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Biomedical subjects

C L Saltzman

Publications and source records attributed to C L Saltzman.

At least 37 records · Page 2Linked to original sources
PubMed2000

Perspective on total ankle replacement.

Total ankle arthroplasty has become a viable alternative to ankle arthrodesis. Modern implant designs involve a syndesmosis fusion and resurfacing of the medial and lateral recesses of the ankle joint or the use of a three-component, mobile bearing implant. In limited clinical series, the early results of both these prosthetic design approaches are encouraging. In selected patients, ankle arthroplasty is an effective approach to relieving pain and improving function. Selected patients can be offered a total ankle replacement as an alternative option to arthrodesis in the treatment of end-stage ankle arthritis. Further development of prosthetic designs, which minimize bone resection and restore normal ankle motion, is needed.

Ankle Joint↗
PubMed1999

Measuring first ray mobility with a new device.

First ray hypermobility has been linked to many abnormal conditions in the foot. First metatarsal vertical displacement is proportional to the measurement of first ray dorsiflexion. A new device that measures first ray mobility has been built and tested. The device applies a dorsiflexing force to the head of the first metatarsal and measures the amount of vertical displacement that results. The design and instrumentation of the device is described. A safe and reliable testing procedure for measuring maximal first ray displacement is discussed. Clinicians could use this measure when selecting treatment options for patients who suffer foot pathologies resulting from faulty mechanics of the first ray.

Biomechanical Phenomena↗
PubMed1999

Does arch height affect impact loading at the lower back level in running?

The purpose of this study was to evaluate the influence of the medial longitudinal arch height on the shock wave that repetitively reaches the lower back in running. Impact forces were measured simultaneously at the ground by a force plate and at the level of the low back, by means of an accelerometer, skin-mounted at the L3 spinal process. The medial longitudinal arch height was calculated as navicular height divided by foot length. Twelve healthy subjects ran barefoot and with an identical sport shoe at a constant speed. The sample size was divided equally into a low-arch and a high-arch group. Statistical analysis was performed by multivariate analysis of variance and Pearson's correlation. At low back level, there was a significantly lower acceleration amplitude and rate in the high-arch group (amplitude = mean, 1.74 g and SD, 0.94 g; rate = mean, 71.2 g/sec and SD, 58.0 g/sec) compared with the low-arch group (amplitude = mean 2.25 g and SD, 1.11 g; rate = mean, 111.5 g/sec and SD, 68.6 g/sec) (P < 0.001, each). At the ground, there was a slight negative correlation between arch height and initial loading rate in AP (-0.19; P < 0.01) and vertical (-0.22; P < 0.001) directions and a positive correlation between arch height and initial loading rate in the medial direction (0.22, P < 0.05). The results indicate that the high-arch foot is a better shock absorber with regard to the low back level than the low-arch foot.

Adult↗
PubMed1999

Total ankle arthroplasty: state of the art.

Total ankle arthroplasty results from the 1970s and 1980s were comparatively poor. The outcomes of these surgeries deteriorated rather dramatically with time. Causes of failure were multifactorial, but the 2 features that seemed central to implant failure were constrained designs and cement fixation. Total ankle operations are considered technically demanding procedures, with relatively high early postoperative complication rates. As yet, the ideal total ankle patient remains to be defined. With the current implant results as a guide, the optimal patient is an older person who is low demand and has multiple joint problems involving either the ipsilateral foot or knee or contralateral ankle. Good alignment and ligamentous stability are essential. Osteonecrosis and profound osteoporosis are associated with poor results due to problems with bony fixation. Patients should be advised that the implant may fail, and that this may require further surgery, including the potential need for an ankle fusion or below-knee amputation. The results of ankle fusions, although usually initially good, seem to deteriorate with time (Table 2). Not uncommonly, patients develop either transverse tarsal or subtalar degenerative joint disease several years after an ankle arthrodesis. Because of the associated pain and functional limitations that can follow ankle fusion, efforts to develop a workable total ankle replacement continue. At present, the long-term results of most new designs are unknown. Today, total ankle arthroplasty probably should be limited to centers where surgeons have the volume of patients to master the demanding techniques needed for these operations and conduct prospective clinical trials to determine what factors lead to successful and unsuccessful outcomes.

Adult↗
PubMed1999

Triple arthrodesis: twenty-five and forty-four-year average follow-up of the same patients.

