Ankle

BACKGROUND: Osteochondral defects of the talus (OCD) are a well-established pathology within the ankle. They are most commonly associated with ankle trauma and whilst many are asymptomatic, they can have a significant negative impact on the patient, most notably with regards pain and mobility. Treatment of these lesions remains variable across the diverse cohort of these patients. AIMS: Evaluating the incidence of talus OCDs. Evaluating anatomic and morphologic data of the lesions against previous studies...

INTRODUCTION AND AIMS: COVID-19 has had a significant impact on orthopaedic surgery globally. This paper aims to evaluate the impact of COVID-19 on foot and ankle trauma in a major trauma centre. METHODS: A retrospective observational study of prospectively collected data was performed. All foot and ankle trauma patients over a 33 week period (1st December 2019-16th July 2020) were analysed. All patients with trauma classified by the AO/OTA as occurring at locations 43 and 81-88 were included...

BACKGROUND: Ankle fractures are a common orthopedic injury that frequently involves associated cartilage lesions, soft tissue damage, and a significant inflammatory burden. Despite studies revealing intra-articular pathology in up to 79% of ankle fractures, only 1% of open reduction and internal fixation (ORIF) procedures undergo arthroscopic evaluation. The primary purpose of this study was to determine the cost effectiveness of ankle arthroscopy performed at time of ORIF for ankle fracture...

OBJECTIVE: The C-sign on lateral radiographs has been subject to considerable debate with respect to its reliable association to subtalar joint tarsal coalition. The purpose of this study was to determine to what degree subtalar joint pronation factors into (a) the appearance of both complete and incomplete type A C-signs and (b) the conspicuity of the middle facet in both flatfeet and rectus feet. STUDY DESIGN: Forty-seven normal adult volunteers were enrolled into the study with a total of 92 feet, of which 42 were flexible flatfeet and 50 were rectus feet with normal subtalar joint range of motion...

This study was aimed at generating and investigating the efficacy of a novel monoclonal bispecific antibody (BsAb) for the combined inhibition of tumor necrosis factor-α (TNF-α) and CXCL10 as a treatment option for rheumatoid arthritis (RA). A novel BsAb targeting TNF-α and CXCL10 was generated by conjugating a single-chain variable fragment (scFv) of the anti-CXCL10 monoclonal antibody to the Fc region of adalimumab (ADA). The effects of the BsAb on the inflammatory response in the in vitro and in vivo development of arthritis and joint destruction were evaluated in human TNF transgenic (hTNF-Tg) mice, and K/BxN serum transfer arthritis models...

'Flexibility' tests are traditionally performed voluntarily-relaxed by rotating a joint slowly, however functional activities are performed rapidly with voluntary/reflexive muscle activity. Here we describe the reliabilities and differences in maximum ankle range of motion (ROMmax ) and plantar flexor mechanical properties at several velocities and levels of voluntary force from a new test protocol on a commercially available dynamometer. Fifteen participants had their ankle joint dorsiflexed at 5, 30, and 60°...

Patients with diabetic peripheral neuropathy (DPN) usually have reduced somatosensory information and altered perception in feet and ankles. Somatosensory information acts as feedback for movement control and loss of somatosensation leads to altered plantar pressure patterns during gait and stance. Offloading devices are used to reduce peak plantar pressure and prevent diabetic foot ulcers. However, offloading devices can unfortunately have negative effects on static and dynamic balance. It is important to investigate these unwanted effects, since patient with DPN already are at high risk of falling and offloading devices could potentially increase this risk...

This study was performed to propose a method, the Feature Ambiguity Mitigate Operator (FAMO) model, to mitigate feature ambiguity in bone fracture detection on radiographs of various body parts. A total of 9040 radiographic studies were extracted. These images were classified into several body part types including 1651 hand, 1302 wrist, 406 elbow, 696 shoulder, 1580 pelvic, 948 knee, 1180 ankle, and 1277 foot images. Instance segmentation was annotated by radiologists. The ResNext-101+FPN was employed as the baseline network structure and the FAMO model for processing...

BACKGROUND: Peripheral regional anesthesia and analgesia may increase the efficiency of ambulatory surgical centers by reducing pain and preventing nausea and vomiting, which are important modifiable causes of prolonged postanesthesia care unit (PACU) length of stay. We hypothesized that the use of peripheral nerve blocks (PNB) was associated with shorter PACU length of stay in ambulatory surgery. METHODS: In this retrospective cohort study, we analyzed data from adult ambulatory surgical cases, in which PNB was a viable anesthetic option (ie, was routinely performed for these procedures), at an academic medical center between 2008 and 2018...

