Successes and pitfalls in the healing of neuropathic forefoot ulcerations with the IPOS postoperative shoe.

Unnecessary amputations can be avoided with the healing of foot ulcerations in neuropathic feet. Traditional approaches have relied on relieving plantar and other extrinsic foot pressures. A retrospective review was performed of the office records of patients with Wagner grade 1 and 2 neuropathic forefoot ulcerations who were prescribed an IPOS (Niagara Falls, NY) postoperative shoe. A total of .33 patients were in the chart review. Twenty-three of these patients were located and agreed to participate in a telephone survey. Patients showed a compliance of 78%. Seventy-seven percent of the patients healed their ulcers and wore prescription inserts and extra-depth shoes at a mean of 8 weeks. Seventy-eight percent of our telephone survey patients were either satisfied or satisfied with reservations. Problems or complications from wearing the IPOS postoperative shoe occurred with 38% of all patients.

Effect of axial load and ankle position on ankle stability.

The range of motion of 10 fresh cadaveric ankle specimens was measured for flexion, anterior-posterior drawer, inversion-eversion, and internal-external rotation under conditions that simulated normal weight-bearing. At a 70 kg load, range of motion significantly diminished in all directions (p < 0.005). Plantar flexion was diminished to a greater degree than dorsiflexion. For anterior-posterior drawer in the loaded state, ankle flexion did not play a significant role in determining stability. Factors such as ligamentous attachments may be more critical than mortise geometry in determining anterior-posterior translation. For torsion and version, stability was greatest in dorsiflexion. That ankle stability is related to articular congruity with increased load-bearing emphasizes the importance of anatomical restoration of the ankle mortise in the injury state.

Effect of the syndesmotic screw on ankle motion.

The purpose of this study was to determine the effect of syndesmotic screw fixation on ankle motion. Eight unpaired osteoligamentous cadaver ankles were tested. The study quantified ankle flexion, talar tilt, ankle drawer, and tibiotalar rotation for each specimen using an MTS biomechanical testing system. Each specimen was tested under a 15-kg and a 70-kg axial load. The testing was repeated after the placement of a syndesmotic screw, a 4.5-mm cortical screw, in accordance with AO technique. There was a statistically significant decrease (P less than .05) in tibiotalar external rotation. There was no statistical difference in ankle flexion. There was a significant decrease in the anterior and the posterior drawer tests with the foot in plantar flexion. These were the most significant results. Syndesmotic screw fixation is used for the internal fixation of certain unstable ankle fractures. Opinions differ as to whether the screw should be removed at 6 weeks (prior to weightbearing) or left in place indefinitely. It was concluded that the syndesmotic screw should be removed prior to the return to full activity. Leaving it in place will contribute to abnormal ankle motion; this may result in local discomfort and a possible fatigue fracture of the screw.