Foot school: Preoperative education before day case elective foot and ankle surgery reduces the length of stay after surgery.

BACKGROUND: This study evaluates the impact of preoperative education on the length of hospital stay after foot and ankle surgery. There are several studies on the benefits of preoperative education prior to hip and knee arthroplasty, especially their role in facilitating early discharges. But studies on the benefits of foot school (Preoperative education) prior to Foot and Ankle surgeries are limited. The aim of this study was to determine if Foot school played a role in expediting early and safe discharges in patients of elective foot and ankle surgeries METHODS: All patients listed for an elective foot and ankle procedure were invited to attend foot school, which consisted of a multi-disciplinary team whose aim was to educate patients about their surgical procedures, rehabilitation and discharge goals. Not all patients attended foot school, as attendance to foot school was recommended but not mandatory for surgery. Data on all foot and ankle surgeries performed in 2019 were collected, and patients were divided into two groups based on their foot school attendance. RESULTS: 92% of the patients who attended foot school were discharged on the same day. 65% of patients who did not attend foot school returned home the same day. There was a statistically significant difference in the observed mean hours after surgery between the two groups. Patients who attended foot school stayed at the hospital for a lesser duration than those who did not (mean difference = 8.55 h, p-value = 0.004). Early discharges can also increase the turnover of patients for day case procedures and improve cost savings. The cost analysis also showed that a portion of the savings from a reduced hospital stay could run foot school service. CONCLUSION: Our study demonstrates that preoperative education allows a significantly shorter hospital stay, thereby facilitating early patient discharges. This can improve the patient turnover rate and also would save the hospital cost per procedure. Patients should, therefore, be encouraged to attend Foot school before their surgical procedure.

Hallux varus: A literature review.

Hallux varus is a rare foot deformity due to iatrogenic, post-traumatic, idiopathic, inflammatory, spontaneous, or congenital pathologies. Acquired hallux varus, in particular, iatrogenic type, is the commonest. The primary pathology is the abnormal musculotendinous forces secondary to soft tissue or bony imbalance exerting varus deforming force. Understanding the anatomy of the hallux stabilisers and the pathophysiology of hallux varus is vital in its management. It would be helpful to understand the potential surgical pitfalls leading to iatrogenic hallux varus. This literature review summarises all the published facts about hallux varus, focussing on anatomy, pathophysiology, clinical and radiological assessment, and management.

Comparison of Scarf-Akin osteotomy with Lapidus-Akin fusion in cases of Hallux Valgus with a disrupted Meary's line: A case series study.

BACKGROUND: Hallux Valgus associated with medial column instability (disrupted Meary's line) can be corrected either with Lapidus-Akin or Scarf-Akin procedure. This study compares these two procedures to ascertain if type of surgical procedure performed affects the correction achieved and recurrence rate at 6 months following operative intervention. MATERIALS AND METHODS: This is a retrospective case series that reviews the incidence of early recurrence of Hallux Valgus deformity in 60 patients with an associated disrupted Meary's line who underwent either a Scarf-Akin osteotomy (n = 30) or a Lapidus-Akin procedure (n = 30) between January 2014 and January 2020. Radiographs, operative and clinical notes were utilized to determine degree of correction and recurrence of deformity at 6 months between both groups. RESULTS: The study found a 47% higher recurrence rate in the Scarf-Akin osteotomy group compared to the Lapidus-Akin group at 6 month follow up. This result was statistically significant with a p-value of 0.002 (95% CI 7-49%). Lapidus-Akin procedure was also found to be superior to the Scarf-Akin procedure in achieving a better degree of correction in the Hallux Valgus angle by an average of 11 degrees. CONCLUSION: A disrupted Meary's line is a risk factor for recurrence of Hallux Valgus deformity. The authors recommend that Lapidus-Akin procedure has a significantly reduced recurrence rate compared to a Scarf-Akin osteotomy in Hallux Valgus with disrupted Meary's line.

The long-term outcome of silastic implant arthroplasty of the first metatarsophalangeal joint: a retrospective analysis of one hundred and eight feet.

