Functional anatomy of the ankle joint ligaments.
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Ankle Joint↗
Biomedical subjects
R A Mann
Publications and source records attributed to R A Mann.
Guidelines for hospitalization for foot and ankle surgery: report of Committee of American Orthopaedic Foot and Ankle Society.
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Ankle Joint↗
Arthrodesis of the first metatarsophalangeal joint as salvage for the failed Keller procedure.
Arthrodesis of the first metatarsophalangeal joint was performed in eleven patients (sixteen feet) after a Keller procedure had failed. Multiple intramedullary threaded Steinmann pins were used to fix the bone at the site of the arthrodesis, and a successful arthrodesis was achieved in each patient. Interposition of a graft of bone from the iliac crest was done in four feet with an excessively short hallux. Lateral metatarsalgia that was due to intractable keratoses on the plantar part of the foot was relieved in eleven (92 per cent) of the twelve feet that had it preoperatively. Cock-up deformity of the hallux was also improved. Residual stiffness of the interphalangeal joints, which was a major preoperative problem, was not improved. Arthrodesis of the first metatarsophalangeal joint is a useful procedure to salvage a failed result of the Keller procedure.
Aged↗
Monarticular nontraumatic synovitis of the metatarsophalangeal joint: a new diagnosis?
Seven patients presented with forefoot pain in the metatarsal head region, with an average age of 57 years, and no history of trauma. Six had pain in the second metatarsophalangeal joint, while one patient had pain in the third. Physical examination demonstrated generalized thickening of the involved metatarsophalangeal joint along with warmth and tenderness to compression. Range of motion was decreased in flexion and two patients had a subluxed metatarsophalangeal joint. All patients demonstrated some instability of the joint with dorsoplantar stress. Palpation of the intermetatarsal space demonstrated some evidence of irritation of the common digital nerve. The toe demonstrated some thickening. Roentgenograms demonstrated some widening of the metatarsophalangeal joint in four of these patients. One patient responded to conservative treatment, and the remaining six patients underwent synovectomy. In three cases the common digital nerve was resected. Follow-up was 16 months, and four of the six patients operated on felt their symptoms were completely relieved, one patient felt that the symptoms were improved, and one patient believed her surgery was of no benefit. Synovial tissue in all cases revealed pathologic changes of chronic synovitis. The etiology of this synovitis is unknown. The excessive synovium resulted in the joint thickening, which probably accounts for the neuritic symptoms, the generalized thickening of the toe, and the instability of the joint. Because of the poor response to conservative treatment, perhaps earlier synovectomy is the treatment of choice for this entity.
Adult↗
Rupture of the posterior tibial tendon causing flat foot. Surgical treatment.
Rupture of the posterior tibial tendon results in a progressive, painful flat-foot deformity. Other physical findings are an inability to invert the heel on tip-toe standing and loss of inversion power. In this study we report on seventeen patients with this condition who were surgically treated with a transfer of the flexor digitorum longus tendon into the navicular or an advancement of the posterior tibial tendon. Follow-up results were excellent in twelve, good in one, fair in three, and poor in one patient. Arthrodesis of the talonavicular and calcaneocuboid joints was subsequently done for the patient with the poor result.
Adult↗
Foot disorders. A four-article symposium. Introduction.
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Adaptation, Physiological↗
Metatarsalgia. Common causes and conservative treatment.
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Arthritis, Rheumatoid↗
Intractable plantar keratosis.
As I mentioned in the beginning of this discussion, it is imperative to treat all of these intractable plantar keratoses conservatively with proper shoes, metatarsal supports, and local care of the lesion before considering any type of surgical intervention. Many patients will respond to conservative management, and it is certainly the treatment of choice if the patient is satisfied with it.
Foot Dermatoses↗
Rupture of the tibialis posterior tendon.
The clinician should be aware of the possibility of a rupture of the tibialis posterior tendon in adults who have developed a unilateral flatfoot deformity. By careful physical examination, the diagnosis can readily be made. In more advanced cases roentgenographic changes of medial subluxation of the talar head and evidence of sagging of the talonavicular joint are noted on the lateral view. If conservative treatment fails to result in a satisfactory clinical response, I believe the treatment of choice is a flexor digitorum longus transfer through the navicular. If this procedure fails, bony stabilization of the hindfoot may be indicated.
