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PubMed2002

[Ultrasound diagnosis in knee and foot trauma].

Subsequent to clinical and radiologic examination, ultrasonography is an important diagnostic method in knee and foot trauma, especially to assess pathologic conditions of the periarticular soft tissue. The main indications for ultrasonographic assessment of the knee region are fluid conglomerations, injuries of tendons, ligaments, and muscles, and vascular diagnosis. The indications for ultrasonography in the foot region are diagnosis of foreign bodies, dislocation of the peroneal tendons, lesions to the flexor and extensor tendons, and osseous capsular and ligamentous avulsions. Changes of the soft tissues include articular effusion, fluid conglomeration, ossification, and vascular lesions. Fractures involve the base of the fifth metatarsal, navicular and sesamoid bones, and epiphysiolysis. Rare indications are the search for free articular bodies and free air and the depiction of cartilaginous lesions and fractures of the knee region.

Foot Injuries↗
PubMed1999

Foot landing position during gait influences ground reaction forces.

OBJECTIVE: The purpose of this study was to determine how foot landing position influenced the ground reaction forces of two coordinate systems during gait. DESIGN: Values of ground reaction forces components as expressed in two coordinate systems (room, foot) were used to compare ground reaction forces of different foot landing position. BACKGROUND: Non-neutral foot landing position during gait could influence the mechanics of the whole body motion and/or the foot-ankle complex and produce different ground reaction forces patterns compared to a neutral foot landing position. METHODS: Thirty females were assigned to a foot landing group: toe-out, toe-in or neutral. Each participant walked 10 trials across a force platform while three-dimensional motion was captured. RESULTS: No differences were observed for vertical or anteroposterior ground reaction forces variables between groups for either coordinate system. For medio-lateral forces of both coordinate systems, toe-out participants exhibited greater first lateral and second medial maximum forces and exhibited greater impulses. CONCLUSION: For toe-out participants, greater medio-lateral ground reaction forces of the room coordinate system indicate excessive forces are generated by toe-out participants that do not contribute to moving the participant forward. Furthermore, medio-lateral loading on the foot increases proportionally with the degree of toe-out. RELEVANCE: Establishing norms for clinical populations requires understanding of factors that can influence ground reaction force (GRF). Foot landing position (FLP) only affects the medio-lateral forces. Excessive toe-out landing has been surmised to be related to injury. Greater forces acting medio-laterally to the foot's long axis may have a relevant effect on in/eversion loading of the foot.

Ankle Joint↗
PubMed2004

Lateral column fusions.

There is a considerable amount of literature on the treatment of the medial column. The lateral column is sometimes as difficult and can also pose biomechanical challenges. The distinction of medial or lateral column pain is dependent on the patient's foot type. The senior author has observed that lateral column pain is much more prevalent in a neutral to supinated foot. Chronic pain and end-stage arthrosis of the lateral column joints can be treated successfully with the approaches discussed. As the Achilles tendon is important in medial column collapse, its contribution to lateral column pathology should also be considered.

Arthrodesis↗
PubMedDate not supplied

A prospective comparison of clinical, radiographic, and intraoperative features of hallux rigidus: short-term follow-up and analysis.

Forty-seven patients (50 feet) underwent surgical intervention for symptomatic hallux rigidus between February 1998 and April 1999. Thirty-eight patients (41 feet) returned at 1 year for follow-up evaluation. Each foot was graded according to a four-stage hybrid radiographic grading system. At 1-year follow-up, 10 patients were classified as grade I, 17 as grade II, 12 as grade III, and 2 as grade IV. Subjective evaluation was based on a modified American Orthopaedic Foot and Ankle Surgery hallux metatarsophalangeal-interphalangeal 100-point scale. A pre- and postoperative objective physical examination and radiographic analysis were performed. Statistically significant differences between preoperative and postoperative values were found to exist for each portion of the subjective evaluation (p = .000); nonweightbearing dorsiflexion (p = .001); simulated weightbearing dorsiflexion (p = .003); metatarsal protrusion distance and angle of deviation of the second metatarsophalangeal joint (p = .000); and talar-first metatarsal angle (p = .015). For this specific patient population, the short-term results of surgical intervention for hallux rigidus provided subjective patient improvement and satisfaction, as well as a statistically significant but functionally minimal increase in first metatarsophalangeal joint dorsal range of motion. Additionally, in the 19 patients who underwent a periarticular decompression osteotomy, the intended correlation of plantar transposition of the capital fragment and offsetting the longitudinal shortening of the first metatarsal did not exist.

Adolescent↗
PubMedDate not supplied

Talonavicular joint arthrodesis for paralytic post poliomyelitis forefoot instability.

