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Foot and Ankle Clinics

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https://read.qxmd.com/read/30685017/management-of-avascular-necrosis-in-the-foot-and-ankle
#1
EDITORIAL
Kenneth J Hunt
No abstract text is available yet for this article.
March 2019: Foot and Ankle Clinics
https://read.qxmd.com/read/30685016/management-of-m%C3%A3-ller-weiss-disease
#2
REVIEW
Manuel Monteagudo, Ernesto Maceira
Müller-Weiss disease (MWD) is a dysplasia of the tarsal navicular. The shifting of the talar head laterally over the calcaneus drives the subtalar joint into varus. Failure to identify patients with paradoxic flatfoot varus may lead to the incorrect diagnosis and management. Conservative treatment with the use of rigid insoles with medial arch support and a lateral heel wedge is effective in most patients. Dwyer calcaneal osteotomy combined with lateral displacement seems to be a satisfactory treatment for patients who had failed to respond to conservative measures and a good alternative to the different types of perinavicular fusions...
March 2019: Foot and Ankle Clinics
https://read.qxmd.com/read/30685015/k%C3%A3-hler-disease-avascular-necrosis-in-the-child
#3
REVIEW
Jeremy Y Chan, Jeffrey L Young
Köhler disease is a childhood condition of pain and swelling of the medial midfoot with associated osteochondrosis or avascular necrosis of the tarsal navicular. The age at presentation is between 2 and 10 years, with boys more likely to be affected than girls. Radiographs show increased sclerosis and sometimes flattening and fragmentation of the navicular. Long-term outcomes for Köhler disease are favorable regardless of the type of treatment, although a short period of immobilization with a short leg walking cast may reduce the duration of symptoms...
March 2019: Foot and Ankle Clinics
https://read.qxmd.com/read/30685014/freiberg-disease-and-avascular-necrosis-of-the-metatarsal-heads
#4
REVIEW
Andrew Wax, Robert Leland
Freiberg disease is characterized as osteochondrosis of the second metatarsal head. It is the fourth most common form of primary osteochondrosis with a significant predilection to the adolescent athletic female population, although it has been seen over a wide age range. If treated early, osteochondroses such as Freiberg disease are essentially self-limiting, often resolving with nonoperative management. When surgery is warranted, it is imperative the patient's age, activity level, and degree of articular deformity be taken into account...
March 2019: Foot and Ankle Clinics
https://read.qxmd.com/read/30685013/avascular-necrosis-of-the-sesamoids
#5
REVIEW
Kimberly Bartosiak, Jeremy J McCormick
Avascular necrosis (AVN) of the sesamoid is pathology of the medial or lateral hallucal sesamoid resulting in pain under the first metatarsophalangeal joint often presenting in young female athletes. There is overlap of stress fracture, nonunion, and AVN that makes defining the diagnosis difficult but the treatment and outcomes are similar. The most reliable operative treatment used for AVN of the sesamoid is an accumulation of anatomic and mechanical factors with repetitive microtrauma. Nonoperative modalities are designed to offload the sesamoid...
March 2019: Foot and Ankle Clinics
https://read.qxmd.com/read/30685012/prevention-of-avascular-necrosis-with-fractures-of-the-talar-neck
#6
REVIEW
Michael P Clare, Patrick J Maloney
Displaced talar neck fractures no longer constitute a surgical emergency; timing of definitive surgery has no bearing on the risk of osteonecrosis. Amount of initial fracture displacement is best predictor of osteonecrosis. Grossly displaced fractures or fracture-dislocations should be provisionally reduced, with or without temporary external fixation. Periosteal stripping should be limited to only that necessary to obtain anatomic reduction. Dissection within the sinus tarsi or tarsal canal should be avoided...
March 2019: Foot and Ankle Clinics
https://read.qxmd.com/read/30685011/natural-history-of-avascular-necrosis-in-the-talus-when-to-operate
#7
REVIEW
Andrew Haskell
Avascular necrosis (AVN) of the talus bone is a progressive and debilitating consequence of trauma or exposure to a variety of risk factors. The Ficat classification describes current understanding of the natural history of AVN, including preclinical, preradiographic, precollapse, postcollapse, and arthritic stages. The size and location of the avascular region likely determines risk of progression; however, symptoms do not correlate with stage. Patients may be minimally symptomatic despite diffuse involvement for long periods...
