The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
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A 14-year-old female presented with a painful right ankle that had been worsening over the preceding 2 years. Clinical and radiographic inspection revealed marked bowing with a pathologic fracture of the fibula secondary to the laterally outgrowing bone lesion from the distal tibia proximal to the growth plate. Computerized tomography revealed a 2.44 x 4.48-cm bone tumor proximal to the ankle joint, and this was consistent with her complaint of pain and the observed malposition of the distal leg and ankle. ⋯ In this particular case, excessive bony outgrowth, pain, joint malposition, and pathologic fracture necessitated surgical intervention. The patient was successfully treated with resection of the tumor, after which gradual restoration of the alignment of the distal leg ensued without the need for fibular osteotomy. After more than 3 years of postoperative follow-up, neither radiographic nor clinical evidence of recurrence had been observed and the patient displayed a pain-free range of ankle motion without any physical limitations.
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The radiographic outcomes of 28 feet in 20 pediatric patients with pes planovalgus treated with subtalar arthroereisis, arthroereisis combined with gastrocnemius recession, or arthroereisis combined with gastrocnemius recession and medial column reconstruction were retrospectively analyzed. Preoperative and postoperative radiographic angles for talar declination, calcaneal inclination, and first metatarsal declination in the lateral view, and the angle formed between the longitudinal axis of the talus and the longitudinal axis of the lesser tarsus in the anteroposterior view were compared. Overall, analyses revealed statistically significant differences in the preoperative and postoperative radiographic angles for the 4 measured angles. Analysis by treatment group revealed statistically significant differences in correction of the angle measured in the anteroposterior view. Arthroereisis with gastrocnemius recession showed the greatest correction of this angle (median 19 degrees, range 11 degrees to 34 degrees) compared with the other treatment groups. There were no statistically significant differences in the degree of correction of the calcaneal inclination or talar declination angles, whereas a statistically significant difference in the correction of first metatarsal declination was observed. The greatest degree of angular change was achieved with medial column reconstruction (median 7 degrees, range 0 degrees to 9 degrees). Gastrocnemius recession displayed a notable effect on the correction of transverse plane deformity when used as an adjunct to arthroereisis. However, medial column reconstruction has a negative impact on the degree of correction in the transverse plane when it is used as an adjunct to arthroereisis and gastrocnemius recession. ⋯ 4.
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Dislocation of the ankle joint without a concomitant malleolar fracture is rare. With all reported cases to date being unilateral injuries, we present the case of a 28-year-old male who sustained bilateral ankle dislocations without associated ankle fractures following a road traffic accident. Ten months after the trauma, the patient had returned to work with minimal sequelae related to the injury. To our knowledge, this is the first case of its kind to be reported. ⋯ 4.
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Case Reports
Spontaneous rupture of the anterior tibial tendon in a diabetic patient: results of operative treatment.
Spontaneous rupture of the tibialis anterior tendon is infrequently seen as a clinical entity. In this report, we describe the case of a diabetic neuropathic patient that underwent successful surgical repair of a spontaneously ruptured tibialis anterior tendon with no other factors that would render the tendon susceptible to injury or rupture. ⋯ 4.