Search

Background: Evidence from prospective short-term studies suggest that proximal medial gastrocnemius recession is a safe and efficient procedure to treat chronic plantar fasciitis resistant to nonoperative treatment. The aim of this study was to evaluate the long-term clinical outcomes of proximal medial gastrocnemius recession and stretching compared to a stretching exercise protocol for patients with chronic plantar fasciitis and an isolated gastrocnemius contracture (IGC). Methods: Forty patients with plantar fasciitis lasting more than 1 year were prospectively randomized to a home stretching exercise program only, or to proximal medial gastrocnemius recession in addition to the stretching program. Clinical and functional data in this study were obtained at baseline and 6-year follow-up. The main outcome was the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score. Secondary outcomes were the visual analog scale (VAS) for pain, the Manchester Oxford Foot Questionnaire (MOxFQ), ankle dorsiflexion, and Achilles complex performance. Results: Thirty-three of 40 patients completed the 6-year follow-up. Seven patients had crossed over from nonoperative treatment to operative treatment. At 6 years, the operative group demonstrated significantly better outcomes with AOFAS (88.9 vs 78.6, P =.012), for pain measured by VAS (2.5 vs 5.5, P <.001) and with the MOxFQ total score (24.4 vs 45.9, P =.05) (per protocol analysis excluding crossovers). No between-group differences were observed for ankle dorsiflexion or Achilles complex performance at 6 years. Conclusion: This study demonstrates that the improved function and reduced level of pain by proximal medial gastrocnemius recession and stretching is better compared to stretching alone after 6 years of follow-up for patients with chronic plantar fasciitis and a concomitant isolated gastrocnemius contracture. Level of Evidence: Level I, randomized controlled trial. [ABSTRACT FROM AUTHOR]

Background. Chronic syndesmotic injury may cause long-term pain and reduced ankle function. Today, there is no consensus about the best surgical treatment of these injuries. We present the technique and results of revision and fixation with a suture button and a quadricortical screw. Methods. Eleven patients treated for chronic syndesmotic injury were included. The patients completed questionnaires regarding ankle function, and computed tomography scans were obtained to evaluate tibiofibular distance and osteoarthritis. Complications were registered. Results. At mean 45 months follow-up, the mean American Orthopaedic Foot and Ankle Society ankle-hindfoot score was 87 points. There were 5 complications, including 3 hardware-related pain. The tibiofibular distance was significantly reduced with surgery. Seven patients had progression of osteoarthritis. Conclusions. Even though the majority of the patients had progression of radiological signs of osteoarthritis, the functional outcome after revision and fixation with a suture button and a quadricortical screw in chronic syndesmotic ruptures is good and comparable to the results presented in other studies. Levels of Evidence: Level IV: Case series without control, technical note [ABSTRACT FROM AUTHOR]

Background: Important aspects on the diagnostics of isolated gastrocnemius contractures (IGCs) have been poorly described. This study was designed to validate a new ankle range of motion (ROM) measuring device for diagnosing an IGC. In addition, we wanted to investigate the reliability of the clinical Silfverskiöld test. Methods: Twelve health care personnel (24 feet) were examined by 4 testers on 3 different occasions for the reliability testing of the new ankle ROM measuring device. The same participants were examined using the Silfverskiöld test to examine the reliability of the clinical test. Eleven patients (15 feet) with IGC were examined before gastrocnemius recession, immediately after surgery, and 3 months after surgery to examine the validity and responsiveness of the ankle ROM device. Results: An intraclass correlation coefficient (ICC) >0.85 was found for both inter- and intrarater reliability for the new ankle ROM device. The device confirmed an IGC in 13 of 15 feet before surgery and 3 of 13 feet at 3-month follow-up. At baseline, the measured ankle dorsiflexion was median 3 degrees with the knee in extension, which increased to 10 degrees (P < .001) immediately after surgery and 12 degrees (P = .003) at 3-month follow-up. ICC values of 0.230 to 0.791 were observed for the inter- and intrarater reliability testing of the clinical Silfverskiöld test. Conclusion: The new ankle ROM measuring device was reliable and responsive for detecting IGC. The Silfverskiöld test had poor inter- and intrarater reliability. Level of evidence Level II, prospective cohort study. [ABSTRACT FROM AUTHOR]

