The surgical management of equinus in the adult acquired flatfoot.

Ankle joint equinus plays a significant role in the pathogenesis of adult and pediatric flatfoot. The surgical management of ankle equinus is a widely debated topic, and procedure selection is often based on surgeon preference because there is no consensus regarding the superiority of a single procedure. Gastrocnemius recession offers acceptable cosmesis and minimizes perceived weakness, yet requires increased operating time and is indicated only in mild to moderate contractures. Whereas tendo-achilles lengthening is efficient and technically undemanding, and one may achieve large amounts of required length, final length is sometimes unpredictable and may markedly decrease posterior muscle group strength.

A compression force comparison study among three staple fixation systems.

Traditional staples have recently been redesigned with both new materials and engineering techniques to facilitate interfragmentary compression in theory, resulting in greater friction between bone fragments to counteract shearing forces. In the current study, the biomechanical properties of 3 different staples were investigated. The interfacial force at 2 different sites within a calcaneal bone model was measured after insertion and activation of the OSStaple, the UNI-CLIP, and the Smith and Nephew Standard Large Staple after precompression with the SYNTHES Small Distractor. Additionally, the ability of each staple to maintain compression over a short period of time was investigated. In the current bench study, the OSStaple consistently generated the greatest and most uniform compression across the bone model osteotomy and was also capable of sustaining the compression over the duration of all of the trials.

Syme's amputation: a retrospective review of 10 cases.

Amputation at the level of the ankle joint is a valuable, yet underused procedure for a variety of conditions affecting the foot and ankle. The procedure can provide a comfortable and durable stump that allows a lower extremity amputee to function with minimal disability. The indications, surgical technique, and postoperative prosthetic considerations are reviewed and discussed. Emphasis is placed on the preoperative considerations deemed essential for a successful outcome based on the senior author's experience of 10 cases performed for a wide variety of pathologies. Three case illustrations show the efficacy of the Syme's procedure as an alternative to a higher level amputation, such as below-knee amputation or above-knee amputation.