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Background: Melioidosis is an emerging infectious disease caused by the Gram-negative bacterium Burkholderia pseudomallei, which can lead to a range of clinical manifestations including acute septicaemia and chronic localized infections. Osteomyelitis is an uncommon but well-recognized complication of melioidosis, with the calcaneus being a relatively rare site of involvement. Case Description: The authors present a case series of three patients with calcaneal osteomyelitis caused by Burkholderia pseudomallei, infection. All three patients presented with non-specific symptoms like fever and weight loss, followed by localized ankle/foot pain and swelling. Diagnosis was made based on imaging findings (radiographs and MRI) and isolation of Burkholderia pseudomallei, from blood or pus cultures. Treatment involved a combination of initial intravenous antibiotic therapy (meropenem or ceftazidime) for 4-6 weeks, followed by oral trimethoprimsulfamethoxazole for 6 months. One patient required surgical drainage of a plantar abscess. All patients had a favorable clinical outcome with a resolution of osteomyelitis on follow-up imaging. Conclusion: Calcaneal osteomyelitis is a rare but potentially serious complication of melioidosis. Early recognition and prompt initiation of appropriate antibiotic therapy are crucial for favorable outcomes. Clinicians should maintain a high index of suspicion for osteomyelitis in patients with melioidosis, especially in patients from Endemic areas as well as in patients with risk factors like diabetes. Close follow-up and monitoring for potential relapse or reactivation are essential, particularly in immunocompromised individuals. [ABSTRACT FROM AUTHOR]

Background: Posterior tibial tendon (PTT) tendoscopy and medializing calcaneal osteotomy (MCO) are among the available techniques for patients presenting with symptomatic flexible hindfoot valgus (stage IA) progressive collapsing foot deformity (PCFD). The aim of this study was to determine clinical and radiographic outcomes of combined PTT tendoscopy and MCO for patients presenting with symptomatic stage IA PCFD. Methods: A retrospective cohort study was performed in order to determine clinical and radiographic outcomes of 30 combined PTT tendoscopies and MCO on 27 patients presenting with symptomatic stage IA PCFD, with a minimum follow-up of 24 months. Patient satisfaction was assessed at last available follow-up as very satisfied, satisfied, and unsatisfied. Clinical assessment was performed evaluating preoperative and last available follow-up visual analog scale for pain (VAS-P), Foot and Ankle Outcome Score (FAOS), and the 36-Item Short Form Health Survey (SF-36). Magnetic resonance imaging (MRI) was performed preoperatively on all patients. Standard weightbearing anteroposterior, lateral, and long axial view radiographs of the foot and ankle were taken preoperatively, immediate postoperatively, at 6 weeks, 3 months, 6 months, 1 year postoperatively, and last follow-up evaluation available for each patient. Results: The mean follow-up was 38.6 (range, 26-62) months. We registered 27 very satisfied, 1 satisfied, and 2 unsatisfied patients. There was statistically significant improvement on all clinical scores (VAS-P, FAOS and SF-36), as well as on lateral talo–first metatarsal and hindfoot alignment angles. We found low-grade PTT tears in 5 patients (16.67%) in whom preoperative MRI documented PTT tenosynovitis alone. Conclusion: We found that combined PTT tendoscopy and MCO provide significant clinical and radiographic improvement for patients presenting with symptomatic stage IAB PCFD. PTT tendoscopy should be considered in the treatment of all surgically addressed flexible valgus feet as it detects tendon tears which are frequently missed on an MRI. Level of Evidence: Level IV, retrospective case series. [ABSTRACT FROM AUTHOR]

Background: Calcaneal tuberosity avulsion fractures are challenging to treat because of the poor bone stock and high risk of fixation failure secondary to the strong Achilles tendon pull. The purpose of this study is to compare the tensile force to failure of 2 different types of screw fixation construct in a cadaveric model of calcaneal tuberosity avulsion fracture. Methods: An oblique osteotomy was created in the calcanei of 7 matched pairs of cadaveric specimens to simulate a tuberosity avulsion fracture and one specimen from each pair randomized into one of the 2 groups for comparison. Two cancellous screws were inserted perpendicular to the fracture line at the posteromedial and posterolateral corners of the avulsed fragment for the 2-screw construct. For the second group, an additional stab incision was made at the midline of the Achilles insertional region for a screw placed between the initial 2 screws with a trajectory toward the calcaneocuboid joint in the 3-screw construct. These specimens were then mounted and loaded to failure. Results: The mean force to a predefined failure at 3.0-mm gap for the 3-screw construct was 468.7 ± 267.9 N vs 278.9 ± 164.0 N for the 2-screw construct (P <.001). The addition of a central nonparallel screw in the 3-screw construct significantly increased the force required for fracture gap displacement at all cut-off points (1.0-8.0 mm) when compared to the 2-screw construct (P <.001). Notably, the mean peak tensile force for the 3-screw construct was 499.4 ± 255.4 N occurred at the gap displacement of 4.1 mm for the 3-screw construct whereas the mean peak tensile force for the 2-screw construct was 315.9 ± 162.4 N displacing the gap at 4.3 mm. Conclusion: This study showed that an additional central nonparallel screw in the 3-screw construct provided significant mechanical superiority compared to a 2-screw construct. Clinical Relevance: The present study supported the use of augmented fixation with an additional central off-axis screw to reduce risk of fixation failure in calcaneal tuberosity avulsion fractures. [ABSTRACT FROM AUTHOR]