INTRODUCTION: This meta-analysis aimed to review complication rates following the treatment of an ankle fracture in diabetic patients and to early detect the subgroup of patients at potential risk in order to minimise this complication rate. METHODS: A search of 3 databases was performed for studies published till March 2018. Twelve studies met the eligibility criteria for further statistical analysis. An odds ratio (OR) with a 95% confidence interval (95% CI) for each complication was calculated between the diabetic and non-diabetic groups...

BACKGROUND: There is increasing interest in augmentation of modified Broström repairs for lateral ankle instability with a prosthetic reconstruction using suture tape internal bracing. The aim of this study was to investigate if suture tape augmentation resulted in improved clinical and radiological outcomes compared to a standard modified Broström repair alone. METHODS: A systematic review following PRISMA guidelines was undertaken. All clinical studies published in Medline, Embase, Pubmed and the Cochrane Library Database from inception until January 2020 reporting on the use of suture tape augmentation to a modified Broström repair for lateral ankle instability...

BACKGROUND: The internet is an important source of information for patients undergoing surgery. Multiple studies have identified inappropriately high reading levels of patient information online. The average reading level in the United States is 7-8th grade. Multiple organisations have recommended that patient information not exceed 6th grade level. This study aims to evaluate the reading levels and quality of information regarding ankle fusion surgery online. METHODS: Google, Bing and Yahoo were searched (MeSH "ankle fusion", "ankle arthrodesis") and the top 30 URLs analysed...

BACKGROUND: Peroneal tendon lesions can cause debilitating pain, but operative treatment remains controversial. Some studies recommend peroneal tenodesis or transfer if more than half of the tendon is affected. However, clinical outcomes and inversion/eversion motion after peroneal transfer have not been investigated yet. METHODS: Patients who underwent distal peroneus longus to brevis transfer for major peroneus brevis tendon tears with a minimum follow-up of 2 years were included...

BACKGROUND: The prevalence of hallux valgus increases with age. However, no studies have compared the effectiveness of surgical correction among different age groups. This study investigated the influence of age on clinical and radiological outcomes following hallux valgus surgery. METHODS: Patients who underwent correction for hallux valgus at an academic hospital were stratified into 3 age groups: younger (<50 years), middle-aged (50-59 years), and older (≥60 years)...

BACKGROUND: Total ankle arthroplasty (TAA) is successful by both subjective patient-reported outcome measures (PROMs) and objective functional improvements of gait. Each is reproducible and valid, but they are entirely distinct methods. This study investigated the correlation between subjective and objective outcomes of TAA. METHODS: Seventy patients underwent gait analysis preoperatively and 1 year after TAA. The 36-Item Short-Form Health Survey (SF-36) and visual analog score (VAS) for pain and American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scores were recorded at each interval...

BACKGROUND: Earlier randomized controlled trials (RCTs) reported only midterm (3-4 months) results of extracorporeal shockwave therapy (ESWT) as a treatment for noninsertional Achilles tendinopathy (NAT). This study compared the effectiveness of an eccentric loading program followed by stretching exercises combined with ESWT (study group) or sham ESWT (control group) for treating chronic NAT in both the short and long term. METHODS: This double-blind RCT was conducted between 2018 and 2020...

The purpose of the present study was to examine the effect of chronic ankle instability (CAI) on lower-extremity joint coordination and stiffness during landing. A total of 21 female participants with CAI and 21 pair-matched healthy controls participated in the study. Lower-extremity joint kinematics were collected using a 7-camera motion capture system, and ground reaction forces were collected using 2 force plates during drop landings. Coupling angles were computed based on the vector coding method to assess joint coordination...

BACKGROUND: While ankle muscles, highly affected by aging, are highly implicated in the changes in gait kinematics and involved in the limitation of seniors' mobility, whether neuromuscular electrical stimulation (NMES) training of these muscles could impact gait kinematics in older adults has not been investigated yet. RESEARCH QUESTION: What are the effects of 12 weeks of ankle plantar and dorsiflexors NMES training on strength and gait kinematics in healthy older adults? METHODS: Fourteen older adults (73...

BACKGROUND: Few studies have reported the outcomes following minimally invasive medial displacement calcaneal osteotomy (MDCO) for correction of pes planovalgus deformities. METHODS: Charts were retrospectively reviewed for consecutive patients who underwent minimally invasive MDCO procedures by a single surgeon from 2013 to 2019 with more than 3 months of follow-up. A total of 160 consecutive patients who underwent 189 minimally invasive MDCO procedures were included in the study...

CASE: A 47-year-old woman with adamantinoma of the entire left tibia and distal fibula underwent resection and reconstruction using a total tibia allograft-prosthetic composite with rotating hinged knee replacement and ankle fusion. She is ambulating without tumor recurrence with 2-year follow-up. CONCLUSION: This case report offers a unique reconstruction option for extensive tibia bone primary malignancy. To our knowledge, this is the longest survival for total tibia allograft prosthetic composite reconstruction...