Clinical outcomes of subtalar arthroereisis for the treatment of stage 1 flexible progressive collapsing foot deformity.

BACKGROUND: The use of subtalar arthroereisis as an adjunct to the surgical treatment of stage 1 flexible progressive collapsing foot deformity (PCFD) is controversial. The aim was to investigate the clinical outcomes and report the implant removal rate of subtalar arthroereisis as an adjunct for stage 1 PCFD. METHODS: A retrospective study of 212 consecutive feet undergoing operative management of stage 1 PCFD with adjunctive subtalar arthroereisis between October 2010 and April 2018. The primary outcome was the Foot and Ankle Outcome Score (FAOS). Secondary outcomes included Foot and Ankle Disability Index (FADI), Euroqol-5D-5L Index and implant removal rate. RESULTS: Post-operative clinical FAOS outcomes were collected for 153 feet (72.2%). At mean 2.5-year follow-up, the mean ± standard deviation FAOS for each domain was as follows; Pain: 81.5 ± 18.5, Symptoms: 79.5 ± 12.9, Activities of Daily Living: 82.5 ± 15.4 and Quality of Life: 64.2 ± 23.7. EQ-5D-5L Index was 0.884 ± 0.152. Pre-operative scores were available for 20 of these feet demonstrating a statistically significant improvement in all FAOS, FADI and EQ-5D-5L domains (p < 0.05). The implant removal rate for persistent sinus tarsi pain was 48.1% (n = 102). CONCLUSION: Use of a subtalar arthroereisis implant as an adjunct to conventional procedures in stage 1 flexible PCFD can result in significant improvement in pain and function. Patients should be counselled as to the relatively frequent rate of subsequent implant removal. LEVEL OF EVIDENCE: IV.

Rate of Infection and Causative Organisms in a Lateral Approach Total Ankle Replacement.

BACKGROUND: Although the rate of both superficial and deep infection in total ankle replacement (TAR) can reach up to 13% as reported in the literature, there is little information on the causative organisms, especially in laterally implanted prosthesis. This study aims to identify organisms causing infections to ultimately guide to better antibiotic prophylaxis. METHODS: Between September 2016 and April 2021, we retrospectively reviewed patients who had an infection after a lateral TAR. Cause of the infection, causative organisms, and implant survival were recorded. RESULTS: Out of 130 patients, 10 of 130 patients (7.6%) had a superficial infection whereas 3 of 130 patients (2.3%) had a deep infection. Staphylococcus and Pseudomonas species were found to be the most common. No significant difference was found between the type of plate used for fibula fixation regarding wound dehiscence. CONCLUSIONS: Infection after lateral TAR is generally polymicrobial in nature with Staphylococcus and Pseudomonas species being the most common. LEVEL OF EVIDENCE: Level IV Case Series.

Clinical and Radiological Outcomes of Forefoot Offloading Versus Rigid Flat Shoes in Patients Undergoing Surgery of the First Ray.

BACKGROUND: It is common clinical practice to use either flat or reverse camber shoes to protect the foot for up to 6 weeks after surgery for hallux valgus or hallux rigidus. To date there is a paucity of evidence as to whether there is any difference between these 2 postoperative shoes, in either patient satisfaction or clinical outcomes. METHODS: One hundred consecutive patients undergoing scarf/Akin osteotomies or first metatarsophalangeal joint (MTPJ) arthrodesis were recruited. Patients were randomized 50:50 to either flat or reverse camber postoperative shoes. Patients undergoing ancillary lesser toe procedures were not excluded. Patient satisfaction was assessed by visual analog scale (VAS) pain score and Likert satisfaction survey. Radiographic outcomes were reviewed at 1 year observing differences in fusion rates or deformity recurrence. There were 47 patients in the reverse cam and 43 in the flat shoe group. No difference in primary forefoot operation, additional operation, age at surgery, or preop VAS pain score was seen. RESULTS: At 6 weeks, there was no significant difference in postop VAS pain score. The flat shoe group was significantly more likely to be satisfied with their general mobility (86.0% vs 61.7%; P = .01) and with their stability in the shoe (90.7% vs 69.6%; P = .03). No significant difference was seen between groups for nonunion or hallux valgus recurrence rates. CONCLUSION: Both forms of postoperative footwear were effective in enabling patients to mobilize and in preventing adverse outcomes. Patients were more likely to be satisfied with a flat postoperative shoe due to improved stability and ease of mobilizing. The results of this study aid surgeon decision making for postoperative footwear in forefoot surgery. LEVEL OF EVIDENCE: Level II, prospective randomized controlled trial.

