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'Bones of the Foot' (176)


Nov
2016

Composite injuries of the volar surfaces of fingers are frequently associated with digital vessel and nerve damage. Flow-through glabrous flaps can provide esthetic tissue coverage as well as revascularization, and using a neurovascular flap, allows primary reconstruction of the digital nerve.
Between June 2010 and August 2014, we prospectively studied the use of Microsurgical flow-through glabrous flaps to achieve simultaneously digital revascularization and soft tissue coverage in 13 fingers of 12 patients who experienced volar injuries, comprising 6 great toe fibular flaps, 3 medial plantar flaps, 1 pedis medialis flap, and 3 hypothenar flaps.

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Jun
2017

Management of Talar Component Subsidence.

Foot Ankle Clin 2017 Jun 31;22(2):361-389. Epub 2017 Mar 31.
Shu-Yuan Li, Mark S Myerson
Component subsidence has been found to be the top complication that leads to failure of the total ankle arthroplasty (TAA). The cause of subsidence formation is unclear, and is multifactorial. Talar subsidence is more frequently met than tibial subsidence, and the subsequent big bone loss is demanding to handle.

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Mar
2017

Osteoblastoma is benign bone forming tumour with rare malignant transformation. The common locations include spine, proximal humerus and hip. It rarely affects the talus.

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Mar
2017

As hallux valgus (HV) progresses, the first metatarsal drifts medially and the subsequent lateral drift of the sesamoids results in intersesamoidal crista erosion. This study aimed to provide a novel method of assessing crista erosion and determine if there is a relationship between that erosion and an increase in the distal metatarsal articular angle (DMAA).
The DMAA and size of the intersesamoidal crista was measured on the first metatarsals of 120 adult modern human individuals.

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Mar
2017

Compared with upper extremity injuries, toe amputations and their replantations are rare because of the difficulty of their relatively thinner soft tissue envelope. Consequently, fewer reconstructive options are available for toes and they are rarely reported in the literature. In this study, we reported a case of right third to fifth toe amputations and their subsequent reconstruction with iliac bone grafts and a free anterolateral thigh flap.

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Mar
2017

It is usually accepted that acquired flatfoot deformity after injury is usually due to partial or complete tear of the posterior tibial tendon (PTT), with secondary failure of the other structures which maintain the medial longitudinal arch, such as the plantar calcaneo-navicular (SPRING) ligament. It is unusual to find an isolated Spring Ligament (SL) tear, with an intact TP tendon.
The medial arch reconstruction technique of an isolated SL tear in 5 patients is presented discussed in this paper.

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Dec
2016

Translation and shortening of Scarf osteotomy allows correction of severe hallux valgus deformity. Shortening may result in transfer metatarsalgia.
To evaluate outcome of patients undergoing shortening Scarf osteotomy for severe hallux valgus deformities.

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Dec
2016

Clinical and radiological related outcomes have been reported for Chevron osteotomy as correction for mild to moderate hallux valgus, but only for relatively small patient series. Moreover, evaluation of the patient's point of view has mostly been conducted by means of more physician-based outcome measures. The goal of this study was to evaluate the effect of the Chevron osteotomy for hallux valgus on patients' daily lives using the Foot and Ankle Outcome Score (FAOS) as a validated and a hallux valgus specific patient reported outcome measure (PROM).

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Dec
2016

Hallux varus following scarf osteotomy.

Foot (Edinb) 2016 Dec 19;29:1-5. Epub 2016 Sep 19.
Shahid Akhtar, Sabur Malek, Kartik Hariharan
Hallux varus is an uncommon condition and majority of the cases are iatrogenic. It can occur as a result of any type of hallux valgus correction surgery and in our cases scarf osteotomy is not an exception. Treatment of this complication can be challenging and it is important to understand the factors that cause this deformity before embarking on surgical correction.

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Dec
2016

Platelet-rich plasma (PRP) and concentrated bone marrow aspirate (CBMA) have the potential to improve the quality of cartilage repair in osteochondral lesions of the talus (OLT). In this review, we describe the basic science and clinical evidence that has been published on the topic of PRP and CBMA on 2 commonly used surgical techniques for the treatment of OLT: bone marrow stimulation and osteochondral autograft transfer.

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Dec
2016

A 61-year-old man with a history of squamous cell carcinoma of the lung presented with a progressive left foot pain for 7 months. Bone scan was acquired to evaluate possible metastasis, which showed abnormal accumulation of Tc-MDP in the left foot, which was seen in the medial cuneiform bone on SPECT/CT images. Histopathological examination from biopsy specimen confirmed cuneiform bone metastasis from lung squamous carcinoma.