A 17-year-old patient presented with paralytic valgus left foot deformity after poliomyelitis. Forefoot instability resulted from the transfer of peroneus brevis to the second metatarsal bone. This was secondary to a medial gapping of the talonavicular joint as a result of unbalanced pull of the transferred tendon. Talonavicular arthrodesis following a medial-based wedge articular resection has corrected the deformity.

Adolescent↗
PubMedDate not supplied

Fracture dislocations of the tarsometatarsal joints: Analysis of interrater reliability in using the modified Hardcastle classification system.

Fracture dislocations/subluxations of the tarsometatarsal joint are complex injuries that are often misdiagnosed. Prompt recognition and treatment of Lisfranc injuries decrease the likelihood of long-term sequelae. The original (1909) classification system was modified in 1982 and again in 1986. The 1986 classification system, developed by Hardcastle et al, is used most widely in clinical practice and is cited most often in the biomedical literature. For this-or any-classification system to be beneficial, however, multiple observers must be able to use it in a consistent manner, and a high level of interrater agreement should exist. This study examined interrater reliability among clinicians using the modified Hardcastle classification system for Lisfranc fracture dislocations. Thirteen Lisfranc injury radiographs were evaluated by 21 independent observers consisting of surgeons and residents (podiatric and orthopedic) as well as musculoskeletal radiologists, who classified radiographs according to the modified Hardcastle classification system. We used kappa statistics to evaluate the degree of interrater reliability for the entire group. A mean weighted kappa value of 0.54 was found for the group. Moderate interrater agreement was observed among clinicians interpreting the modified Hardcastle classification system for Lisfranc fracture dislocations.

Fractures, Bone↗
PubMed1993

Spondyloarthropathies and psoriatic arthritis in children.

Data that are relevant to the general understanding of the juvenile-onset spondyloarthropathies are reviewed here. Seronegative enthesopathy and arthropathy syndrome is considered the earliest recognizable form of juvenile-onset spondyloarthropathy, from which other syndromes and diseases emerge. The group also includes juvenile-onset ankylosing spondylitis, a disease defined in adult-based terms when definite changes have occurred in the axial joints; ankylosing tarsitis, a complex disorder in which foot problems resemble those of the spine in ankylosing spondylitis; Crohn's disease and ulcerative colitis-related peripheral and, especially, HLA-B27 axial disease; reactive arthritis and Reiter's syndrome, which might be further classified according to its cause; and juvenile psoriatic arthritis, a disease that resembles juvenile rheumatoid arthritis more than does juvenile-onset spondyloarthropathy.

Arthritis, Psoriatic↗
PubMed1988

Tarsometatarsal fractures and dislocations.

A total of 32 cases of tarsometatarsal fracture dislocations, treated during a 15-year period, have been retrospectively reviewed. Results were assessed in 29 patients with a mean age of 33.8 years and a mean follow-up of 6.3 years. On the basis of Quénu and Küss' classification, five patients had homolateral dislocations, three had divergent dislocations, and 21 had partial dislocations (seven medial partial and 14 lateral partial). Treatment included closed manipulative reduction, occasionally followed by Kirschner (K)-wire fixation. If closed reduction was not achieved, open reduction was performed. Results were assessed according to Hardcastle's scoring system. On that basis, 20 good, 5 fair, and 3 poor results were obtained and there was one early amputation. Good results were associated with an accurate reduction. Open treatment is advocated if minor displacement persists. Routine K-wire fixation is advised for all cases.

Adolescent↗
PubMed1975

The foot in chronic rheumatoid arthritis.

The feet of 200 consecutive admissions with classical or definite rheumatoid arthritis were studied. 104 were found to have pain or deformity. Clinical involvement of the joints was seen more often than radiological joint damage in the ankle, but the reverse was the case in the midtarsal joints. The metatarsophalangeal joints were involved most frequently both clinically and radiologically. Sixty per cent of the patients required modified shoes but only a third of these had received them. The need for more shoes is clear, and although this is a highly selected group of patients they were all under specialist care. The increased expenditure on special footwear would benefit the patient, firstly by improving ambulation, and secondly perhaps by reducing the number of operations necessary. Hallux valgus was very common and occurred with similar frequency to disease in the other metatarsophalangeal joints. Although not exclusive to rheumatoid arthritis, hallux valgus must have been caused for the most part by the rheumatoid arthritis and if so, then it is suggested that the provision of suitable shoes for patients may be less costly than subsequent surgical treatment.

Ankle Joint↗
PubMed2001

Fractures and fracture dislocations of the midfoot: occurrence, causes and long-term results.