Ankle Joint↗
Arthrodesis of the first metatarsophalangeal joint for hallux valgus in rheumatoid arthritis.
We reviewed the results of reconstruction of the fore part of the foot in rheumatoid patients by arthrodesis of the first metatarsophalangeal joint. The follow-up averaged 4.1 years (range, 2.0 to 7.25 years). Eighteen feet in eleven women were operated on. Twelve feet underwent total reconstruction of the fore part: arthrodesis of the first metatarsophalangeal joint and excision of all of the lesser metatarsophalangeal joints. Six feet underwent subtotal reconstruction, which included arthrodesis of the first metatarsophalangeal joint. The results were classified as excellent in fourteen feet, good in two, and fair in two. There were no poor results. Metatarsophalangeal bone fusion was achieved in all but one foot (fusion rate, 94 per cent). The one fibrous ankylosis was painless, with satisfactory function. Interphalangeal degenerative joint disease was a radiographic but not a clinical sequela. Arthrodesis of the first metatarsophalangeal joint provided stability that permanently corrected deformity, permitted the patients to wear ordinary shoes, and, in combination with excisional arthroplasty of involved lesser metatarsophalangeal joints, relieved disabling pain in the fore part of the foot.
Adult↗
Anaesthesia for lower limb amputation. A comparison of spinal analgesia and general anaesthesia in the elderly.
Amputation of the lower limb for vascular disease has a high morbidity and mortality. A comparative study in 60 patients was carried out between spinal analgesia with sedation and general anaesthesia with controlled ventilation which maintained end expiratory carbon dioxide 4-4.5 k Pa. The spinal technique had advantages over general anaesthesia during surgery and in the first 24 hours, but no long term benefits. Meticulous pre-operative preparation, intra-operative care and careful postoperative management, including monitoring of end expiratory carbon dioxide tension, appeared to be major factors contributing towards the low morbidity and mortality.
Aged↗
Acquired flatfoot in adults.
The main causes of the acquired flatfoot deformity in adults are reviewed. This condition can be extremely disabling; however, careful analysis combined with thoughtful conservative management or surgical treatment can usually enable the patient to maintain a functional level.
Adult↗
Biomechanical approach to the treatment of foot problems.
A biomechanical approach is essential to proper diagnosis of foot and ankle problems. With full knowledge of how the average or neutral foot and/or ankle functions, one can then readily "spot" variations from these "norms", and thus gain significant clues in solving your patient's complaints. This requires careful observation and recording of attitudes in stance, gait at various speeds, and ranges of motion in small and larger joints. The author has attempted to point out the pertinent methods of such examinations, the range of "norms" based on scientific data, and how to interpret the variations from these "norms". Furthermore, once your diagnosis has been established, this biomechanical analysis of your patients' specific complaints and findings, coupled with your patients' activities and goals, will influence your office and presurgical planning.
Ankle↗
Running symposium.
The running symposium has been designed to demonstrate to the reader the basic mechanics of the running gait, as compared to normal walking. It is imperative in order to understand the nature of the problems seen in runners to understand the forces and motions which are occurring in the various joints of the lower extremity, so that as much as possible, treatment can be based upon accurate anatomical diagnoses, rather than empiric treatment. The second part of this symposium discusses the nature of the injuries seen in the lower extremity in runners. Suggestions are made as to how to manage the problems as well as their prevention. Finally, a comment is included on the nature of the running shoe and on shoe selection.
Athletic Injuries↗
Amputation of the great toe.
Four patients who had undergone reimplantation of the great toe to create a thumb were studied. The follow-up period ranged from 29 to 62 months. In all cases, the great toe was disarticulated at the metatarsophalangeal joint. The patients felt their feet functioned at approximately 85% of normal, and none had any significant complaint of metatarsalgia. The one patient who participated in sports after the surgery noted that it was difficult to "push off" moving away from the involved foot. X-ray examination demonstrated retraction of the sesamoids, which accounted for the increased plantar flexion of the first metatarsal shaft. The second metatarsophalanageal joint drifted into varus an average of 8 degrees. The Harris mat demonstrated that there was an increase in weightbearing beneath the second and third metatarsal heads. It appears as though, on the basis of this study, the loss of the great toe in this manner does not significantly affect the normal everyday function of an individual's foot.
Amputation, Surgical↗