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Nov
2016

Patient-reported outcome measures have become important tools for assessing health status in a variety of patient populations. Many historically or commonly used patient-reported outcome measures in orthopaedics are narrow in scope and are limited by the burden associated with their administration, making them useful only for specific populations. The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed to overcome these limitations.

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Aug
2016

Symptomatic Hallux valgus can be treated with metatarsal osteotomy combined with proximal phalangeal osteotomy, however this might not be sufficient to treat severe HV deformities.
Fifteen feet in eleven female patients treated with double first metatarsal and proximal phalanx osteotomies without lateral release were prospectively studied and outcome measures including radiological angles and validated patient reported outcome scores collected.
Mean radiological follow up was 15 months and PROMs data 17 months.

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Aug
2016

Osteoarticular TB around the tarsal navicular is a chronic, uncommon condition affecting the midfoot, which causes significant morbidity to the patient. Tuberculosis around the tarsal navicular is rarely described in the literature. A series of three cases - two involving the talo-navicular joint and one involving the naviculo-cuneiform joint is described.

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Aug
2016

Transmetatarsal amputations have generally been accepted as a relatively more definitive amputation compared with other lesser ray resections. However, many investigators have reported a high occurrence of more proximal amputation after transmetatarsal amputation. A systematic review was performed to evaluate the occurrence of reamputation and reoperation after transmetatarsal amputations.

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Aug
2016

Treatment of fifth metatarsal fractures in elite athletes or delayed/non unions often requires operative fixation. However, this can cause technical difficulties and we present an operative tip to avoid complications is presented.

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May
2016

Fibular hemimelia is a rare but the most common congenital long bone deficiency, encompassing a broad range of anomalies from isolated fibular hypoplasia up to substantial femoral and tibial shortening with ankle deformity and foot deficiency. Most cases of fibular hemimelia manifest clinically significant leg length discrepancy (LLD) with time that requires adequate correction by bone lengthening for stable walking. Bone lengthening procedures, especially those for pathological bones, are sometimes associated with severe complications, such as delayed consolidation, fractures, and deformities of the lengthened bones, leading to prolonged healing time and residual LLD at skeletal maturity.

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Sep
2016

Four patients were referred to our department to undergo a bone scan for suspected reflex sympathetic dystrophy in the upper limbs. After TC-HMDP injection in the foot, they developed a "sock sign," defined by highly increased uptake in the injected lower limb. The sock sign has been previously described in only 1 case in the literature and attributed to intra-arterial injection.

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May
2016

The aim of our study was to assess the usefulness of the MUNIX method in reflecting the clinical dysfunction in patients with amyotrophic lateral sclerosis (ALS), as well as to assess an intra-rater reproducibility of MUNIX. The study group consisted of a total of 15 ALS patients. The mean age of symptoms onset was 55 years, and the mean disease duration was 10 months.

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Jun
2016

Among the many surgical techniques used for hallux valgus correction, different osteotomies may be performed in the proximal phalanx as well as lateral release as associated procedures. The aim of this study is to analyze the anatomical relationships and the risks for the soft tissue lessions when performing the dorsomedial minimally invasive surgery (MIS) portal for the Akin osteotomy, and the MIS dorsolateral portal for lateral release, in order to define a safety zone when conducting the procedure in order to avoid complications.
The procedures were carried out on 16 fresh-frozen cadaveric feet.

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Dec
2016

Severe motorcycle spoke injuries of the heel lead to Achilles tendon defects, calcaneal tubercle exposure or loss, and overlying soft tissue defects, which are challenging to treat. Given the special physiological and developmental characteristics of children, severe spoke injuries of the heel in children are especially troublesome.We report details of 31 cases of severe motorcycle spoke injuries of the heel in children.

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Jun
2016

The reporting of isolated metatarsal tuberculosis in the available literature is sparse, herein we report a case of 26-year-old female who presented with insidious onset pain and swelling in her forefoot. Radiograph showed osteolysis of the first metatarsal. Magnetic resonance imaging showed osseous erosion with marrow oedema.

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Apr
2016

History A 53-year-old woman presented to the hospital for evaluation of progressive long-standing left dorsomedial foot pain, which was made worse with weight bearing. There was no history of trauma. Prior assessments were performed at another facility, and she did not to respond to conservative therapy.

