Special report: Highlights of the 23rd Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society, Toronto, Ontario, Canada, 13-15 July 2007.

The 23rd Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society (AOFAS) was held 13-15 July 2007 at the Westin Harbour Castle Hotel in Toronto, Ontario, Canada. There were 538 registrants in attendance, including 182 individuals from 29 countries outside the United States.

Results of non-surgical treatment of stage II posterior tibial tendon dysfunction: a 7- to 10-year followup.

BACKGROUND: There are few long-term studies on the non-operative treatment of Stage II Posterior Tibial Tendon Dysfunction (PTTD). The purpose of this study is to describe the natural history and determine the efficacy of non-operative treatment of Stage II PTTD using clinical outcome scores. MATERIALS AND METHODS: Patients with Stage II PTTD treated with a Double Upright Ankle Foot Orthosis (DUAFO) with a minimum followup of 7 years were identified retrospectively. Patients were evaluated with the AOFAS Ankle/Hindfoot Score, SF-36, Foot Function Index (FFI), Visual Analog Scale (VAS) for pain, and a custom questionnaire in addition to a comprehensive physical examination. RESULTS: Thirty-three feet in 32 patients were included with an average followup of 8.6 years. Success defined as being brace-free and avoiding surgery was 69.7%. Five patients (15.2%) were unable to completely wean from a brace. Five patients went on to surgery. The mean AOFAS and FFI score was 78.4 and 18.4, respectively. Compared to national norms, SF-36 subscores for each age sub-category showed no significant difference in any of the age groups (p<0.05). Average VAS pain scale score was 1.9. Satisfaction was rated as "satisfied" in 20 patients (60.6%), "satisfied with minor reservations" in 11 patients (33.3%), partially satisfied in one (3.0%), and "unsatisfied" in one (3.0%). None of the patients rated as "satisfied with major reservations". CONCLUSION: Treatment of Stage II PTTD with a DUAFO has been shown to be a viable alternative to surgery with a high likelihood of adequate function, avoidance of surgery, and being brace-free at 7- to 10-year followup.

Long-term evaluation of interdigital neuroma treated by surgical excision.

BACKGROUND: We examined a large cohort of patients who had interdigital neurectomy and evaluated their clinical outcomes by using a previously developed scoring system as well as a visual analog scale (VAS). In addition, we wanted to identify risk factors that may lead to poorer outcomes. MATERIALS AND METHODS: A retrospective review identified 232 patients who had neuroma excision between 1994 and 2004, after failure of conservative treatment. Each patient was contacted via mail and given a Neuroma Clinical Evaluation Score survey as well as a visual analog score. Each patient received a unique identification number, allowing the evaluation process to be single-blinded. RESULTS: Of the 232 patients contacted, 120 (52%) returned their completed surveys. The average Giannini neuroma score was 53: 61 feet (51%) had good or excellent results, 12 (10%) had fair results, and 48 (40%) had poor results. The average VAS score was 2.5. The only significant (p = 0.027) difference in outcome was the location of the neuroma: second webspace had worse outcomes than third webspace neuromas on both the VAS and neuroma score. CONCLUSION: This retrospective review identified location in the second webspace as a possible prognostic indicator of poor outcome, but the more important finding may be that outcomes of neuroma excision do not appear to be as successful at long-term followup as previously reported.

The effect of cigarette smoking on hindfoot fusions.

In a group of 160 patients who had hindfoot fusions (isolated subtalar, talonavicular, and calcaneocuboid fusions and double and triple arthrodeses), smokers had a significantly higher rate of nonunion than did nonsmokers (18.6% vs. 7.1%). The relative risk of developing a nonunion was 2.7 times higher for smokers than non-smokers. With the numbers available, there was a trend for patients who had quit smoking prior to surgery to have a higher rate of nonunion (11.1%) than patients who had never smoked, but not as high as those who continued to smoke. There was no statistical difference in the rate of infection or delayed wound healing among the groups.

Keller resection arthroplasty for treatment of hallux valgus deformity: increased correction with fibular sesamoidectomy.

Thirty-eight patients (50 feet) were treated with Keller resection arthroplasties combined with fibular sesamoidectomies. Thirty-six patients were females (48 feet) and two were males (two feet). Their ages ranged from 55 to 87 years and averaged 68.4 years. Preoperative metatarsophalangeal (MTP) angles averaged 34 degrees (range, 10 to 55 degrees) and intermetatarsal (IM) angles averaged 15 degrees (range, 8 to 27 degrees). All patients were evaluated at an average of three years after surgery. An average correction of 18 degrees in the MTP angle and 6 degrees in the IM angle were obtained. At follow-up, 76% of patients had no pain, 14% had mild pain, and 10% had moderate pain; 76% had no activity limitations, 22% had recreational limitations, and 2% had daily limitations. Ninety-five percent of patients were satisfied with the results of their surgery.