Lisfranc injuries consist of a wide spectrum of injuries, ranging from subtle injuries to severe fracture-dislocations. Injuries with instability of the tarsometatarsal, intercuneiform, or naviculocuneiform joints should be treated with anatomic reduction and stable fixation. The best method of fixation is debated. Transarticular screw fixation has the disadvantage of damaging the tarsometatarsal joints. Bridging the tarsometatarsal joints with use of low-profile locking plates avoids the placement of screws through the joint and potentially reduces the risk of posttraumatic arthritis. Primary arthrodesis of the 3 medial tarsometatarsal joints is also an option in treating Lisfranc injuries and has been shown to lead to better outcomes compared with transarticular screw fixation in ligamentous Lisfranc injuries. In this article, we show the technique of open reduction and internal fixation of Lisfranc fracture-dislocation with use of dorsal bridging locking plates. The following steps are presented in the video: (1) incision technique with use of a dorsomedial incision and a dorsolateral incision, (2) open reduction and temporary fixation of the tarsometatarsal joints with use of Kirschner wires, (3) confirmation of anatomic reduction of the tarsometatarsal joints with direct visualization and fluoroscopy, (4) fixation of the medial 3 tarsometatarsal joints with dorsal bridging locking plates, (5) placement of a "homerun" screw from the medial cuneiform to the base of the second metatarsal, (6) fixation of the fourth and fifth tarsometatarsal joints with Kirschner wires, and (7) checking of reduction and fixation with use of fluoroscopy and performance of wound closure. Postoperatively, the foot is kept non-weight-bearing in a below-the-knee cast for 6 weeks, followed by 6 weeks of protected weight-bearing in a walker boot. Any Kirschner wires fixating the fourth and fifth tarsometatarsal joints are removed 6 weeks postoperatively. We prefer to remove the dorsal bridging plates 4 to 6 months postoperatively. Anatomic reduction and stable fixation is associated with better functional outcomes. Hardware failure and loss of reduction are potential complications that can lead to worse outcomes. [ABSTRACT FROM AUTHOR]

Gunshot injuries to the foot with segmental bone defects can be challenging to treat. When the vascularity is intact and the soft tissues allows, the goal should be to reconstruct the bony defect. We present 2 cases of a gunshot injury to the foot with a defect of the first metatarsal bone. Both cases were treated, with favorable outcome, with a structural iliac crest graft, internal fixation, and bone morphogenic protein 2. Level of Evidence: V, cases series, technical., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Polytrauma patients with bilateral femur shaft fractures are known to have a higher rate of complications when compared with those who have sustained unilateral fractures. The current study tests the hypothesis that the high incidence of posttraumatic complications in patients who do not have a severe head or chest injury is caused by accompanying injuries rather than by the additional femur fracture., Methods: Inclusion criteria New Injury Severity Score > 16 points; AIS score value of the chest ≤3 points and no severe head injury. Two study groups: a unilateral group (USF group) (n = 146) and a bilateral femur shaft fracture group (BSF group) (n = 19). Endpoints monitored were length of stay in the intensive care unit, duration on a ventilator, and several postsurgical complications (e.g., SEPSIS, acute lung injury). Statistics Fisher's exact test for binary variables, and independent t-tests and regression analyses for continuous indicators of injury severity and clinical outcomes., Results: Patients with bilateral femur fractures had a significantly higher incidence of hemothorax. Moreover, they received blood transfusions more often upon admission, and exhibited a longer ICU stay (p = 0.008). However, this patient group did not exhibit a significantly higher incidence of postsurgical complications (p = 0.1) than those with unilateral fractures. After adjusting for injury severity, no difference in the length of the ICU stay was observed. Bilateral fracture patients who were in an uncertain condition preoperatively had a longer length of stay in the ICU postoperatively (p = 0.002)., Conclusions: In the absence of major head or chest injuries, patients with multiple injuries and bilateral femur shaft fractures have a similar complication rate to polytrauma patients with unilateral fractures. Moreover, an uncertain condition preoperatively was associated with an increased stay in the intensive care unit. The results support the idea that associated injuries rather than the additional femur fracture are responsible for complications during the clinical stay.