considerations, and postoperative management when performing triple arthrodesis. When taken into account, these recommendations provide a favorable outcome for both the patient and the surgeon.