BACKGROUND: Triple arthrodesis is used to treat major deformities of the hindfoot and is often performed in young patients. The purpose of this study was to assess the long-term outcomes of triple arthrodesis in young patients. METHODS: Sixty-seven feet of fifty-seven patients were evaluated at an average of twenty-five and forty-four years after triple arthrodesis. The most common indication for the operation was neuromuscular imbalance of the hindfoot, which was secondary to poliomyelitis in thirty-seven feet (55 percent), Charcot-Marie-Tooth disease in six (9 percent), spinal cord abnormalities in four (6 percent), cerebral palsy in three (4 percent), and Guillain-Barré syndrome in one (1 percent). RESULTS: Fifty-two feet (78 percent) had some residual deformity after the arthrodesis. However, these deformities appeared to be nonprogressive between 1973 and 1994. Pseudarthrosis occurred in thirteen feet. Thirty feet or ankles (45 percent) were painful at the first follow-up evaluation, and thirty-seven feet or ankles (55 percent) were painful at the second follow-up evaluation. Of the thirty feet or ankles that were painful at the first follow-up evaluation, twenty-three were painful at the second follow-up evaluation. Of the thirty-seven feet or ankles that were not painful at the first follow-up evaluation, fourteen were painful at the second follow-up evaluation. Eighteen patients (32 percent) needed walking support at the time of the first follow-up, and thirty-nine patients (68 percent) needed it at the time of the second follow-up. Two of the patients who needed support at the first follow-up evaluation did not need it at the second follow-up evaluation. At the first follow-up evaluation, twenty-one ankles (31 percent) had no radiographic evidence of degenerative changes. However, by the second follow-up evaluation, all of the ankles had some degenerative changes. Similar progressive arthritic findings were noted at the naviculocuneiform and tarsometatarsal joints. According to the system of Angus and Cowell, the overall result at the time of the first follow-up was rated as good in fifty feet (75 percent) and as fair in seventeen feet (25 percent). At the time of the second follow-up, nineteen feet (28 percent) were rated as good, forty-six (69 percent) were rated as fair, and two (3 percent) were rated as poor. CONCLUSIONS: Despite progressive symptoms and radiographic degeneration in the joints of the ankle and midfoot, fifty-four patients (95 percent) were satisfied with the result of the operation. The triple arthrodesis was a satisfactory solution for imbalance of the hindfoot in this group of patients.

Adolescent↗
PubMed1999

The diagnosis of the os trigonum syndrome with a fluoroscopically controlled injection of local anesthetic.

PURPOSE: To report the results of excision of the os trigonum using a fluoroscopically controlled injection of local anesthetic to diagnose the os trigonum syndrome. DESIGN AND PATIENTS: Os trigonum syndrome is a recognized cause of pain in the posterior aspect of the foot and ankle. The symptoms and physical findings, however, are often nonspecific and difficult to differentiate from other causes of posterior ankle pain. We report four patients with persistent posterolateral ankle pain despite prolonged nonoperative treatment. An os trigonal syndrome was diagnosed by a positive response to a fluoroscopically guided local anesthetic injection in the region of synchondrosis between the os trigonum and the posterior talus. RESULTS: All four patients underwent excision of the os trigonum with complete resolution of symptoms and return to full activity. CONCLUSIONS: Fluoroscopically controlled injection can help confirm the suspected diagnosis of an os trigonum syndrome and may have positive predictive value regarding the outcome of excisional surgery.

Adolescent↗
PubMed1998

The effect of foot structure on the three-dimensional kinematic coupling behavior of the leg and rear foot.

BACKGROUND AND PURPOSE: Differences in foot structures have been reported to account for the large variability in findings in previous studies that have examined the relationship between foot structure and the interdependent rotations of the lower extremity. The purpose of this study was to determine, in individuals with radiographically distinct foot structures, the effect of foot structure on three-dimensional kinematic behavior of the leg and rear foot during running. SUBJECTS AND METHODS: Based on radiographic measurements, 10 recreational runners were assigned to a low rear-foot group and another 10 recreational runners were assigned to a high rear-foot group. Three-dimensional kinematic data were collected during treadmill running. Individual axis rotations and the "coupled" relationship between the leg and rear-foot segments were defined using a Cardan angle system of three ordered rotations. RESULTS: The predominant rotations suggest a combined subtalar and talocalcaneal joint axis to favor calcaneal eversion and inversion for the low rear-foot group and tibial medial and lateral rotation for the high rear-foot group. Group differences were also found for the coupling ratio, which described the proportion of calcaneal eversion and inversion transferred or coupled to tibial axial rotation. CONCLUSION AND DISCUSSION: The rotational patterns and coupling response unique to each foot group may enhance our understanding of lower-extremity injuries related to certain foot structures. An assessment of the coupling relationship in combination with traditional frontal-plane measurements may better guide decisions regarding selection of footwear and orthoses.