March 2019: Foot and Ankle Clinics
https://read.qxmd.com/read/30685010/imaging-features-of-avascular-necrosis-of-the-foot-and-ankle
#8
REVIEW
Spencer Couturier, Garry Gold
Avascular necrosis of the foot and ankle is a rare but important cause of pain and functional abnormality. This process may occur in any bone in the foot and ankle; however, it presents most often in characteristic locations. Understanding of key radiographic findings is important in management of these lesions. MRI is the most sensitive and specific method for detection and characterization of this abnormality.
March 2019: Foot and Ankle Clinics
https://read.qxmd.com/read/30685009/an-alumina-ceramic-total-talar-prosthesis-for-avascular-necrosis-of-the-talus
#9
REVIEW
Akira Taniguchi, Yasuhito Tanaka
Avascular necrosis tends to occur in the talus because of poor blood supply caused by the extended coverage to the articular cartilage on its surface. Treatment is conservative in the earlier stage of this disease; however, surgical treatment is usually indicated in the advanced stage. Nonunion, leg length discrepancy, or hindfoot instability may occur in patients treated with ankle or tibio-talo-calcaneal fusion. Arthroplasty using a customized total talar prosthesis designed using the computed tomography image of contralateral talus has the potential advantages of weightbearing in the earlier postoperative phase, prevention of lower extremity discrepancy, and maintenance of joint function...
March 2019: Foot and Ankle Clinics
https://read.qxmd.com/read/30685008/tibiotalocalcaneal-arthrodesis-for-severe-talar-avascular-necrosis
#10
REVIEW
James R Lachman, Samuel B Adams
Severe talar avascular necrosis has many etiologies and can cause bone loss/hindfoot deformity. Tibiotalar calcaneal arthrodesis is a salvage procedure after severe talar avascular necrosis. Large bone voids can present significant challenges. Modest successes have been reported with structural block allograft tibiotalocalcaneal arthrodesis using either plate and screws, intramedullary nail fixation, or a combination. The advent of 3-dimensional printed titanium trusses has given surgeons another option for filling voids and providing structural support to prevent collapse...
March 2019: Foot and Ankle Clinics
https://read.qxmd.com/read/30685007/ankle-arthrodesis-for-talar-avascular-necrosis-and-arthrodesis-nonunion
#11
REVIEW
Jonathon D Backus, Daniel L Ocel
This article reviews the surgical treatment of talar avascular necrosis. Specifically, arthrodesis for this complex entity and potential treatment of nonunions are discussed. The hallmarks of treatment are evolving and can range from nonoperative measures to amputations. Nonoperative treatment and the results of current arthrodesis techniques for late-stage avascular necrosis are reviewed. Surgical correction requires an understanding of the condition's natural history, utilization of structural and nonstructural bone grafting techniques, and stable fixation...
March 2019: Foot and Ankle Clinics
https://read.qxmd.com/read/30685006/vascularized-pedicle-graft-for-talar-osteonecrosis
#12
REVIEW
Elizabeth A Cody, James A Nunley
Vascularized bone grafting for talar avascular osteonecrosis is indicated for patients with modified Ficat and Arlet stage I to III disease with minimal subchondral collapse. Outcomes may be more durable than core decompression alone, especially in patients with more advanced disease. Our preferred method, described in this article, involves core decompression followed by use of a vascularized cuboid pedicle graft placed in the defect. Outcomes reported in a small case series have been encouraging, with more than 80% of patients requiring no further surgery...
March 2019: Foot and Ankle Clinics
https://read.qxmd.com/read/30685005/avascular-necrosis-of-the-tibial-plafond-following-rotational-ankle-fractures
#13
REVIEW
Angela K Heinen, Thomas G Harris
Avascular necrosis (AVN) following rotational ankle fractures is most commonly described in the talus; however, it can also occur in the tibial plafond. These sequelae of ankle fractures are rarely described in the literature. Diagnosis of AVN is best confirmed with MRI of the involved extremity. Treatment options range from conservative treatments such as observation and limited weight-bearing to surgical management including percutaneous drilling, ankle arthrodesis, and total ankle arthroplasty. More research is needed to further identify patients at high risk for developing these sequelae of ankle fractures and to aid in the treatment and surgical decision-making process...