Background: Addressing hindfoot varus via calcaneal osteotomy with simultaneous peroneal tendon repair from a single incision has not been thoroughly assessed. Some concerns with one incision are wound complications, nerve damage, and symptomatic hardware., Methods: Patients operated on by one surgeon May 2012 to January 2022 were retrospectively reviewed with minimum 2-year follow-up via in-person visit, telephone, and chart review. Patients with peroneal tendon repair in conjunction with a modified Dwyer (with lateral shift) osteotomy fixated with a laterally applied locking plate were included. Those whose osteotomies were fixated with posteriorly applied screws were excluded., Results: Fifteen patients were assessed, 13 males and 2 females, average age 56.9 ± 9.9 years. There were no wound complications or nerve injuries. One patient elected to have plate removal. There was 1 deep vein thrombosis. Return to activity including sports was 5.3 ± 1.3 months. On average, postoperative Roles and Maudsley and AOFAS hindfoot scores improved to "significant from pre-treatment" 11 with "excellent" results., Conclusion: Peroneal tendon repair can be performed through the same incision as a modified Dwyer calcaneal osteotomy to address hindfoot varus deformity. In this series, there were no wound or nerve issues., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Amol Saxena, DPM, MPH, reports disclosures relevant to this article from Trimed, Inc: royalty & speaker fees. Disclosure forms for all authors are available online.

Abstract Background Three-dimensional (3D) printing technology has developed rapidly in orthopaedic surgery and effectively achieves precise and personalized surgery. The purpose of this meta-analysis was to assess the efficacy of 3D printing technology in the management of displaced intra-articular calcaneal fractures (DICFs) by extended lateral approach (ELA). Methods We searched PubMed, Web of Science, Embase, Cochrane Library, CNKI, VIP, and VANFUN databases were searched up to October 2020. All clinical studies comparing traditional surgery and 3D printing-assisted surgery in the management of DICFs were obtained, evaluating the quality of the included studies and extracting data. For each study, we assessed odds ratios (ORs), standard mean difference (SMD), and 95% confidence interval (95% CI) to assess and synthesize the outcomes. Results Three RCTs and nine retrospective studies involving 732 patients were included met our inclusion criteria with 366 patients in the 3D group and 366 patients in the conventional group. The meta-analysis showed that there were significant differences of the operative time in the 3D group [SMD = − 1.86, 95% CI (− 2.23, − 1.40), P

Background: We compared the effectiveness of the extensile lateral approach (ELA) and modified sinus tarsi approach (MSTA) with a variable-angle locking anterolateral plate in treating Sanders type II and III calcaneal fractures.Methods: We reviewed 45 DIACFs treated by a single surgeon from 2017 to 2020. Open reduction using ELA and MSTA was performed in 25 and 20 patients, respectively. Follow-up evaluations included radiological assessments and clinical evaluations.Results: Pre- and postoperative radiologic parameters for the calcaneus were significantly different. The average American Orthopaedic Foot and Ankle Society scores were 81.24 and 85.00, the mean visual analogue scale scores were 2.28 and 1.65, and the wound-related complication rates were 64.0% and 15.0% in the ELA and MSTA groups, respectively. Bony union was achieved in all cases.Conclusions: For Sanders type II and III fractures, MSTA seems to be a safer and more satisfactory method, with fewer postoperative complications. [ABSTRACT FROM AUTHOR]

