Atypical stress-avulsion fracture of the Lisfranc joint complex.

Antiphospholipid syndrome and systemic erythematosus have been associated with metatarsal stress fractures. Stress fractures of the Lisfranc joint complex are uncommon injuries but have been reported to occur most frequently in ballet dancers. We present a case of an avulsion fracture of the Lisfranc joint complex that occurred spontaneously. We have reviewed the association between systemic conditions and metatarsal fractures and proposed a series of hypothetical pathological events that may have contributed to this unusual injury.

The conundrum of calcaneal spurs: do they matter?

BACKGROUND: Chronic plantar heel pain is a common and potentially debilitating condition, often caused by plantar fasciitis. Plantar calcaneal spurs were originally considered the cause of plantar fasciitis but are now regarded as an incidental finding by most authors. We aimed to test this hypothesis and to investigate predisposing factors for the development of spurs. METHODS: We reviewed all lateral ankle X rays taken in our institution over a 6-month period and identified all X rays demonstrating calcaneal spurs. Then, we identified a similar number of age- and sex-matched controls without spurs. We contacted both groups by telephone and compared symptoms of heel pain, plantar fasciitis, associated comorbidities, and foot and ankle outcome scores (FAOSs). RESULTS: We reviewed the X rays of 1103 consecutive patients and found a spur prevalence of 12.4%, more common in women and older patients. Questioning of the spur group and control group found a higher body mass index in the spur group. Patients with spurs were 4 times more likely to have diabetes mellitus and 10 times more likely to have lower-limb osteoarthritis. Patients with spurs had more foot pain and poorer FAOS than the control group, even when patients with plantar fasciitis were excluded. CONCLUSION: Our results demonstrate that the presence of a plantar calcaneal spur may be an indicator of foot pain independent of plantar fasciitis. Although spurs may not cause foot pain themselves, they may be an indication of other associated conditions. CLINICAL RELEVANCE: We have demonstrated the relevance of a radiographic finding once considered irrelevant.

Long-term follow-up of lateral reconstruction with extensor retinaculum flap for chronic ankle instability.

BACKGROUND: Chronic instability is a common complication of lateral ankle sprains. Furthermore, patients often have unrecognized associated lesions affecting the ankle and subtalar joints. Many stabilizing surgical techniques have been described, each with variable results. This article reports the long-term results of ligamentous retensioning combined with reinforcement using an extensor retinaculum flap. PATIENTS AND METHODS: This is a retrospective, multicenter study. One hundred fifty cases were reviewed at a mean follow-up of 11 years. Functional results were assessed using the Karlsson score. Pre- and postoperative radiological assessment employed stress x-rays to measure varus tilt and anterior drawer and the Van Dijk classification to grade osteoarthrosis. The Stata 10 program was used for statistical analysis. RESULTS: A thorough preoperative workup identified ligamentous lesions of the subtalar joint in 30% of cases. At review, 93% of patients were satisfied. Residual instability was present in only 4.8%. Radiographic analysis of both ankles revealed a differential in varus tilt of only 0.12° and in anterior drawer of 0.17~mm. There was no deterioration of the articular surfaces after 11 years of follow-up. CONCLUSION: To the authors' knowledge, this is the largest series reported with such a follow-up. This technique addressed both lateral ankle and subtalar instability without sacrificing the peroneal tendons. It protected against progression of posttraumatic arthrosis and provided superior results to other reported techniques in terms of patient satisfaction and residual instability.

A single-center prospective evaluation of the Ponseti method in nonidiopathic congenital talipes equinovarus.

BACKGROUND: The Ponseti method has revolutionized the management of idiopathic congenital talipes equinovarus (CTEV). However, nonidiopathic CTEV is still often primarily treated by extensive surgical soft tissue release. We believe that nonoperative treatment of these patients using the Ponseti method may give very satisfactory results. METHODS: We examined the demographics of nonidiopathic CTEV and the success of the Ponseti method in this population over a 5-year period. We treated 29 patients with 43 nonidiopathic and 97 patients with 138 idiopathic CTEV feet. Patients with nonidiopathic CTEV made up 23% of all cases. The commonest etiologies were arthrogryposis (5 cases), trisomy 21 (4 cases), and spina bifida (3 cases). Average follow-up was 39 (nonidiopathic group) and 35 months (idiopathic group). RESULTS: The Ponseti method was initially successful in 91% of nonidiopathic and 98% of idiopathic feet. Recurrence of deformity occurred in 44% of nonidiopathic and 8% of idiopathic feet. Thirty-seven percent of nonidiopathic feet required extensive surgical release compared with 2% in the idiopathic group. CONCLUSIONS: Although the success rate of the Ponseti method in nonidiopathic CTEV is inferior to that in idiopathic CTEV, 63% of our nonidiopathic patients did not require extensive surgery. We believe that the Ponseti method should be used in all cases of nonidiopathic CTEV. LEVEL OF EVIDENCE: Level III--prospective cohort study.