March 2019: Foot and Ankle Clinics
https://read.qxmd.com/read/30685004/core-decompression-and-bone-grafting-for-osteonecrosis-of-the-talus-a-critical-analysis-of-the-current-evidence
#14
REVIEW
Assem A Sultan, Michael A Mont
Several operative treatments have been explored to treat patients with progressive or symptomatic osteonecrosis of the talus, aiming to alleviate pain and restore mobility. Because most affected patients are typically younger and more active individuals, joint preservation techniques have received increasing attention. Core decompression, either through an open or percutaneous drilling approach has been used. Similarly, nonvascularized and vascularized bone grafts have been used in clinical practice with varying results...
March 2019: Foot and Ankle Clinics
https://read.qxmd.com/read/30685003/epidemiology-cause-and-anatomy-of-osteonecrosis-of-the-foot-and-ankle
#15
REVIEW
Daniel K Moon
Osteonecrosis arises throughout the foot and ankle in various forms and due to numerous causes, with a thousand US cases per year estimated for the ankle alone. Although research continues to elucidate specific mechanisms at work, the pathophysiology remains poorly understood. Nevertheless, the various osteonecrosis pathways converge on osteocyte death, and bony lesions follow a pattern of progression. Understanding the specific anatomy and biomechanics associated with common forms of foot and ankle osteonecrosis should help guide diagnosis and interventions, particularly at earlier stages of disease where etiology-specific approaches might become optimal...
March 2019: Foot and Ankle Clinics
https://read.qxmd.com/read/30414663/preface
#16
EDITORIAL
Andrea Veljkovic
No abstract text is available yet for this article.
December 2018: Foot and Ankle Clinics
https://read.qxmd.com/read/30414662/plantar-plate-injury-and-angular-toe-deformity
#17
REVIEW
Craig C Akoh, Phinit Phisitkul
Lesser toe plantar plate injuries at the metatarsophalangeal (MTP) joint are a common source of metatarsalgia. The second MTP joint is the most commonly affected digit. The fibrocartilaginous plantar plate is the most important static stabilizer of the MTP joint; high loading with weight bearing can lead to attritional plantar plate injuries. Chronic pain with weight bearing is the common presentation of lesser toe instability. Untreated plantar plate instability can lead to hammer toe and mallet toe deformities...
December 2018: Foot and Ankle Clinics
https://read.qxmd.com/read/30414661/turf-toe-injury-current-concepts-and-an-updated-review-of-literature
#18
REVIEW
Tim M Clough, Haroon Majeed
Turf toe injuries can be a disabling if not recognized and treated early. A high index of suspicion, based on the mechanism of injury and appropriate imaging, helps in the timely diagnosis. These injuries are frequently known to occur on artificial playing surfaces, because of the increased traction at the shoe-surface interface. Stress and instability testing are key components to assess the need for surgical intervention. Accurate timely diagnosis and treatment can allow full return to physical activities for most athletes, back to their pre-injury level...
December 2018: Foot and Ankle Clinics
https://read.qxmd.com/read/30414660/low-energy-lisfranc-injuries-in-an-athletic-population-a-comprehensive-review-of-the-literature-and-the-role-of-minimally-invasive-techniques-in-their-management
#19
REVIEW
Mario I Escudero, Michael Symes, Andrea Veljkovic, Alastair S E Younger
Tarsometatarsal (TMT) joint complex injuries can be caused by either direct or indirect injuries. The Lisfranc joint represents approximately 0.2% of all fractures. Up to 20% of these injuries are misdiagnosed or missed on initial radiographic assessment; therefore, a high index of suspicion is needed to accurately diagnose TMT joint injuries and avoid the late sequelae of substantial midfoot arthrosis, pain, decreased function, and loss of quality of life. This review discusses the anatomy, diagnosis, and management of athletic Lisfranc injuries, including a description of the preferred minimally invasive surgical techniques used by the senior author of this article...
December 2018: Foot and Ankle Clinics
https://read.qxmd.com/read/30414659/spring-ligament-instability
#20
REVIEW
Gonzalo F Bastias, Miki Dalmau-Pastor, Claudia Astudillo, Manuel J Pellegrini
The crucial role of the spring ligament complex within the pathologic process that leads to flatfoot deformity has evolved recently. There has been improvement in the anatomic knowledge of the spring ligament and understanding of its complex relationship to the deltoid complex and outstanding advances in biomechanics concepts related to the spring ligament. Optimization of flatfoot treatment strategies are focused on a renewed interest in the spring ligament and medial soft tissue reconstruction in concert with bony correction to obtain an adequate reduction of the talonavicular deformity and restoration of the medial longitudinal arch...
December 2018: Foot and Ankle Clinics
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