ABSTRACT
BACKGROUND: Insertional Achilles tendinopathy is a common complaint among patients. Oftentimes, conservative treatment is inadequate, and surgical treatment is required. However, there is no published consensus regarding surgical intervention in reference to insertional Achilles tendinopathy. METHODS: The purpose of this systematic review was to evaluate the surgical management of insertional Achilles tendinopathy and report which surgical procedures provide the greatest pain reduction and improvement in functional outcome. A review of PubMed, OVID, Google Scholar, and Cochrane Controlled Trials Register was performed using a defined search strategy and inclusion criteria. RESULTS: Of 2,863 articles identified using the defined strategy, 20 met the inclusion criteria (three prospective and 17 retrospective). Operative interventions included Achilles tendon debridement, reattachment with suture anchors, reconstruction with flexor hallucis longus tendon autograft or bone-patellar tendon autograft, and gastrocnemius recession. All of the studies, regardless of intervention, showed generalized improvement after surgery. Wide variation in outcome scoring systems prevented direct comparison between studies and interventions. CONCLUSIONS: This systematic review did not identify a superior treatment for insertional Achilles tendinopathy but rather found that the surgical treatment should be based on the extent of tendon injury.
Subject(s)
Achilles Tendon , Orthopedic Procedures , Tendinopathy , Achilles Tendon/surgery , Humans , Prospective Studies , Retrospective Studies , Tendinopathy/surgeryABSTRACT
Tendon transfers are commonly performed procedures in the foot and ankle. They have been described for multiple tendons and a myriad of pathologies. One issue with these procedures has always been inadequate fixation with several methods available to the surgeon. In this report, we describe a novel technique in foot and ankle surgery using a cortical button and an interference screw.
Subject(s)
Ankle Joint/surgery , Bone Screws , Foot/surgery , Orthopedic Fixation Devices , Tendon Transfer/instrumentation , Humans , Tendon Transfer/methodsABSTRACT
Injuries to the foot and ankle are often missed or underestimated in patients with polytrauma and are a source of long-term limitations. Injures below the knee are among the highest causes for unemployment, longer sick leave, more pain, more follow-up appointments, and decreased overall outcome. As mortalities decrease for patients with polytrauma a greater emphasis on timely diagnosis and treatment of foot and ankle injuries is indicated. Geriatric patients represent nearly one-quarter of trauma admissions in the United States. This article discusses perioperative management and complications associated with foot and ankle injuries in polytrauma, and in diabetic and geriatric patients.
Subject(s)
Ankle Injuries/diagnosis , Ankle Injuries/surgery , Foot Injuries/surgery , Multiple Trauma/diagnosis , Multiple Trauma/surgery , Accidents, Traffic , Diabetic Foot/complications , Diabetic Foot/surgery , Foot Injuries/diagnosis , Fracture Fixation/methods , Fracture Healing/physiology , Humans , Reoperation , Risk Factors , Soft Tissue Injuries/diagnosis , Soft Tissue Injuries/surgeryABSTRACT
Correction of a bunion deformity with the use of proximal first ray procedures has historically included additional distal soft tissue and bone work about the first metatarsophalangeal joint. We report the case of a young adult female who underwent isolated first tarsometatarsal fusion for correction of a bunion deformity. Moreover, we describe the published data related to this approach. This technique could have the potential to improve patient outcomes by avoiding postoperative arthrofibrosis of the first metatarsophalangeal joint.
Subject(s)
Arthrodesis/methods , Hallux Valgus/surgery , Female , Hallux Valgus/diagnostic imaging , Humans , Metatarsal Bones/surgery , Radiography , Tarsal Bones/surgery , Young AdultABSTRACT
Diabetes is the leading cause of nontraumatic amputations. Although laboratory assessment may not alone determine the optimal level of amputation thorough assessment of a variety of laboratory values is critical to overall care of the patient and may place the patient into risk category. This systematic review analyzes publications related to diabetic lower extremity amputations and associated laboratory values, including lymphocyte count, albumin, hemoglobin, and glycemic control.