Etiology and outcome of 155 patients with midfoot fractures between 1972 and 1997 were analyzed to create a basis for treatment optimization. Cause of injuries were traffic accidents (72.2%), falls (11.6%), blunt injuries (7.7%) and others (5.8%). Isolated midfoot fractures (I) were found in 55 (35.5%) cases, Lisfranc fracture dislocations (L) in 49 (31.2%), Chopart-Lisfranc fracture dislocations (CL) in 26 (16.8%) and Chopart fracture dislocations (C) in 25 (16%). One hundred and forty eight (95%) of the midfoot fractures were treated operatively; 30 with closed reduction, 115 with open reduction, 3 patients had a primary amputation. Seven (5%) patients were treated non-operatively. Ninety seven (63%) patients had follow-up at an average of 9 (1.3-25, median 8.5) years. The average scores of the entire follow-up group were as follows: AOFAS - sum of all four sections (AOFAS-ET): 296, AOFAS-Midfoot (AOFAS-M): 71, Hannover Scoring System (HSS): 65, and Hannover Questionnaire (Q): 63. Regarding age, gender, cause, time from injury to treatment and method of treatment no score differences were noted (t-test: p>0.05). L, C or I showed similar scores and CL significantly lower scores (AOFAS-ET, AOFAS-M, HSS, Q). The highest scores in all groups were achieved in those fractures treated with early open reduction and operative fixation. Midfoot fractures, particularly fracture dislocation injuries, effect the function of the entire foot in the long-term outcome. But even in these complex injuries, an early anatomic (open) reduction and stable (internal) fixation can minimize the percentage of long-term impairment.

Adolescent↗
PubMed2001

Method for manual reduction of displaced intra-articular fracture of the calcaneus: technique, indications and limitations.

One hundred and two cases of displaced intra-articular fractures of the calcaneus were treated using this method for manual reduction. All but three were treated within three days of injury. The average follow-up was seven years and three months (range three to 14 years). Patients' ages ranged from 21 to 76 years. Results were assessed by clinical outcome as well as roentgenographic appearance. Successful reductions were obtained in 92 cases. In the remaining 10 cases, the reduction was felt to be unsatisfactory and either percutaneous pinning or open reduction internal fixation was performed. In most cases fractures were reduced and treated successfully using this method of manual reduction. The use of this method does not preclude any further treatment options, and we therefore feel this method is the treatment of choice.

Adult↗
PubMed1981

The early complications of subtalar dislocation.

Although the treatments and results of subtalar dislocations are usually considered as nonproblematical, review of 10 cases seen over a 6-year period proved otherwise. Difficulties were encountered with four of these cases consisting of associated foot injuries, failure to recognize the dislocation, incarceration of the dislocation, vascular complications, and iatrogenic infection. The management of these cases is discussed.

Adolescent↗
PubMed1987

The role of subtalar motion and ankle contact pressure changes from angular deformities of the tibia.

It is a well known entity that fractures of the tibia heal with some component of angular deformity. Ankle and subtalar joints may compensate for small degrees of angular deformities, but the exact amount of malunion that can be accepted without development of late sequalae has yet to be determined. Two recent studies from this institution have concluded that contact changes at the tibiotalar joint tend to be greater with distal third tibial fracture deformities compared to proximal and middle with the ankle in neutral, 5 degrees dorsiflexion, and 20 degrees of plantar flexion. Anterior and posterior bow deformities produced a greater change in contact area of the tibiotalar joint than with valgus or varus deformities. This phenomena may be possibly explained by the subtalar motion in the horizontal plane which averages 23 degrees. Thus, it was the primary purpose of this paper to determine the exact role, if any, in subtalar motion on tibiotalar contact in angular deformities of the tibia. To achieve this objective the subtalar joint was transfixed thereby eliminating its perceived compensatory movement. Six cadaveric lower extremities were disarticulated at the knee joint and stripped of soft tissue preserving capsular and ligamentous structures. A custom universal joint was used to create various angulatory deformities at proximal, middle, and distal third levels of the tibia.(ABSTRACT TRUNCATED AT 250 WORDS)

Ankle Joint↗
PubMed1989

Kinematics of the ankle/foot complex--Part 3: Influence of leg rotation.

In an in vivo kinematical investigation, the movements of the ankle/food complex induced by external rotation of the leg from an internally rotated position were analyzed by roentgen stereophotogrammetry. Radiopaque markers were introduced into the tibia, talus, calcaneus, navicular, medial cuneiform, and first metatarsal bones of eight healthy volunteers. Rotations occurring between these bones after 10 degrees increments of leg rotation were calculated in three dimensions. Movement of the leg from an internally rotated position to the neutral was found to induce motion mainly as internal rotation of the talus in relation to the tibia. Further external rotation induced motion mainly in the talonavicular and talocalcaneal joints, whereas a smaller amount of motion was seen in the joint between the navicular and the medial cuneiform.

Ankle Joint↗