Background: The treatment of chronic calcaneal osteomyelitis is a challenging and increasing problem because of the high prevalence of diabetes mellitus and operative fixation of heel fractures. In 1931, Gaenslen reported treatment of hematogenous calcaneal osteomyelitis by surgical excision through a midline, sagittal plantar incision. We have refined this approach to allow successful healing and early mobilization in a modern series of complex patients with hematogenous, diabetic, and postsurgical osteomyelitis. Methods: Twenty-eight patients (mean age 54.6 years, range 20-94) with Cierny-Mader stage IIIB chronic calcaneal osteomyelitis were treated with sagittal incision and calcaneal osteotomy, excision of infected bone, and wound closure. All patients received antibiotics for at least 6 weeks, and bone defects were filled with an antibiotic carrier in 20 patients. Patients were followed for a mean of 31 months (SD 25.4). Primary outcome measures were recurrence of calcaneal osteomyelitis and below-knee amputation. Secondary outcome measures included 30-day postoperative mortality and complications, duration of postoperative inpatient stay, footwear adaptions, mobility, and use of walking aids. Results: All 28 patients had failed previous medical and surgical treatment. Eighteen patients (64%) had significant comorbidities. The commonest causes of infection were diabetes ± ulceration (11 patients), fracture-related infection (4 patients), pressure ulceration, hematogenous spread, and penetrating soft tissue trauma. The overall recurrence rate of calcaneal osteomyelitis was 18% (5 patients) over the follow-up period, of which 2 patients (7%) required a below-knee amputation. Eighteen patients (64%) had a foot that comfortably fitted into a normal shoe with a custom insole. A further 6 patients (21%) required a custom-made shoe, and only 3 patients required a custom-made boot. Conclusion: Our results show that a repurposed Gaenslen calcanectomy is simple, safe, and effective in treating this difficult condition in a patient group with significant local and systemic comorbidities. [ABSTRACT FROM AUTHOR]

Background: Calcaneal fractures are not uncommon, accounting for 2% and 60.0% of all adult and tarsal fractures, respectively. Its treatment is still controversial. Aim of the work: To assess results and complications of calcaneal fractures treatment by fixation with calcaneal plate on clinical and radiological basis. Patients and Methods: A convenient sample of 20 patients, with calcaneal fractures and treated by calcaneal plate fixation were included. They were assessed in preoperative period in a systematic manner. Then, treated with a locking plate. Postoperatively, immediate X-rays, examination of the neurovascular status had been done. Anti-edematous, pain therapy, intravenous antibiotics and anticoagulation medication were administered. All patients had been followed up at 8, 16 weeks after operation and assessed for functional and anatomical state. RESULTS: According to the American Orthopedic Foot Ankle Society [AOFAS] Ankle-Hindfoot Score, the outcome was excellent [30.0%], good [40.0%], fair [20.0%] and poor [10.0%]. At the last follow‑up, Bohler’s angle was restored to normal [20°-40°] in 17 feet [85 %] while 3 feet [15 %] was less than normal. Wound infection was seen in [10%], each of varus heel deformity and flexion deformity of big toe was found in one patient [5.0%] and two case had reflex sympathetic dystrophy.Finally, there was no association between fracture type and subtalar arthritis. However, patients with subtalar arthritis had significantly lower AOFAS score when compared to patients with no subtalar arthritis [76.22±6.24 vs 87.0±6.05 respectively, p < 0.001]. Conclusion: Displaced calcaneal fractures treated surgically are associated with a relatively better functional outcome, provided that, Bohler's angle was restored to its normal or near normal values.

Background: Three-dimensional (3D) printing technology has developed rapidly in orthopaedic surgery and effectively achieves precise and personalized surgery. The purpose of this meta-analysis was to assess the efficacy of 3D printing technology in the management of displaced intra-articular calcaneal fractures (DICFs) by extended lateral approach (ELA). Methods: We searched PubMed, Web of Science, Embase, Cochrane Library, CNKI, VIP, and VANFUN databases were searched up to October 2020. All clinical studies comparing traditional surgery and 3D printing-assisted surgery in the management of DICFs were obtained, evaluating the quality of the included studies and extracting data. For each study, we assessed odds ratios (ORs), standard mean difference (SMD), and 95% confidence interval (95% CI) to assess and synthesize the outcomes. Results: Three RCTs and nine retrospective studies involving 732 patients were included met our inclusion criteria with 366 patients in the 3D group and 366 patients in the conventional group. The meta-analysis showed that there were significant differences of the operative time in the 3D group [SMD = − 1.86, 95% CI (− 2.23, − 1.40), P < 0.001], intraoperative blood loss [SMD = − 1.26, 95% CI (− 1.82, − 0.69), P < 0.001], the number of intraoperative X-ray exposures [SMD = − 0.66, 95% CI (− 1.20, − 0.12), P < 0.001], postoperative complications [OR = 0.49, 95% CI (0.31, 0.79), P < 0.001], excellent and good rate of calcaneal fracture outcome [OR = 4.09, 95% CI (2.03, 8.22), P < 0.001]. Conclusion: The current study indicates that 3D printing-assisted ELA surgery showed a better rate of excellent and good outcome, shorter operation time, less intraoperative blood loss, fewer intraoperative fluoroscopies, fewer complications. Besides, there is still a need for large-sample, high-quality, long-term randomized controlled trials to confirm the conclusion. [ABSTRACT FROM AUTHOR]