Subject(s)
Amputation, Surgical/methods , Diabetic Foot/diagnosis , Diabetic Foot/surgery , Surgical Wound Infection/diagnosis , Surgical Wound Infection/epidemiology , Albumins/metabolism , Amputation, Surgical/adverse effects , Anti-Bacterial Agents/therapeutic use , Blood Chemical Analysis , Blood Glucose/analysis , Combined Modality Therapy , Debridement/methods , Female , Hemoglobins/metabolism , Humans , Incidence , Leukocyte Count , Male , Middle Aged , Perioperative Care/methods , Risk Assessment , Severity of Illness Index , Surgical Wound Infection/therapy , Treatment Outcome , Wound Healing/physiologyABSTRACT
INTRODUCTION: Insertional Achilles tendinopathy is a problem frequently encountered by the foot and ankle surgeon. Conservative care yields mixed results, and this condition is often treated surgically. Our hypothesis is that the suture bridge technique through a central posterior incision allows adequate visualization for thorough debridement and exostectomy and provides a stable tendon-to-bone interface for healing. MATERIAL AND METHODS: The medical records of 35 patients who underwent surgical treatment for insertional Achilles tendinopathy with the suture bridge technique, by a single surgeon, between 2006 and 2012 were retrospectively reviewed. American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot instruments as well as a subjective questionnaire were utilized. RESULTS: In all, 30 individuals who met the inclusion criteria for the treatment of insertional Achilles tendinopathy were evaluated at a mean follow-up of 28.93 ± 16.99 months. We included 10 men and 20 women, with a mean age of 49.1 ± 9.2 years. The mean preoperative AOFAS score was 56.6 ± 14.0. The average postoperative AOFAS score significantly increased to 91.7 ± 10.4 (P < .0001). One participant required revisional surgery, consisting of a flexor hallucis longus transfer performed by another physician. There were no wound complications or infections. Overall, there was a 97% (28/29) satisfaction rate. CONCLUSION: The central incision with complete detachment of the Achilles tendon and reattachment with the suture bridge technique for the treatment of insertional Achilles tendinopathy provides an effective treatment with good to excellent clinical outcomes in 97% of patients, with a mean follow-up of 29 months.
Subject(s)
Achilles Tendon/surgery , Suture Techniques , Tendinopathy/surgery , Achilles Tendon/injuries , Female , Humans , Male , Middle Aged , Reoperation/statistics & numerical data , Retrospective Studies , Surveys and Questionnaires , Treatment OutcomeABSTRACT
INTRODUCTION: Atraumatic avascular necrosis (AVN) is an unusual pathology to the foot. Risk factors include the use of corticosteroids, smoking, alcohol, rheumatologic disorders, hematologic disorders, and metabolic disorders. To the authors' knowledge, this study presents the first case of bilateral atraumatic AVN to the navicular and medial cuneiform in a patient with systemic lupus erythamatosus (SLE). CASE DESCRIPTION: A 40-year-old man presented with a past medical history of SLE in which he developed AVN of the tarsal navicular and medial cuneiform. This occurred first on the subject's right foot and then while recovering from surgical intervention, on his left foot. Talonaviculocuneiform arthrodesis was performed with the use of distal tibial autograft on both extremities. The subject's American Orthopaedic Foot and Ankle Society midfoot score improved from 34 to 80 at 21 months on the right and 37 to 90 at 15 months to the left. DISCUSSION: Patients with SLE carry a significant risk of developing AVN. Comorbidities such as vasculitis, corticosteroid use, cytotoxic medication, and peripheral neuropathy are known risk factors in the development of AVN. Unusual features such as multifocal AVN and unusual anatomic locations can occur with SLE. AVN of the foot is generally treated with surgical intervention. Treatments such as core decompression, open reduction and internal fixation, and arthrodesis have been recommended based on the symptoms and presentation. CONCLUSION: The authors present a very rare presentation of bilateral osteonecrosis of the tarsal navicular and first cuneiform in a patient with SLE. The patient was treated with bilateral talonaviculocuneiform arthrodesis. The patient demonstrated considerable improvement to both extremities. LEVELS OF EVIDENCE: Therapeutic, Level IV.
Subject(s)
Lupus Erythematosus, Systemic/complications , Osteonecrosis/diagnosis , Tarsal Bones/pathology , Adult , Arthrodesis , Humans , Magnetic Resonance Imaging , Male , Osteonecrosis/surgery , Pain/etiology , Tarsal Bones/surgery , Tarsal Joints/surgeryABSTRACT
Tibiotalocalcaneal arthrodesis using intramedullary nail fixation is a technically demanding procedure. Periprosthetic fracture in association with tibiotalocalcaneal arthrodesis is a rare occurrence, with relatively few instances reported. The present report describes 2 such instances that occurred after tibiotalocalcaneal arthrodesis using retrograde femoral intramedullary nail fixation. Studies have suggested that a longer nail might decrease the incidence of periprosthetic fracture. Other factors could also have an influence, including the proximal screw orientation and the presence of medical comorbidities, such as osteopenia.
