Isolated Gastrocnemius Recession for Treatment of Insertional Achilles Tendinopathy: A Pilot Study.

INTRODUCTION: Many surgeries exist for treatment of insertional Achilles tendinopathy. Another surgical option to consider is an isolated gastrocnemius recession. Recent studies have demonstrated the success of a gastrocnemius recession for noninsertional Achilles tendinitis. We hypothesize that an isolated gastrocnemius recession can be a successful, effective, and less invasive surgery for patients with chronic insertional Achilles tendinopathy. MATERIALS AND METHODS: This article presents a retrospective review of one surgeon's results of 11 patients (2010-2012), with an average age of 59 years who presented with chronic insertional Achilles tendinopathy. Gastrocnemius recessions, either endoscopic or open, were performed after an average of 6.2 months of conservative treatment. All patients' radiographs were reviewed preoperatively for any calcaneal spurs and divided into groups accordingly. Average follow-up time postoperatively was 13.8 months. Plantarflexion strength, equinus deformity, as well as the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot instrument was assessed. RESULTS: In all, 10/11 (91%) patients had high patient satisfaction, pain relief, no residual equinus deformity, loss in muscle strength and returned to regular activities successfully at 1-year follow up. All patients and groups had significant improvement in AOFAS scores. The median postoperative AOFAS score was 94.8. All patients and patient groups had significant improvement pre- to postoperatively. Patients without spurs appear to do better than patients with spurs. One patient developed recurrence of insertional heel pain and equinus deformity. Other complications included 2 sural nerve parasthesias, which resolved. CONCLUSION: An isolated gastrocnemius recession for chronic insertional Achilles tendinopathy can provide high satisfaction, pain relief, and a faster recovery period with few or no complications. LEVELS OF EVIDENCE: Therapeutic, Level IV: Case series.

Relationship between student academic and clinical performance in podiatric medical education at Des Moines University.

BACKGROUND: This study was performed to determine whether a relationship exists regarding academic achievement between years 1 and 2 of podiatric medical education at Des Moines University. Furthermore, this study evaluates the relationship between academic performance in the first 2 years and clinical performance in year 3. METHODS: The academic records of four classes (2007-2010, N = 164) were examined for grade point averages and clinical performance scores using pairwise Pearson product moment correlations. RESULTS: Significant high correlations existed in academic performance scores between year 1 and year 2 for individual classes and pooled data. Significant low to moderate correlations were found between academic performance and clinical performance scores for individual classes and pooled data. CONCLUSIONS: These results help define the relationship between student academic and clinical performance for podiatric medicine students at Des Moines University and suggest that nonacademic characteristics may play a pivotal role in clinical abilities. These characteristics need to be further identified and developed in the academic curriculum. There may be attributes identified that also benefit the admissions process.

Distraction arthrodesis of the subtalar joint using allogeneic bone graft: a review of 15 cases.

Distraction arthrodesis of the subtalar joint is often used for the correction of neglected calcaneal fractures. Although different techniques have been advocated, there remains some debate as to the optimal type of bone graft for this purpose. This study retrospectively reviewed one surgeon's results for distraction arthrodesis of the talocalcaneal joint for 15 consecutive feet in 15 patients using 12 frozen femoral head and 3 freeze-dried iliac crest allografts. Indications for distraction arthrodesis in this series included neglected calcaneal fracture (n = 10), failed open reduction with internal fixation (n = 3), malunion after ankle fusion (n = 1), and subtalar joint arthritis with deformity (n = 1). The mean patient age was 47.5 (range 29 to 66) years, and the mean duration of follow-up was 20.6 (range 13 to 31) months. Complete union was achieved in 14 (93.33%) feet. Orthobiological agents were used in every case, including 7 (46.67%) platelet-rich plasma, 5 (33.33%) demineralized bone matrix combined with platelet-rich plasma, 2 (13.33%) platelet-rich plasma combined with an implantable electrical bone growth stimulator, and 1 (6.67%) demineralized bone matrix only. One (6.67%) patient developed a nonunion with collapse of the allogeneic graft, requiring revision with autogenous iliac crest bone graft. There were 8 (53.33%) minor complications, including 4 (26.66%) cases with inferior heel irritation, 2 (13.33%) with sural nerve paresthesia, and 2 (13.33%) with wound dehiscence. In conclusion, the use of allograft for subtalar joint distraction arthrodesis results in similar union rates as autogenous iliac crest grafting previously reported in the literature.