Despite the advances in operative management, displaced intra-articular calcaneal fractures (DIAFCs) are often associated with long term sequelae, permanent disability, a considerable reduction in quality of life, and a high socio-economic cost. Randomized controlled trials have shown that patient reported outcomes of surgery are no better than those of nonoperative management. Methodological flaws and selection bias may have influenced the results, however, and subgroup analysis showed that some patients could benefit from surgery, whilst patients' preference can be the decisive factor in choosing a management modality. Fractures with significant lateral wall displacement predisposing to impingements often require surgery, and management has to be individualized and tailored to the patient. Surgery does not usually achieve excellent results, though it exposes the patient to potential risks and complications. Wound healing problems and infections affect around 20% of patients when the extensile lateral approach has been used. Sinus tarsi approach and minimally invasive surgery may be viable alternatives, offering similar results with fewer wound complications, but most of the available studies are of low to moderate quality. Late subtalar joint arthrodesis is often required: however, such procedure would be less technically difficult and could result in better foot function should the shape of the calcaneus have been anatomically restored with surgery in the acute phase. [ABSTRACT FROM AUTHOR]

Management of unicondylar femoral fractures is mainly done by open reduction and internal fixation. Anatomic reduction in the articular surface is paramount in this type of lesion. Medial condyle fractures lack specific osteosynthesis material for fixation. We report a case resolved with the sparsely documented technique using calcaneal plate fixation.

Summary: Sepsis of the calcaneal bursae (CB) presents significant treatment challenges with limited clinical data available in the literature. The objective of this retrospective cohort study was to assess the clinical outcomes associated with CB lavage using either a through‐and‐through needle or bursoscopic technique. Clinical records of 29 horses treated for septic calcaneal bursitis using either technique between 2005 and 2019 were reviewed. Fisher's exact test was used to assess statistical significance between first surgical technique and success at first surgery (i.e. not requiring >1 lavage), survival to discharge and return to work (RTW). Bursoscopy was performed in 13/29 (44.8%) cases, and needle lavage in 16/29 (55.2%). In the needle group, 12 (75%) horses were discharged following the first surgery. Four had repeat interventions; two (12.5%) had needle lavage and two (12.5%) had bursoscopy. Of the two horses to have repeat needle lavage, one was subjected to euthanasia and one discharged, and of the two that underwent bursoscopy, one was discharged and one received a third bursoscopy prior to discharge. In the bursoscopy group, seven (53.8%) were discharged and three (23.1%) were subjected to euthanasia following the first surgery. Three (23.1%) received a second bursoscopic lavage with one discharged, one subjected to euthanasia and one having a third bursoscopic lavage prior to discharge. Overall, 18/24 (75%) followed up cases RTW, 10 (55.5%) from the needle group, eight (44.4%) the bursoscopy group. No statistically significant differences between first surgical technique used and success at first surgery (no subsequent lavage(s) required), survival to discharge or return to work were detected. The main limitations of this study are that it is a retrospective study, has a small population with limited statistical power and potential selection bias. No statistically significant differences existed between the outcomes of the two techniques, contrary to the belief that bursoscopic lavage is superior. Larger, multicentred studies, with greater statistical power are required to further assess this relationship. [ABSTRACT FROM AUTHOR]

Management of intra-articular calcaneal fractures remains a debated topic in orthopedics, with operative fixation often held in reserve due to concerns regarding perioperative morbidity and potential complications. The purpose of this study was to identify the characteristics of patients who developed surgical complications to inform the future stratification of patients best suited to operative treatment for intra-articular calcaneal fractures. All patients who underwent open reduction and internal fixation of calcaneal fractures utilizing the Sinus Tarsi approach between March 2014 and July 2018 were identified using theatre records. Patient imaging was used to assess pre- and postoperative fracture geometry with computed tomography used for preoperative planning. Each patient's clinical presentation was established through retrospective analysis of medical records. Patients provided verbal consent to participation and patient reported outcome measures were recorded using the Maryland Foot Score. Fifty-eight intra-articular calcaneal fractures (53 patients; 5 bilateral, mean age = 46.91 years) with a mean follow-up of 35.4 months (6-57) were included. Five patients (9.4%) had wound complications; 2 superficial (3.7%), 3 deep (5.6%); 4 of whom were smokers. Smokers were statistically more likely to have wound infections than nonsmokers (p =.04). Intra-articular fractures of the calcaneus should be considered for surgical intervention in order to improve long-term functional outcomes. The Sinus Tarsi approach provides the potential to decrease the operative complication rate whilst maintaining adequate fixation, however, the decision to surgically manage these fractures should be carefully balanced against the risk of postoperative complications. This increased risk of complication associated with smoking may tip the balance against benefit from surgical management. [ABSTRACT FROM AUTHOR]