Pediatric complex regional pain syndrome.

Complex regional pain syndrome (CRPS) is a relatively new diagnostic entity in pediatrics. There is debate as to what constitutes the most effective treatment for pediatric CRPS. This study presents the patient characteristics, clinical course, and treatment outcome of 20 children diagnosed with CRPS at a major children's hospital during a 4-year period. The results showed that pediatric CRPS occurs predominantly in girls (90%) in later childhood and adolescence (mean age, 11.8 [range, 8-16 years]). It affects mainly the lower limbs (85%), with a predilection for the foot (75% of all cases), and was frequently initiated by minor trauma (80%). In many cases, there was a lengthy time to diagnosis (mean, 13.6 weeks) that delayed the institution of treatment, which consisted of intensive physiotherapy and psychological therapy. Most children (70%) required adjuvant medications (amitriptyline and/or gabapentin) for analgesia and to enable them to participate in physiotherapy. A high percentage of children had complete resolution of symptoms using this treatment regime (mean, 15.4 weeks [range, 3 days to 64 weeks]), but 40% required treatment as a hospital inpatient and 20% had a relapse episode. In conclusion, pediatric CRPS is under-recognized by clinicians, resulting in diagnostic delays, but has a favorable outcome to noninvasive treatment in that complete resolution of symptoms and signs occur in most patients. However, the lengthy period to achieve symptom resolution in some children and a high relapse rate support the need for further research into other treatment modalities.

Computed tomography measurement of the accuracy of component version in total hip arthroplasty.

The version of the acetabular and femoral components in 111 primary total hip arthroplasties was prospectively evaluated intraoperatively by the surgeon and compared with postoperative computed tomography (CT) scan measurements. Intraoperative estimations by the surgeons for acetabular and femoral components were all within 10 degrees to 30 degrees anteversion, with means of 16.0 degrees (SD = 4.0 degrees ) and 16.4 degrees (SD = 3.2 degrees ), respectively. However, CT scan acetabular measurements ranged from 12 degrees retroversion to 52 degrees anteversion (mean = 22.0 degrees anteversion, SD = 14.0 degrees ). Similarly, femoral component version ranged from -15 degrees retroversion to 45 degrees anteversion (mean = 16.8 degrees anteversion, SD = 11.1 degrees ). According to CT calculations, only 71% of femoral and 45% of acetabular components were within the expected clinical version range. In conclusion, the intraoperative estimation of acetabular and femoral version in a total hip arthroplasty is of limited accuracy.

Foot deformities in children with hereditary motor and sensory neuropathy.

The authors reviewed 104 feet from 52 consecutive children with hereditary motor and sensory neuropathy (HMSN) seen for the first time in clinics in two pediatric institutions between 1996 and 2003. Sixty-nine feet had a cavovarus deformity, 23 feet had a planovalgus deformity, and 12 feet had no significant deformity. All cases with deformity had bilateral involvement, and of those with deformity, only 45% had symmetric involvement. In HMSN I, III, IV, V, and X-linked HMSN, cavovarus was the most common deformity. However, in HMSN II, 55% of feet had a planovalgus deformity, 36% had a cavovarus deformity, and 9% had no deformity. In all, 43 feet underwent surgery of some type. Surgery, and in particularly combined bony and soft tissue procedures, was performed much more frequently on feet with cavovarus than planovalgus deformities. Soft tissue surgery alone was performed at an earlier age than combined bony and soft tissue surgery.