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Jun
2016

Stress fractures are frequently underdiagnosed and undertreated despite being common in sports. Early diagnosis is crucial; therefore, a high index of clinical suspicion is required. Complementary examinations are essential for diagnosis and follow-up.

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Mar
2016

Tibiotalocalcaneal fusion is an effective salvage procedure for combined end-stage ankle and subtalar arthrosis and for the management of severe planar deformities of the ankle and hindfoot. Although the procedure results in a rigid ankle and hindfoot, it is often the only means of providing patients with a stable and painless foot and ankle for ambulation. Some patients who require the procedure have substantial bone loss that can be managed with a variety of autograft and allograft options.

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Apr
2016

The coracoclavicular joint (CCJ) is considered as a rare articulation in humans. Though rarely it could be symptomatic, its presence should be acknowledged by physicians. The aim of this systematic review is to conduct an evidence synthesis on the prevalence of this condition in different ethnic populations.

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Jun
2016

Due to overlapping clinical and radiological features, the differentiation between osteomyelitis and bone tumor can be challenging. A 48-year-old lady presented with intermittent left foot pain for a few months. Plain radiographs showed an osteolytic lesion affecting the proximal diaphysis of the left fourth metatarsal bone, with thinning and irregularities of the cortex and focal periosteal reaction.

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Jun
2016

We present a rare case of interposition of the flexor hallucis longus (FHL) tendon blocking percutaneous closed reduction of a displaced tongue-type calcaneal fracture, and necessitating open repositioning of the tendon and internal fixation through a single extensile lateral approach. Although not recognized until during surgery, with a high index of suspicion, preoperative diagnosis of this injury combination should be possible on high resolution CT, thus enabling better planning of the procedure. The presence of a small sustentacular fragment, especially if markedly displaced or rotated, should further alert the physician as to increased likelihood of such tendon entrapment within the fracture.

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Apr
2016

Sinus tarsi syndrome is a pain in the lateral side of the hind foot that is responsive to injection of local anesthetic agents. We report a case of a 42-year-old man who presented with pain over the lateral aspect of the right foot. Laboratory investigations and x-ray were normal.

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Jun
2016

The position of the lateral sesamoid on standard dorso-plantar weight bearing radiographs, with respect to the lateral cortex of the first metatarsal, has been shown to correlate well with the degree of the hallux valgus angle. This study aimed to assess the inter- and intra-observer error of this new classification system.
Five orthopaedic consultants and five trainee orthopaedic surgeons were recruited to assess and document the degree of displacement of the lateral sesamoid on 144 weight-bearing dorso-plantar radiographs on two separate occasions.

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Mar
2016

A 63-year-old woman initially presented with progressive left foot pain for 3 months, not responding to conservative management. MRI of the left foot showed a suspicious lesion in calcaneus. An open biopsy was consistent with metastatic lung adenocarcinoma.

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Nov
2015

The aim of this study is to determine whether surgery offers protection against early subtalar arthrodesis in displaced intraarticular calcaneal fractures. Systematic review and meta-analysis: searches of electronic databases 1980 to August 2014, checking of reference lists, hand searching of journals, and contact with experts. Randomized controlled trials (RCTs) in which surgical treatment was compared with nonsurgical treatment of displaced intra-articular calcaneal fractures from 1980 to 2014.

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Dec
2015

This study assesses the outcomes of surgical vs. conservative management in the treatment of the Jones fracture.
A systematic review using four databases from their inception until September 2014 was undertaken.

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Dec
2015

Talar head fractures are uncommon. This rarity contributes to the lack of structure and clarity in its management. The purpose of this systematic review is to analyse the published literature on management of these injuries and suggest a treatment plan that was followed in our case.

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Dec
1969

Therapeutic use of high-amplitude pressure waves, or shock wave therapy (SWT), is emerging as a popular method for treating musculoskeletal disorders. However, the mechanism(s) through which this technique promotes healing are unclear. Finite element models of a shock wave source and the foot were constructed to gain a better understanding of the mechanical stimuli that SWT produces in the context of plantar fasciitis treatment.

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Jan
2016

Bone is the third most common site of metastasis from hepatocellular carcinoma (HCC), the first two being the lung and lymph nodes, respectively. Metastatic HCC has been reported in the vertebrae, ribs, pelvis, and femur, which are more common sites of bone metastases. We present a case of HCC with metastasis to the distal tibia, fibula, and small bones of the feet as the only sites of bone metastasis, along with a brief literature review.