Introduction: Diffuse-type tenosynovial giant cell tumor (D-TGCT) originates from synovial cells in tendon sheaths and bursae and rarely presents as a calcaneal mass., Case Report: A 44-year-old female presented with left heel pain that had persisted for over a year and had worsened over the past six months. A mass was found on the Lateral radiograph of the calcaneus, which was diagnosed as an aneurysmal bone cyst. Non-contrast computed tomography (CT) and magnetic resonance imaging (MRI)diagnosed a benign tumor. Based on light microscopy, special stains, and immunohistochemistry, a final diagnosis of diffuse tenosynovial giant cell tumor (D-TGCT) was rendered., Results: D-TGCT is a slow-growing, infiltrative tumor that can form single or multiple masses outside the joint, and can also involve adjacent jointsmainly affects weight-bearing joints such as the knee, hip, and ankle. However, D-TGCT presents as a calcaneal mass, which poses a diagnostic challenge for all radiologists., Conclusion: A calcaneal mass exhibiting well-defined borders, focal cortical destruction, a sclerotic rim, and T2WI hypointensity, the possibility of D-TGCT should be considered., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

In calcaneal fractures, Böhler's and Gissane's angles are considered important parameters to guide treatment strategy and provide prognostic information during follow-up visits. Therefore, lateral radiographs have to be accurate. The aim of this study was to evaluate the effect of craniocaudal and posteroanterior angular variations (i.e., simulate lower leg malposition) from the true lateral radiograph on Böhler's and Gissane's angles. In this radioanatomical study, 15 embalmed, skeletally mature, human anatomic lower limb specimens were used. Using predefined criteria, a true lateral radiograph (i.e., 0° angular variation) was obtained. Angular variations from this true lateral radiograph were made from –30° to +30° deviation in the craniocaudal and posteroanterior direction at 5° intervals. Böhler's and Gissane angles were independently assessed by 2 experienced trauma surgeons. Böhler's angle decreased with increasing caudal angular variations (maximum –4.3° deviation at –30°). With increasing of the posterior angular variations, Böhler's angle increased (maximum 5.0° deviation at +30°) from the true lateral radiograph, but all deviations were within the measurement error. The deviation of the angle of Gissane was most pronounced in the cranial direction, with the mean angle decreasing by –8.8° at +30° angular variation. Varying angular obliquity in the caudal and posteroanterior direction hardly affected Gissane's angle. Foot malpositioning during the making of a lateral radiograph has little influence on Böhler's and Gissane's angles. If used for clinical decision-making in initial treatment and during follow-up of calcaneal fractures, these parameters can reliably be obtained from any lateral radiograph. [ABSTRACT FROM AUTHOR]

Intra-articular calcaneal fractures represent an ongoing challenge for the orthopedic community, with the benefits of the previous "gold standard" treatment of open reduction and internal fixation having been called into question in several large randomized controlled trials. Fine wire circular fixation may represent a useful alternative treatment for these injuries, combining minimally invasive application with rigid fixation, which allows the possibility of early weight bearing We performed a systematic review of published studies that used circular fixation for calcaneal fractures and recorded functional outcomes at follow-up. In a total of 11 studies with 255 calcaneal fractures for which there was follow-up, our inclusion criteria were met: 8.2% of fractures were bilateral, 11.9% of fractures were open fractures, and 12.6% of patients had multiple orthopedic injuries. Functional outcomes were assessed with the use of a variety of tools across the different studies, but outcomes compared favorably with those seen with open reduction and internal fixation. Although pin site infections were common (22.6%), serious complications, including deep infection (0.8%), wound infection (1.6%), and complex regional pain syndrome (0.8%), were exceedingly rare. The results suggest that this is a viable alternative treatment for calcaneal fractures, but higher-quality randomized controlled trials are required before the technique can enter mainstream use. [ABSTRACT FROM AUTHOR]

