A retrospective analysis of anterior calcaneal osteotomy with allogenic bone graft.

Anterior calcaneal osteotomy (ACO) with extension bone graft is commonly employed in the treatment of symptomatic supple, hypermobile flatfoot in adolescent as well as adult (>or= 18 years of age) patients. Although autogenous bone graft has been considered the gold standard, allogenic bone is widely used for this procedure because it is readily available, requires no additional procedure for procurement and has incorporation rates similar to autogenous bone graft. There is increasing agreement among surgeons that the union rates with allograft bone are comparable with that observed with autograft bone when used in the ACO. We reviewed the medical records of 51 consecutive patients who had undergone 53 ACO with allogenic bone graft for the repair of flatfoot deformity in an effort to further evaluate outcomes associated with the use of allogenic bone graft. All of the patients had at least 12 months of follow-up. The mean time to graft incorporation was 9.10 +/- 1.54 weeks for adolescents and 9.81 +/- 2.13 weeks for adults (P = .0149), The incidence of graft incorporation (bone union) was 100% and 90% (P = .1391) in the adolescent and adult groups, respectively. Complications included lateral column pain, sinus tarsitis, nonunion, calcaneocuboid capsulitis, complex regional pain syndrome, incisional dehiscence, and sural neuritis; and all of the complications occurred in the adult group. The results support the understanding that ACO with allogenic bone graft is a reasonable alternative to autograft bone graft in the treatment of flexible flatfoot in adolescent and adult patients.

Scarf osteotomy for the correction of adolescent hallux valgus.

Adolescent hallux valgus deformity is a complex surgical condition. Although several techniques have been described to correct this deformity in adults, limitations exist for adolescents because of the presence of open growth plates and high recurrence rates. This retrospective study reports results of 7 patients (14 feet) using the Scarf osteotomy for correction of adolescent hallux valgus deformity. All patients underwent concomitant bilateral hallux valgus surgery. Radiographic evaluation measures included intermetatarsal 1-2 angle, hallux valgus angle, and distal metatarsal articular angle. Data recorded from the lateral radiograph evaluated the first metatarsal declination angle. Postoperative patient satisfaction was assessed using a standard patient satisfaction survey. Postoperative, subjective, and objective measurements were calculated using the American College of Foot and Ankle Surgeons (ACFAS) Scoring Scale for the First Metatarsophalangeal Joint and First Ray and the American Orthopaedic Foot & Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scoring Scale. Average patient age and follow-up were 14.43 years and 57 months, respectively. There was 100% maternal inheritance of hallux valgus deformity. The average postoperative ACFAS Metatarsophalangeal Joint and First Ray Scale (module 1) score was 94.72, and the average AOFAS Hallux Metatarsophalangeal-Interphalangeal Scale score was 96.43. Complications included 1 patient who underwent revision surgery on 1 foot 18 years after the date of index surgery because of painful recurrence of the deformity. The authors believe the Scarf osteotomy is a safe, effective, and versatile procedure for the correction of juvenile and adolescent hallux valgus deformity.

Brace management for ankle arthritis.

Management of ankle arthritis can be difficult for the physician and patient. Conservative options are limited but should be exhausted in an effort to prolong ankle arthrodesis. Custom braces can provide an effective means to alleviate pain, improve quality of life, and prolong ankle arthrodesis in patients affected by advanced ankle arthritis with or without deformity.

Long leg calcaneal axial and hindfoot alignment radiographic views for frontal plane assessment.

Reconstructive surgery for hindfoot, ankle, and leg deformities is facilitated by proper radiographic analysis. The long leg calcaneal axial and hindfoot alignment views have been proved to be useful in deformity planning at The Foot and Ankle Institute at The Western Pennsylvania Hospital. These radiographic views can be attained in an office setting or in any hospital radiology department. The details provided herein of this radiographic technique will be useful to physicians, office staff, and radiology technicians to facilitate proper imaging of hindfoot, ankle, and leg deformities.