The Role of Equinus in Flatfoot Deformity.

Equinus plays an important role in flatfoot deformity. Proper evaluation and surgical management are critical to comprehensively treat and successfully resolved patients' symptoms. We have discussed the cause, evaluation, and some of the common surgical options. Each procedure has its inherent benefits and risks. It is imperative that the foot and ankle surgeon identify and include these procedures as part of the complete reconstructive surgery.

Posterior Tibial Tendon Transfer for the Correction of Drop Foot.

Background: Drop foot is a crippling condition that often requires surgical intervention to restore functional dorsiflexion. Although transfer of the posterior tibial (PT) tendon has been well described for the treatment of drop foot, there is no consensus on whether tendon transfers affecting the ankle joint sufficiently restore functional status for daily activities. In addition, most studies have focused on drop foot caused by peripheral nerve disorders. The purpose of this study was to evaluate the functional outcomes and patient satisfaction following PT tendon transfer for the correction of drop foot resulting from both peripheral and central neurologic causes. Methods: Patients with drop foot who underwent a PT tendon transfer were followed for a minimum of 1 year and investigated retrospectively. Outcome measures included the American Orthopaedic Foot & Ankle Society ankle and hindfoot scoring system, a patient satisfaction questionnaire, postoperative ankle range of motion, and postoperative ambulatory status. Results: We evaluated 15 feet in 14 patients at a median follow-up of 50 months. The median postoperative American Orthopaedic Foot & Ankle Society ankle and hindfoot score was 85.0. Thirteen patients (92.9%) reported that they would undergo the procedure again. The median postoperative passive ankle dorsiflexion was 5.0°, and the median postoperative passive ankle plantarflexion was 30.0°. Thirteen patients (92.9%) were able to ambulate postoperatively. Ten (71.4%) ambulated without the use of an ankle-foot orthosis (AFO), and three (21.4%) ambulated with the use of an AFO. Overall, orthoses were able to be discontinued in 73.3% of the cases. Conclusions: Our results suggest that the PT tendon transfer is an effective procedure for the treatment of drop foot that can improve the patient's functional status and ability to ambulate. The majority of patients were able to discontinue the use of their AFO postoperatively.

A Comparison of Split Peroneus Brevis Tendon and Semitendinosus Allograft Tendon for Lateral Ankle Ligament Reconstruction.

Lateral ankle instability is a debilitating condition that is often unresponsive to conservative therapy. Many techniques for operative repair have been proposed, most commonly performed as the Broström or modified Broström procedure. In patients with failed primary repair, hereditary collagen disorders, strenuous work activity, obesity, or ligamentous laxity, the Broström repair is less likely to be successful, and anatomic or nonanatomic reconstruction should be considered. The purpose of this study was to compare the functional outcomes and patient satisfaction between anatomic and nonanatomic reconstruction of the lateral ankle ligament complex for lateral ankle instability using a retrospective cohort study. We evaluated 64 ankles in 62 patients who underwent either a split peroneus brevis tendon (n = 36) or semitendinosus allograft tendon reconstruction (n = 28) for lateral ankle instability performed by the same surgeon. Postoperative American Orthopedic Foot and Ankle Society (p = .943) and patient satisfaction (p = .279) found no significant difference between either technique. Our results suggest that both split peroneus brevis and semitendinosus allograft may be viable alternatives for lateral ankle instability when primary ligamentous repair is not attainable.

The multiplanar effect of first metatarsal osteotomy on sesamoid position.

The standard classification system used to measure the sesamoids in the evaluation of hallux abductovalgus is a uniplanar description of a multiplanar deformity. Additionally, it cannot accurately describe a true measure of sesamoid positional change in the perioperative period because the first metatarsal is laterally transposed during corrective surgery. The intended emphasis of this investigation is to evaluate the sesamoid position in multiple planes relative to a stationary anatomical landmark following first metatarsal osteotomy for the surgical correction of hallux abductovalgus deformity. A retrospective radiographic review of 46 feet in 38 patients demonstrated statistically significant (P < .001) differences between preoperative and postoperative values for the first intermetatarsal angle, hallux abductus angle, sesamoid rotation angle, tibial sesamoid position, and tibial sesamoid grade. However, there was no significant difference in the sesamoid position in both the transverse (P = .07) and frontal (P = .29) planes when measured relative to the stationary second metatarsal. Based on the preceding results, the appropriate expected surgical outcome of hallux abductovalgus correction may be to relocate the first metatarsal on top of the relatively immobile sesamoids.

The effect of primary fracture line location on the pattern and severity of intraarticular calcaneal fractures: a retrospective radiographic study.

This retrospective radiographic study sought to evaluate how primary fracture line location relates to the pattern and severity of intraarticular calcaneal fractures. Preoperative lateral radiographs and semicoronal computed tomography scans of 100 displaced intraarticular calcaneal fractures (89 patients) were evaluated for Bohler's angle, Sanders classification, and calcaneocuboid, anterior, or middle subtalar articular involvement. Primary fracture line location was measured on semicoronal computed tomography views as a ratio of the width of the posterior facet. There were 60 Sanders type II (29 IIA, 29 IIB, 2 IIC), 35 type III (10 IIIAB, 9 IIIAC, 16 IIIBC) and 5 type IV fractures. The mean Bohler's angle was 10.1+/-15.6 degrees. The mean primary fracture line location was calculated to be found at 45.7+/-18.2% of the width of the posterior facet, as measured from lateral to medial. Statistical analysis found a significant association between primary fracture line location and Sanders class (r=.636; P<.001) and Bohler's angle (r=-.287; P=.005); as the fracture line moved medially, comminution increased and Bohler's angle decreased. Forty-eight percent of the fractures involved the calcaneocuboid joint; 39% involved the anterior (n=28) or middle (n=11) subtalar facets, or both. A medial primary fracture line correlated to greater involvement of the calcaneocuboid joint (r=.247; P=.015) and the anterior (r=.241; P<.001) and middle (r=.344; P=.003) facets. These results suggest that intraarticular calcaneal fractures exhibiting a medial primary fracture line are associated with a more severe fracture pattern and an increased incidence of anterior articular extension.