Adolescent↗
PubMed1998

Ankle osteoarthritis scale.

Although there is a wide array of outcome tools for assessing patients with symptomatic ankle arthritis, no disease-specific instrument for ankle arthritis has been shown to be reliable and valid. The purpose of this study was to develop a simple, reliable, and validated outcome measure for the clinical assessment of ankle osteoarthritis. We modified the Foot Function Index, a visual analog-based scale used to assess rheumatoid foot problems, to measure patient symptoms and functional limitations stemming from osteoarthritis of the ankle joint. Test-retest reliability and criterion and construct validity were determined for the overall Ankle Osteoarthritis Scale and its two subscales (pain and disability). Overall reliability (r=0.97; 95% confidence interval [CI], 0.94-0.99), pain subscale reliability (r=0.95; 95% CI, 0.90-0.98), and disability subscale reliability (r=0.94; 95% CI, 0.88-0.97) were excellent. Criterion validity testing of the instrument with the WOMAC (a disease-specific scale for osteoarthritis) and the SF-36 (a general health survey) showed a high degree of concordance for related subscales. Construct validity using a physical measure of ankle function demonstrated sensitivity of the instrument to the degree of joint dysfunction. Normative data were obtained from 562 individuals who were not patients (264 men and 298 women). The responses were analyzed for trends in gender, body mass index, presence of arthritis, history of fracture in relation to the response levels, and age. A small but statistically significant main effect for gender was found, with women consistently reporting higher pain, disability, and total index scores. Body mass index and arthritis were also found to correlate with response answers across the subscale and total index scores; however, these factors only accounted for 12% of the variation. The Ankle Osteoarthritis Scale is a reliable and valid self-assessment instrument that specifically measures patient symptoms and disabilities related to ankle arthritis.

Adult↗
PubMed1998

Assessing sesamoid subluxation: how good is the AP radiograph?

Subluxation of the metatarsosesamoid joints frequently occurs with the development of hallux valgus deformity, and the restoration of a normal metatarsosesamoid articulation has been proposed as essential for achieving a biomechanically sound operative result. The position of the sesamoid bones on the AP radiograph is used often to assess the pre- and postoperative relationship between the hallucal sesamoids and the metatarsal sulci. We evaluated the validity of this approach. Thirty subjects with hallux valgus and 30 control subjects participated in this study by undergoing both AP and tangential weightbearing radiographs. The sesamoid station on the AP radiographs was compared with the position of the sesamoids on tangential radiographs, using a new continuous measure to estimate subluxation. In approximately half of the cases, we found a difference between the apparent sesamoid station on the AP radiograph and the true position on the tangential one. Increased metatarsal rotation was associated with misclassification of the sesamoid station on the AP radiograph. We conclude that the standard method for measuring the sesamoid station on the AP radiograph is not valid. Surgeons wishing to evaluate the metatarsosesamoid joint should obtain weightbearing tangential radiographs.

Evaluation Studies as Topic↗
PubMed1998

A history of medical scientists on high heels.

For 250 years medical scientists have propagandized about the health hazards of high-heeled shoes, which originated four centuries ago. Physicians, however, largely unaware of their own profession's tradition, keep reinventing the diagnostic wheel. This professional amnesia has held back the momentum of the process of educating the public. Consequently, despite these warnings, millions of women continue to wear high-heeled shoes. This article describes the history of the medical profession's recognition of this worldwide health problem and the current understanding of the deleterious and often irreversible biomechanical effects of high-heeled shoewear. The article emphasizes that the reemergence of high heels and of medical interest in them in the third quarter of the 19th century, following their disappearance in the wake of the French Revolution, was associated with increasing pressure by employers to wear such shoes for long hours at work. Although medical scientists have recognized this specifically occupational phenomenon for more than a century, full-scale epidemiological studies may be necessary to bring about substantial social-behavioral change.