Purpose There are multiple skeletal maturity grading systems, but none of them utilizes the phalanges of the foot. To minimize radiation, it would be ideal if one could assess the skeletal maturity of a foot based on bones seen on routine foot radiographs, if guided growth is being considered as a treatment option. We developed a system that correlates changes of the appearance of the foot phalanges to peak height velocity (PHV) and the recently described calcaneal apophyseal ossification grading system. Methods We selected 94 children from the Bolton-Brush study, each with consecutive radiographs from age ten to 15 years old. Using the anteroposterior view, we analyzed the ossification patterns of the phalanges and developed a sixstage system. We then determined the PHV for each subject and defined its relationship with our system. Our system was then compared with the previously established calcaneal system. Results We calculated an Intraclass correlation coefficient (ICC) range of 0.957 to 0.985 with a mean of 0.975 and interclass reliability coefficient of 0.993 indicating that this method is reliable and consistent. Our system showed no significant difference between gender with respect to PHV, which makes it a reliable surrogate for determining bone age in paediatric and adolescent patients. Conclusions Our system has a strong association with the calcaneal system. It is a simple six-stage system that is reliable and correlated more strongly with PHV than chronological age. The system requires knowledge of the ossification markers used for each stage but is easily used in a clinical setting. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to compare the postoperative pain levels in patients undergoing osteosynthesis of the calcaneus with either a popliteal nerve block or an ankle block. Methods: A retrospective analysis of all consecutive patients undergoing operative fixation of a calcaneal fracture via a sinus tarsi approach between August 2012 and April 2017 in a single foot/ankle specialized center was performed. Single-shot popliteal blocks were placed using ultrasound guidance by an anesthesiologist while ankle blocks were placed by a foot/ankle specialized surgeon. Pain levels were measured through the numerical rating scale (NRS). In total, 83 patients were included in this study; 33 received a popliteal block, and 50 received an ankle block. No statistically significant differences were present in baseline characteristics between the 2 groups. Results: Comparable postoperative pain levels were observed in both groups. There was no statistically significant difference in amount of morphine used between the 2 groups. Conclusion: No differences were found in postoperative pain levels between patients receiving a single-shot popliteal block and patients who received a single-shot ankle block following calcaneal fracture surgery. Level of Evidence: III, comparative series. [ABSTRACT FROM AUTHOR]

Background: Calcaneal fractures are uncommon and have a substantial impact on hindfoot function and quality of life. Several surgical treatment options are available; both in surgical approach and type of operation. The aim of this study was to compare functional outcome and quality of life following ORIF and primary arthrodesis. Furthermore, predictors of worse functional outcome were explored.Methods: A retrospective cross-sectional cohort study was performed in patients with surgical fixation of a calcaneal fracture with a minimum follow-up of 18 months. Patients received ORIF through the 1) Extended Lateral Approach (ELA), 2) Sinus Tarsi Approach (STA) or 3) primary arthrodesis via STA. Participants were presented a questionnaire containing demographics, the AOFAS hindfoot scale, Foot Function Index, SF-36, EQ-5D and patient satisfaction.Results: In total 95 patients participated in this study. The three groups were comparable regarding patient characteristics. A median score of 74.5 points on the AOFAS hindfoot scale and 11.9 on the FFI was found for the entire group. There were no statistically significant differences between patients with ORIF of primary arthrodesis. Patients scored a median of 49.0 on the Physical Component Scale of the SF-36 and 55.4 on the Mental Component Scale. On the EQ-5D patients scored a median of 0.8 points. Again no statistically significant differences were observed between the three subgroups. Socio-economic status was the only statistically significant predictor of worse functional outcome (β: 4.06, 95% CI: 0.50-7.62) after multivariable analysis.Interpretation: Good midterm outcomes following in terms of functional outcome and in quality of life are observed. We observed no statistical significant difference in functional outcome between patients with ORIF and patients with primary arthrodesis. The only predictor of worse functional outcome is a lower socio-economic status. [ABSTRACT FROM AUTHOR]

Unlabelled: Subtalar joint distraction arthrodesis has been well reported with use of structural iliac crest or local autologous bone graft for malunited calcaneal fractures. Early reports for structural allograft did not yield good, consistent results, leading to a subsequent lack of recommendation in previous literature. Newer studies have had promising results utilizing femoral allograft as an alternative to autogenous bone graft. We performed a retrospective chart review on 10 patients (12 feet) undergoing subtalar joint distraction arthrodesis with femoral neck allograft for malunited calcaneal fractures. The primary aim of this study was to report on successful union rates and, in addition, outline any consistent complications. Twelve of the 12 procedures (100%) yielded successful fusion with a mean final follow-up of 7.7 months (range = 2.2-35.1 months). The mean increase in talocalcaneal height was 4 mm (range = 2-6 mm). The overall complication rate was 16.6%, including one superficial wound complication that healed uneventfully and one hardware removal. In conclusion, the current study reports a 100% successful fusion rate with interpositional structural femoral neck allograft in treatment for malunited calcaneal fractures.Levels Of Evidence: Therapeutic, Level IV: Case series. [ABSTRACT FROM AUTHOR]

