Joint Manipulation Under Anesthesia for Arthrofibrosis After Hallux Valgus Surgery.

Arthrofibrosis is a known complication of hallux valgus surgery. Joint manipulation under anesthesia has been studied for adhesive capsulitis of the shoulder; however, a paucity of published data exists on the use of this modality in the foot and ankle. The purpose of the present study was to investigate the outcomes of first metatarsophalangeal joint manipulation for arthrofibrosis that occurred as a complication of bunion surgery. The study population consisted of patients attending a single foot and ankle specialty clinic who were evaluated for arthrofibrosis after bunion surgery. Patients who underwent joint manipulation under anesthesia were asked to complete a research visit in which a clinical examination was performed and the presence and severity of joint pain were assessed. A total of 38 patients (34 females, 4 males, 53 feet), with a mean age of 55.7 ± 11.8 (range 30 to 83) years, agreed to participate. The mean follow-up period was 6.5 ± 3.4 (range 1 to 17) years. The visual analog scale scores improved significantly from baseline to the final follow-up visit (baseline 6.5 ± 1.5, range 2 to 10; final follow-up visit 2.3 ± 1.5, range 0 to 6; p < .001). Furthermore, joint motion had increased significantly (p < .001) for both dorsiflexion and plantarflexion at the final follow-up examination. The final range of motion (dorsiflexion, r = -0.431, p = .002; plantarflexion, r = -0.494, p < .001) correlated highly with patient self-reported pain in the first metatarsophalangeal joint. Our findings suggest that joint manipulation could be a useful modality for increasing first metatarsophalangeal joint mobility and alleviating pain in patients who experience arthrofibrosis after surgical correction of hallux valgus.

The radiographic effects of the scarf bunionectomy on rearfoot alignment.

STATEMENT OF PURPOSE: Excessive pronation of the rearfoot has been implicated as a destabilizing force in the progression of hallux abducto valgus. Although the scarf bunionectomy has been shown to effectively correct the intermetatarsal angle associated with hallux valgus deformity, its effect on the rearfoot has yet to be established. The purpose of this case series is to demonstrate the effect of the scarf bunionectomy on rearfoot alignment. METHODOLOGY: Medical records were reviewed to isolate patients who underwent unilateral or bilateral scarf bunionectomies (with or without akin osteotomy) who had complete medical records, follow-up of at least 12 months, and met the inclusion/exclusion criteria. Preoperative and postoperative radiographic measurements were analyzed at various postoperative time intervals. Standard deviations and statistical significance was obtained. RESULTS: One hundred feet (71 patients) were included in this analysis. The long-term results of this study highlighted the scarf osteotomy's ability to affect the medial longitudinal arch by decreasing the intermetatarsal angle and lateral talar-first metatarsal angle. The talar declination and calcaneal inclination angle were not significantly altered with the scarf bunionectomy. CONCLUSION: This case series demonstrates that the scarf bunionectomy had significant effect on radiographic alignment of the bunion deformity and medial longitudinal arch over time. However, its effect on the rearfoot position was not statistically significant. LEVELS OF EVIDENCE: Therapeutic, Level IV: Case Series.

Static Versus Dynamic Musculoskeletal Ultrasound for Detection of Plantar Plate Pathology.

Musculoskeletal ultrasound (US) is a common modality used to examine plantar plate pathology. Comparison of the diagnostic accuracy of static versus dynamic ultrasound has not been previously published. The objective of this study was to prospectively compare the value of using preoperative static and dynamic ultrasound findings to diagnose plantar plate pathology using intraoperative inspection as the standard of reference. Patients attending a single foot and ankle specialty clinic from August 2012 to June 2013 with clinically suspected plantar plate pathology that was unresponsive to conservative care served as the study population. Static and dynamic ultrasound exams were performed by a single experienced rater and compared to intraoperative findings. The overall accuracy, sensitivity, specificity, positive predictive value and negative predictive value were determined for static and dynamic ultrasound exams. Thirty-six patients (45 lesser metatarsophalangeal joints) were included in this analysis. Of the 36 patients, 29 were females and 7 were males with average age of 57.9 ± 7.8 years (range, 38-73). There were 38 plantar plate tears (84.4%) noted on intraoperative examination. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for the static US exam were 80.0%, 81.6%, 71.4%, 93.9%, and 41.7%, respectively. The same values for the dynamic US exam were 88.9%, 100%, 28.6%, 88.3%, and 100%, respectively. Static and dynamic ultrasound techniques are each highly sensitive methods for assessing plantar plate pathology. However, the sensitivity and accuracy of the exam is best when dynamic assessment of the plantar plate is employed. Caution should be used when relying solely on static images to diagnose subtle injuries in this area of the foot. LEVELS OF EVIDENCE: Diagnostic Level II, Prospective.

The calcaneal scarf osteotomy: surgical correction of the adult acquired flatfoot deformity and radiographic results.

PURPOSE: Surgical correction of the adult acquired flatfoot deformity (AAFD) is continually evolving. This technique article presents the technique of the calcaneal scarf osteotomy (CSO) and radiographic evidence supporting the ability of this procedure to correct an AAFD. METHOD: The technique described here is a single osteotomy that corrects flatfoot deformity in all 3 planes. Retrospectively, medical records were reviewed to identify patients who underwent a CSO for surgical correction of AAFD. Pre- and postoperative radiographs were reviewed. RESULTS: Thirty patients (32 feet) had an average age of 49.0 ± 17.2 years (range = 35-73 years) with an average of 5.7 ± 2.0 years (range = 1-11 years) of follow-up. Anteroposterior and lateral radiographic parameters were significantly altered with this procedure (P < .001). CSO-induced calcaneal-cuboid joint arthritis did not occur. DISCUSSION AND CONCLUSIONS: The results of the current study demonstrate that the CSO significantly changes radiographic exam parameters in patients who suffer from AAFD. Therefore, the CSO provides triplanar correction through one osteotomy with early return to weight bearing and lacks the complications such as lateral column pain associated with other calcaneal osteotomies. LEVELS OF EVIDENCE: Level IV, Retrospective cohort study.

Gait changes with the use of Heelys: a case study.

Heelys shoes are a novel athletic shoe with a concealed wheel. They have been popular among youths since their introduction in 2000. This case study serves as a first look into the biomechanical implications of Heelys shoes on gait. Pressure readings of the forefoot, midfoot, and rearfoot during ambulation in regular athletic-shoe walking, Heelys without the wheel walking, Heelys with the wheel walking, and Heelys skating with the wheel were recorded on a single subject using the Pedar X System. A visual gait analysis was also performed on the subject. The resulting data show increased forefoot and rearfoot pressure while walking with the Heelys with the wheel. The visual gait analysis showed a diminished heel strike and a more rapid forefoot loading. These results demonstrate that Heelys do in fact affect the biomechanics of gait.