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A bizarre parosteal osteochondromatous proliferation (BPOP) is a rare, benign, osseous tumor that presents as an exophytic cortical growth consisting of bone, cartilage, and fibrous tissue. However, the identification of BPOP by preoperative imaging along with appropriate diagnosis and treatment without recurrence is challenging, particularly for BPOPs that rarely develop in certain parts of the body. Herein, we report a rare case involving a BPOP at the sesamoid bone of the hallux that was first suspected on preoperative computed tomography imaging. There has been no recurrence 3 years after surgical resection.

Category: Hindfoot Introduction/Purpose: Initial treatment of symptomatic talocalcaneal coalition (TCC) is reduced activity or cast immobilization. If these conservative treatments does not relieve symptoms, surgical treatment is recommended. The operation for TCC is usually treated by an open procedure. We report the results of the three cases by endoscopic resection using posteromedial approach. Methods: Three consecutive patients (3 feet, 2 men and 1 female) who underwent surgery for TCCs were reviewed. Patient’s age at the time of surgery were 12, 13, 19 years respectively. All patients suffered from a foot pain after ankle sprain. Two patients didn’t play sports because of this pain. This operation is performed in the supine position. Two portals are each created at the proximal and distal to the vertex of the medial malleolus. Portal positions are marked by use of sonography to avoid the injury of tendons and neurovascular. By use of a shaver a radiofrequency device, as much soft tissue must be removed as possible to allow easy coalition resection, the surgeon performs sufficient resection of the coalition using an abrader until the normal articular surface can be confirmed. Movements of ankle and toes are encouraged from immediately post-operatively. Weight bearing is permitted 1 week after surgery. Results: All patients had a relief of pain. The mean preoperative and final follow-up AOFAS ankle-hind foot scale scores were from 65.3 to 92.3. Two patients returned to playing sports by three months. The mean operation time was 123 minutes (range: 97–148 minutes). However, compared with the initial cases, recent cases tended to have shorter surgical times. No complications occurred. Conclusion: A posteromedial approach for TCC is a useful technique because the advantage of allowing (1) a direct approach to both the middle- and posterior-facet coalitions without obstruction, (2) the creation of sufficient working space, (3) the obtuse insertion angle between the endoscope and instrument. On the basis of these advantage, endoscopic resection of a TCC using the posteromedial approach is considered a useful technique. To decrease the risk of neurovascular damage and tendon injury, portal positions are marked in advance by use of sonography, so that, a safe endoscopic resection of the coalition is performed.

Category: Sports Introduction/Purpose: Traumatic peroneal tendon dislocation is an uncommon lesion that mainly affects young adults. It occurs most frequently during sports activities and generally during an ankle sprain. Unfortunately, most cases lead to recurrent peroneal tendon dislocation (RPTD). Therefore, most cases need operative treatments. Many surgical techniques for the treatment of RPTD have been described. One of the most popular operative procedures is the modified Das De procedure, which is the superior peroneal retinaculum (SPR) repair. Since 2014, we have performed the procedure along with tendoscopy. The purpose of this study is a preliminary report on the tendoscopic modified Das De procedure. Methods: We performed surgery for RPTD in 5 consecutive patients (4 men and 1 woman, mean age 21.4 years). All the patients were injured during sports activities. This procedure was performed with the patient in the lateral decubitus position. Two portals were made. Three anchors were inserted in the fibula. An 18-gauge needle, into which a shuttle relay had been looped (2-0 Prolene), was used to thread through the SPR. Six passes were made (Image), and the sutures were tightened in order to reattach the SPR to the fibula. A knotless anchor was screwed into the lateral aspect of the fibula to allow for suturing by using the bridge technique. For postoperative care, a short-leg cast was applied for 3 weeks. The patients were allowed partial and full weight bearing at 2 and 3 weeks, respectively. Evaluation parameters included the operation time, complications, return to regular sports activities, and recurrence. Results: The mean operation time was 88.8 minutes (range: 69–125 minutes), which was relatively longer than that of our previous open modified Das de procedure (mean: 40.0 minutes). However, compared with the initial cases, recent cases tended to have shorter surgical times. No complications occurred. All the patients could return to regular sports activities within 4 months after surgery. No recurrence was observed during the follow-up period (mean: 11.4 months; range: 9–14 months). Conclusion: The tendoscopic modified Das De procedure for RPTD required a longer operation time compared to open surgeries. However, the operation time is expected to be shortened as the surgeon gains experience. In addition, this procedure was not associated with any early severe complications and allowed patients to return to sports activities within a short period. Long-term studies involving a large number of cases are needed. However, this procedure is an attractive option because it is less invasive and has achieved similar results as those in open procedures.

Category: Midfoot/Forefoot Introduction/Purpose: Hallux valgus that is defined as HVA (hallux valgus angle) >20 is one of the most common forefoot problems and can lead to alterations of the plantar pressure pattern. In addition, it can cause clinically gait alterations. Hence, we investigated the plantar pressure pattern and the gait-related factors using the gait analyzer. The purpose of this study was to examine the relationship between gait alterations or motor function and hallux valgus deformity. Methods: In 2009, we examined 309 inhabitants (male, 105; female, 204; age, >65 years) of Miyagawa village in Mie, Japan and compared the plantar pressure pattern between the subjects who has hallux valgus (HVA, >20; n=88) and those who does not have hallux valgus (HVA, < 20; n = 221). Furthermore, we compared gait-related factors among mild group (20< HVA < 30; n=88), moderate group (30< HVA < 40; n=24), and severe group (HVA, >40; n=9). If the right and left hallux valgus varied in severity, we selected severe side. The plantar pressure pattern and the gait-related factors such as stride, step width, foot angle (Figure 1), and gait speed were measured using the gait analyzer (Walk way MW 1000; Anima, Tokyo, Japan). Statistical analyses were performed using t-test, Chi-Square test, or logistic analysis adjusted age, gender and height. P < 0.05 was considered significant. Results: The average weight and height of hallux valgus group were significantly lower, and age of hallux valgus group were significantly higher than those of normal group. About the plantar pressure pattern, ratio of the subjects in hallux valgus group who can use the hallux ball in toe off were significantly less than those of normal group. However, the gait-related factors were not significantly different between 2 groups. On the other hand, when we compared by severity, step width tended to increase with progression of hallux valgus. Moreover, stride, gait speed, and foot angle of severe group were the lowest among 4 groups (normal, mild, moderate, and severe). Especially stride of severe group was significantly lower than those of other 3 groups. Conclusion: Mild hallux valgus can cause alterations of the plantar pressure pattern, but didn’t cause motor functional decline. However, when hallux valgus become severe, hallux valgus can cause not only gait alterations but also motor functional decline.