Fractures of the foot and ankle are common in all age groups. Soft tissue swelling, smoking and co-morbidities such as diabetes mellitus and peripheral vascular disease should be considered when forming the management plan. Careful attention to neurovascular status and the soft tissue envelope of the foot and ankle is essential to the management of these injuries especially where crush injuries have occurred. Open fractures should be treated urgently with a combined approach with the plastic surgeons. A good understanding of surgical anatomy is key to managing these fractures. Good intra-articular involvement and ligamentous stability are crucial in predicting long-term prognosis. The core principles of management are: to maintain the soft tissue envelope (minimize disruption); to obtain appropriate alignment; restoration of joint surfaces; and rehabilitation to obtain optimum function. [ABSTRACT FROM AUTHOR]

Subtalar hyperpronation and ankle dorsiflexion restriction have been theoretically associated with Achilles tendinopathy (AT). However, evidence to support these associations is lacking. To compare foot alignment and ankle dorsiflexion range of motion (ROM) between the symptomatic and non-symptomatic limbs of individuals with unilateral AT. And to verify whether differences exist between individuals with symptomatic pronated feet and individuals with symptomatic neutral/supinated feet in terms of tendon pain, structure, and symptom severity. Sixty-three participants with unilateral AT underwent a bilateral evaluation of pain during tendon palpation, symptom severity, tendon thickening, tendon neovascularization, ankle dorsiflexion ROM, and foot posture alignment [foot posture index (FPI), navicular drop, navicular drift, and longitudinal arch angle (LAA)]. Side and group comparisons were made using t-tests and correlations were evaluated using the Pearson test. There were no differences between the symptomatic and non-symptomatic limbs regarding foot posture alignment. Specifically, non-significant negligible differences were observed between limbs regarding FPI [mean difference (MD)=-0.23; 95% confidence interval (CI)=-0.70, 0.25), navicular drop (MD=0.58 mm; 95%CI=-0.25, 1.43), navicular drift (MD=0.16 mm; 95%CI=-0.77, 1.09), and LAA (MD=0.30º; 95%CI=-1.74, 2.34). There was no difference between limbs regarding ankle dorsiflexion ROM. However, lower ankle dorsiflexion was associated with worse symptom severity (r = 0.223). Finally, no difference was observed between individuals with symptomatic pronated feet and individuals with symptomatic neutral/supinated feet in terms of tendon pain or structure. Static foot alignment measures do not seem to be clinically relevant in patients with AT. Smaller ankle dorsiflexion ROM, however, was associated with greater symptom severity in this population. • Individuals with Achilles tendinopathy (AT) and symptomatic pronated feet did not differ from individuals with AT and symptomatic neutral/supinated feet in terms of tendon pain, structure, or symptom severity. • The symptomatic and non-symptomatic limbs of individuals with unilateral AT had no differences in terms of foot alignment, evaluated by static measures. • Pronated foot posture was not more prevalent in individuals with AT when compared to neutral/supinated foot postures. • Smaller ankle dorsiflexion range of motion was associated with greater symptom severity and may be relevant for this population. • Static foot alignment measures do not seem to be clinically relevant in patients with AT. [ABSTRACT FROM AUTHOR]

Introduction: The diagnosis of calcaneal osteomyelitis is a challenge, and diagnostic delays have been reported in the literature. The progression is often indolent, laboratory results commonly fail to reveal an underlying infectious process and radiographs changes are seen after 7 days. We discuss the literature on the diagnosis and treatment of calcaneal osteomyelitis which can result in long-term sequelae in the pediatric patient. Case presentation: A 9-year-old white boy presented to our institution with heel pain and an inability to weight bear. There was a 10-day delay in diagnosis of calcaneal osteomyelitis, with a total of three presentations to our emergency department. The condition was misdiagnosed as Sever's disease on two separate occasions with discharge home. On his third presentation the diagnosis was finally clinched when he developed more definitive signs and symptoms, with pyrexia and signs of lymphangitis. Magnetic resonance imaging revealed diffuse osteomyelitis of his calcaneum. He underwent surgery and 2 weeks of antibiotics administered intravenously, followed by 4 weeks of oral therapy. We are happy to report a good recovery without any complications at his 12-month follow up. Conclusions: Physicians should include calcaneal osteomyelitis as a differential in any child presenting with heel pain. Delays in the diagnosis can result in disastrous complications in the pediatric patient, such as growth arrest. [ABSTRACT FROM AUTHOR]

Lateral column lengthening osteotomy is very useful surgical technique in treating stage II of pes planovalgus deformity of the foot. Either autograft from the iliac crest or allograft can be used for this purpose. In our technique we describe a novel method of obtaining bone graft locally from the calcaneus and therefore avoiding complications and morbidity associated with iliac crest graft. [ABSTRACT FROM AUTHOR]

Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.