PURPOSE: The short-term results of silastic implant of the first metatarsophalangeal joint (MTPJ) have been successful. However, reservations exist regarding long-term results. The aim of this study was to evaluate long-term outcome of silastic implant prosthesis in treatment of hallus rigidus. METHODS: This was a retrospective study, with 108 feet in 83 patients, operated upon between 1988 and 2003. Mean age at operation was 55 years (SD 8.1) with a follow-up period of 8.5 years. Outcome measures included the American Orthopaedic Foot and Ankle Scoring system(AOFAS), passive and active arc of motion. Patients' satisfaction was assessed using the visual analogue scale. All the patients had anteroposterior and oblique views and were assessed for loosening and osteolysis. Pedobarographic studies were performed using the Musgrave Footprint. Complications and revisions were recorded. RESULTS: The mean total AOFAS score was 77.5 (SD 13.4). Mean active and passive arc of motions were 36.8 degrees (SD 19.13) and 46.82 degrees (SD 17.19), respectively. Patient satisfaction showed mean VAS of 7.73 (SD 2.41). Prostheses were removed in three feet at three, five and seven years respectively because of persistent pain. Radiologically 25 feet (23 %) had osteolysis but were non progressive and didn't correlate with the functional outcome. CONCLUSION: We can conclude that silastic implant arthroplasty is an effective procedure in hallux rigidus management with satisfactory functional outcome and high patient satisfaction.

Surgeon administered regional blocks for day case forefoot surgery.

INTRODUCTION: The aim was to see if as surgeons we were providing safe, efficient and effective, regional blocks for patients undergoing day case, forefoot surgery. We also assessed the costs of, providing this service. METHODS: 63 consecutive patients were recruited prospectively for local anaesthetic block. Blocks were, performed by the orthopaedic team. Efficacy of block was assessed intra-operatively with a visual, analogue score (VAS) of 0-10. Satisfaction with the anaesthetic procedure was also assessed. RESULTS: Average time to perform the block was 6 min. Mean VAS for knife to skin was 0.44 (95%, confidence 0.07-0.81) and for ankle tourniquet was 1.39 (95% confidence 0.85-1.39). Patients were, highly satisfied with the blocks. No complications were reported. CONCLUSIONS: These blocks are quick and easy to perform by orthopaedic surgeons. They are well, tolerated and effective. They result in considerable cost savings to the Hospital.

Fibula lengthening osteotomy to correct valgus mal-alignment following total ankle arthroplasty.

Total Ankle Arthroplasty (TAA) is increasing in popularity following the development of the, next generation of implants and improved surgical technique giving better long-term results. Significant mal-alignment of the ankle pre-operatively has always provided a challenge to the surgeon, to regain anatomical alignment to reduce subsequent wear. We present a series of two cases of TAA, who developed post-operative valgus deformity requiring salvage procedure in the form of a fibula, lengthening osteotomy.

Is there a role for total ankle replacement in polio patients?: A case report and review of the literature.

Although poliomyelitis is almost eradicated, as orthopaedic surgeons we occasionally encounter residual deformities in patients who suffered the disease in the past. An equino-varus deformity of the foot is the commonest deformity seen. In this report we present a 53 years old lady who had poliomyelitis as a child and presented with a painful, degenerate ankle and 12 degrees of varus deformity. CT confirmed advanced degenerative changes. The management options included realignment and fusion, supramalleolar ostoetomy or total ankle replacement. In view of the satisfactory active range of motion and advanced OA confirmed by CT scan we considered the option of total ankle replacement. To our knowledge this has never been reported before. At two and half years follow up the patient showed satisfactory functional results (AOFAS score 88/100) and high satisfaction. Plain radiographs revealed a well aligned joint with no evidence of loosening or osteolysis.

Stress fracture of the fourth metatarsal in a child: a case report and review of the literature.

Metatarsal stress fractures are uncommon in the children. They usually occur in the distal part of the metatarsal and common in second and third metatarsals. Stress fracture in the proximal fourth metatarsal in a child is very rare. We report a stress fracture in the proximal fourth metatarsal in an 8-year-old boy, which was successfully treated with non-operative management.

Interesting clinical presentation of anterior knee pain causing diagnostic dilemma.

A diverse variety of lesions may occasionally occur in the patella. In this case report, we are presenting an interesting case of anterior knee pain in middle aged gentleman. Initial investigations including Magnetic Resonance Imaging not showed any abnormality. Due to prolonged continued pain he had bone scan and MRI, which confirmed the diagnosis of Brodie's abscess. We are presenting this case of Brodie's abscess of the patella causing diagnostic dilemma because of its rarity.

The influence of postoperative coronal alignment on revision surgery in total knee arthroplasty.

This study examines the association between postoperative coronal tibiofemoral alignment and revision surgery in knee arthroplasty. We retrospectively reviewed the case notes and post-operative long-leg radiographs of 197 Kinemax knee arthroplasty with mean follow-up of 9 years (SD 2.2). They were divided into three groups: neutral, valgus and varus. Revision or decision to revise was used as a hard endpoint. There was no statistical difference among the three groups (p=0.78). We conclude that aseptic failure of a total knee is multifactorial. Coronal tibio-femoral alignment may not be as important a cause of failure as has been previously thought.