Biomechanical Phenomena↗
PubMed1998

Total ankle arthroplasty: a unique design. Two to twelve-year follow-up.

We evaluated the intermediate-term results of a novel total ankle arthroplasty that includes insertion of the components without cement and arthrodesis of the tibiofibular syndesmosis as part of the operative procedure. One hundred consecutive Agility ankle replacements were performed in ninety-five patients between 1984 and 1993. At the time of follow-up, eighty-three patients (eighty-six ankles) were alive and twelve patients (fourteen ankles) had died. Five (6 per cent) of the eighty-six ankles in the living patients had been revised. Including the components that had been revised for loosening, twenty-one (twelve tibial and nine talar) components had migrated. Delayed union of the syndesmosis (twenty-eight ankles) and non-union of the syndesmosis (nine ankles) were associated with the development of lysis around the tibial component. Non-union of the syndesmosis was also associated with migration of the tibial component and circumferential radiolucency around that component. In addition to the patients who died, one patient had a resection of the implant with subsequent arthrodesis. The remaining eighty-two patients (eighty-five ankles) were the basis for the clinical evaluation in the study. The average age at the time of the procedure was sixty-three years (range, twenty-seven to eighty-one years). At the time of the most recent follow-up (range, 2.8 to 12.3 years; average, 4.8 years), forty-seven (55 per cent) of the remaining eighty-five ankles were not painful and twenty-four (28 per cent) were only mildly painful. The range of motion of the fifty-six ankles that were examined at the time of follow-up averaged 36 degrees (range, 10 to 64 degrees), and the results for seventy-nine (93 per cent) of the eighty-five ankles were satisfactory to the patients.

Adult↗
PubMed1998

A primer on lower extremity outcome measurement instruments.

Tracing the roots of lower extremity outcome scales is an interesting and somewhat bemusing journey. A large number of different grading methods can be found with limited reliability and/or validity testing. The usefulness of these instruments in the assessment of patient outcomes after lower extremity interventions is worrisome. This article focuses on the most commonly used scales and demonstrates an alarming and incestuous pattern of cross-validation with moderate to weak associations between potentially unreliable and crudely validated original instruments.

Activities of Daily Living↗
PubMed1997

Anatomic determinants of first metatarsophalangeal flexion moments in hallux valgus.

A laboratory cadaver model was used to assess the effects of the major anatomic components of hallux valgus deformity on first metatarsophalangeal flexion moments. The individual components of the flexor hallucis longus' effective tendon moment arm were evaluated as a function of imposed hallux valgus, of hallux pronation, and of combined hallux valgus and pronation. To simulate the effects of distal first metatarsal surgery, the components' changes after metatarsal head lateral translation or supination were assessed. Significant changes in effective tendon moment arm occurred with increases in the hallux valgus angle, with changes in the hallux pronation angle, and with combined increases in the hallux valgus angle and hallux pronation angles. The changes involved primarily were a redirection of the moment vector's projection within the superior and inferior plane or medial and lateral plane, rather than an appreciable alteration of the magnitude of the resultant. By contrast, neither translational nor rotational displacements of the metatarsal head influenced any of the individual components of the effective tendon moment arm.

Biomechanical Phenomena↗
PubMed1997

Vascular supply of nerves in the tarsal tunnel.

The normal vascular supply of nerves in the tarsal tunnel was studied by intra-arterial injection of latex. In general, the blood supply to the tibial nerve and its branches came directly from corresponding arteries. Each nutrient artery to the tibial nerve bifurcated on the surface of the lateral plantar nerve fasciculus to create longitudinal vessels that made anastomoses with bifurcating nutrient vessels proximally and distally. This primary longitudinal system supplied intersubfascicular vessels to the medial plantar fasciculus. The last nutrient artery from the posterior tibial artery usually supplied the terminal branching point of the tibial nerve midway through the tarsal tunnel. The lateral and medial plantar nerves received most of the nutrient vessels from their corresponding arteries in shorter intervals. In 65% of cases, the lateral plantar nerve received a nutrient vessel from the medial plantar artery. Potential anatomical areas of vascular compromise in the etiology or surgical release of tarsal tunnel syndrome are discussed.

Aged↗