One of the most severe complications in calcaneal fractures is a malunion. When a malunion occurs, subtalar bone block distraction arthrodesis provides restoration of calcaneal height, length, correction of varus deformity, and elimination of subtalar joint arthritis. A systematic review showed the union rate for all procedures was 95.78%. The overall complication rate was 38% for all procedures. This is the first study to categorically break down complications with statistical analysis. The data presented indicate the level of difficulty of the subtalar distraction bone block arthrodesis for calcaneal malunions and may even suggest the need for newer techniques., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The calcaneal fat pad is a major load bearing component of the human foot due to daily gait activities such as standing, walking, and running. Heel and arch pain pathologies such as plantar fasciitis, which over one third of the world population suffers from, is a consequent effect of calcaneal fat pad damage. Also, fat pad stiffening and ulceration has been observed due to diabetes mellitus. To date, the biomechanics of fat pad damage is poorly understood due to the unavailability of live human models (because of ethical and biosafety issues) or biofidelic surrogates for testing. This also precludes the study of the effectiveness of preventive custom orthotics for foot pain pathologies caused due to fat pad damage. The current work addresses this key gap in the literature with the development of novel biofidelic surrogates， which simulate the in vivo and in vitro compressive mechanical properties of a healthy calcaneal fat pad. Also, surrogates were developed to simulate the in vivo mechanical behavior of the fat pad due to plantar fasciitis and diabetes. A four-part elastomeric material system was used to fabricate the surrogates, and their mechanical properties were characterized using dynamic and cyclic load testing. Different strain (or displacement) rates were tested to understand surrogate behavior due to high impact loads. These surrogates can be integrated with a prosthetic foot model and mechanically tested to characterize the shock absorption in different simulated gait activities, and due to varying fat pad material property in foot pain pathologies (i.e., plantar fasciitis, diabetes, and injury). Additionally, such a foot surrogate model, fitted with a custom orthotic and footwear, can be used for the experimental testing of shock absorption characteristics of preventive orthoses.

Objectives: The complications associated with iliac crest bone-graft harvest have resulted in the development of alternative harvest sites. Lower extremity alternative sites that have been reported for foot and ankle procedures include greater trochanter, proximal tibia, distal tibia, and calcaneus. These sites have been studied in terms of complications, postoperative pain, and quality of the harvested bone. The long-term effect of the harvest on the bone of the calcaneus has not been reported., Methods: Case report on incidental CT imaging 4 years after bone graft harvest from the calcaneus., Results: This case demonstrates the failure of the calcaneal trabecular bone to regenerate after harvesting cancellous bone graft for foot fusion procedure., Conclusions: The calcaneal graft site should not be used for a repeat bone-graft harvest without advanced imaging to confirm reconstitution of the harvest bed., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To observe the clinical effect of vacuum sealing drainage (VSD) technique and simple dressing change in the treatment of delayed severe infection after calcaneal fracture surgery. Methods: From August 2008 to July 2015 , 73 patients with delayed severe infection were treated after calcaneal fractures 3 months in Department of Foot and Ankle, the Second Hospital of Tangshan City, according to the treatment methods are divided into vacuum sealing drainage group of 38 cases, 35 cases of simple dressing group.Two groups of patients after regular wound debridement debridement and sterilization after vacuum sealing drainage group received double wound VSD dressing group received postoperative dressing, two groups of patients with sensitive antibiotics for treatment.Two groups of patients according to the frequency of dressing change, wound healing time, bacterial clearance time and healing time were compared in stage Ⅱ during the perioperative period. Results: Vacuum sealing drainage group: dressing: 7 times, the wound healing time was 27 days, bacterial culture negative for 8 days, the healing time of 13.5 days of perioperative period; treatment group: 34 times the number of dressing, wound healing time was 44 days, bacterial culture negative for 18 days, the healing time of 17 days of surgery period. Two groups of data were compared with the median, after the rank sum test, the difference was statistically significant ( Z values were -6.670, -5.529, -5.011, -3.227, P <0.05). The vacuum sealing drainage group compared with conventional dressing group significantly reduced the number of dressing, wound healing time, healing time was significantly shortened bacterial clearance time and perioperative period Ⅱ. Conclusion: Double VSD is easy , safe and quick, short cure time, less pain, higher quality of late life advantages, compared with the traditional dressing treatment of calcaneal fractures of postoperative delayed severe infection, is a safe and effective method.