The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
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The aim of this study was to compile specific foot injuries occurring in pediatric patients that result from equestrian sports and to highlight the importance of wearing adequate riding boots to protect the feet. During a 12-year period, 258 children were admitted to Children's Hospital of Geneva for injuries resulting from horseback riding. Amongst these children, 8 sustained foot lesions that required hospital admission. ⋯ Serious foot injuries may occur in children during equestrian activities. These lesions may be very disabling. Therefore, it is important for doctors, instructors, and parents to promote the use of appropriate safety equipment, including strengthened riding boots and safety stirrups.
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Pure frontal plane rotatory dislocation of the ankle joint without an associated fracture is an extremely rare injury. We report one such case of an eversion rotatory dislocation and one case of an inversion rotatory dislocation. ⋯ In the patient with lateral rotatory dislocation, medial malleolar hypoplasia was also a contributing factor. Both patients healed the presenting index injury with nonoperative treatment, whereas the lateral rotatory dislocation had a lateral ankle stabilization to prevent subsequent injury.
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Ten patients (11 feet) with severe, high-velocity, open injuries to the midfoot were treated with uniplanar external fixation. The mean patient age was 38 years. Five wounds measured >10 cm, and 3 had extensive degloving of the foot extending into the lower leg. ⋯ All demonstrated stiffness at the midfoot and restriction of subtalar and forefoot motion, with 5 also having restricted ankle motion. Radiographically, all fractures were healed at the time of follow-up; 4 were malunited, with 1 demonstrating ankylosis across the tarsometatarsal joint. These results suggest that crush injuries to the midfoot often result in persistent morbidity despite early comprehensive management with external fixation.
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Randomized Controlled Trial Multicenter Study
Extracorporeal shockwave therapy versus placebo for the treatment of chronic proximal plantar fasciitis: results of a randomized, placebo-controlled, double-blinded, multicenter intervention trial.
Extracorporeal shockwave therapy (ESWT) has demonstrated efficacy in the treatment of recalcitrant proximal plantar fasciitis. The objective of this investigation was to compare the outcomes of participants treated with a new ESWT device with those treated with placebo. A total of 172 volunteer participants were randomized in a 2:1 active-to-placebo ratio in this prospective, double-blind, multicenter trial conducted between October 2003 and December 2004. ⋯ On the visual analog scale, the participant's self-assessment of heel pain displayed a mean reduction of 3.39 in the shockwave group and 1.78 in the placebo group; this difference was statistically significant (P<.001). No serious adverse events were observed at any time. It was concluded that ESWT was both efficacious and safe for participants with chronic proximal plantar fasciitis that had been unresponsive to exhaustive conservative treatment.
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This retrospective radiographic study sought to evaluate how primary fracture line location relates to the pattern and severity of intraarticular calcaneal fractures. Preoperative lateral radiographs and semicoronal computed tomography scans of 100 displaced intraarticular calcaneal fractures (89 patients) were evaluated for Bohler's angle, Sanders classification, and calcaneocuboid, anterior, or middle subtalar articular involvement. Primary fracture line location was measured on semicoronal computed tomography views as a ratio of the width of the posterior facet. ⋯ Forty-eight percent of the fractures involved the calcaneocuboid joint; 39% involved the anterior (n=28) or middle (n=11) subtalar facets, or both. A medial primary fracture line correlated to greater involvement of the calcaneocuboid joint (r=.247; P=.015) and the anterior (r=.241; P<.001) and middle (r=.344; P=.003) facets. These results suggest that intraarticular calcaneal fractures exhibiting a medial primary fracture line are associated with a more severe fracture pattern and an increased incidence of anterior articular extension.