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Jun
2016

The fifth metatarsal is a common site for both acute and stress fractures in the foot. They are usually isolated low-energy or stress fractures. Vitamin D deficiency has been associated with fragility fractures in many parts of the body.

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Dec
2015

Giant cell tumour (GCT) of the small bones is relatively uncommon tumour. It occurs most commonly in the distal portions of femur and radius and proximal end of tibia. GCT of small bones presents at advanced stages with major bony destruction.

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Dec
2015

The purpose of this study was to evaluate the clinical outcome of a two staged approach of subtalar arthrodesis followed by TAR for patients with ankle arthritis and AVN talus.
Out of total 210 TARs performed at our institute; 7 patients underwent a two staged procedure between 2006 and 2010. All patients had over 3 years of follow up (except one).

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Jun
2016

Soft tissue approach to hallux valgus deformity correction has not been popular due to concerns of its effectiveness. Osteodesis procedure is a soft tissue technique that has been reported with favorable results, especially its long term deformity recurrence rate was very low. Recurrence complication after Lapidus procedure has seldom been reported and its remedial surgery not much discussed yet.

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Dec
2015

The fifth metatarsal Jones fracture is a unique injury. Previous studies have identified possible biomechanical risk factors related to this fracture, as well as potential subsequent effects on bone healing complications. The purpose of this retrospective study was to determine the effect of metatarsus adductus (MAA) on bone healing in patients following intramedullary screw fixation of the Jones fracture.

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Nov
2015

Spina bifida is associated with foot deformities, which may lead to foot ulcers, osteomyelitis, and limb amputation. Calcanectomy and Symes amputations have been reported successful in spina bifida. There is lack of evidence for transtibial amputations.

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Nov
2015

Pseudodystrophy is a rare condition clinically resembling reflex sympathetic dystrophy. Distinction between both disorders is based on clinical features and bone scintigraphy. We report a case of 12-year-old girl presented with pain, swelling, and functional impairment of left foot after minor trauma.

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Sep
2015

Twenty-five displaced intra-articular calcaneal fractures in 21 patients, aged 15-55 years were included in this study. Sanders' type I fractures, severe crushing or partial amputation, were excluded from the study. Patients were divided into group 1 (open fractures treated by MIS), and group 2 (closed fractures treated by ORIF).

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Sep
2015

Congenital lower limb shortening is a group of relatively rare, heterogeneous disorders. Proximal focal femoral deficiency (PFFD) and fibular hemimelia (FH) are the most common pathologic entities in this disease spectrum. PFFD is characterized by variable degrees of shortening or absence of the femoral head, with associated dysplasia of the acetabulum and femoral shaft.

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Sep
2015

To evaluate functional and radiological results of internal fixation of displaced talar neck fractures.
Twenty patients with displaced talar neck fractures who underwent surgery and fixation by cancellous screws were evaluated. Patients were evaluated by American Orthopedic Foot and Ankle Society score which is based on pain (40 points), function (50 points) and alignment (10 points) with excellent (90-100 points), good (75-89 points), fair (60-74 points) and poor scores (<60 points) and radiographically for assessment of union, osteonecrosis and osteoarthritic changes in the subtalar and ankle joint.

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Jun
2015

A rare case of bilateral calcaneal stress fractures in a patient with Diamond-Blackfan anaemia is described. This has not been previously reported in the literature. A calcaneal stress fracture is an important differential diagnosis in a patient presenting with heel pain.

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Jun
2015

Presented is a rare case of tibial and fibular osteomyelitis and a case of fibular periositis, both a direct consequence of a peculiar drug use technique. The osseous manifestations secondary to presentation of necrotic wounds with indurated rim and serous drainage with associated cellulitis, both resulting from "skin popping." Due to the complex treatment plan required, the importance of a motivated patient, a strong social support system, a controlled environment, and a multidisciplinary team cannot be overstated.

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Jun
2015

Benign tumors of the talus are rare, and their management is controversial. Recent efforts have extended the safety margin of intralesional excision and curettage by chemical and physical means. Cryotherapy as adjuvant therapy is associated with risks of local wound and bony complications (delayed healing, potential for pathological fractures).

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Jun
2015

The talus, the second largest tarsal bone, has distinctive imaging characteristics and injury patterns. The predominantly extraosseous vascular supply of the talus predisposes it to significant injury in the setting of trauma. In addition, the lack of muscular attachments and absence of a secondary blood supply can lead to subsequent osteonecrosis.

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