Foot & ankle international
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Randomized Controlled Trial
Comparison of radial versus focused extracorporeal shock waves in plantar fasciitis using functional measures.
Recent literature shows evidence for effective treatment for plantar fasciitis using either focused or radial shock waves. Up to now no research has been available which compares these different procedures. We hypothesized (H(0) Hypothesis) that for plantar fasciitis, outcomes following focused or radial shock wave treatment were equal. ⋯ This study provides some evidence for focused extracorporeal shock wave treatment being superior to radial extracorporeal shock wave therapy for recalcitrant plantar fasciitis.
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Comparative Study
Comparison of free muscle and perforator skin flaps for soft tissue reconstruction of the foot and ankle.
Free tissue transfer is generally required for reconstruction of soft-tissue defects of the foot and ankle region because of the limited local tissue available. This type of reconstruction may interfere with postoperative function and footwear if a bulky flap is used. ⋯ Free ALT flap consisting of skin and adaptable subcutaneous tissue, both diminishes donor site morbidity and is ideally suited for most soft-tissue reconstruction of the dorsal foot, heel and plantar foot. Free muscle flaps, however, may offer relatively less complicated tissue transfers and are preferred at the ankle region in the presence of open tibia fractures, and in high risk patients to decrease the perioperative morbidity.
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Severe post-traumatic ankle arthritis poses a reconstructive challenge in the young and active patient. Bipolar fresh osteochondral allograft (BFOA) may represent an intriguing alternative to arthrodesis and prosthetic replacement. The aim of this study was to describe a lateral trans-malleolar technique for BFOA, and to evaluate the results in a case series. ⋯ The use of BFOA represents an intriguing alternative to arthrodesis or arthroplasty. We believe precise allograft sizing, stable fitting and fixation and delayed weightbearing were key factors for a successful outcome. Further research regarding the immunological behavior of transplanted cartilage is needed.
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The treatment of ankle fractures with syndesmotic injuries associated with disruption of the deltoid ligament complex is controversial. The purpose of this study was to compare both the biomechanical and physiologic properties of suture-button fixation to the intact syndesmosis and screw fixation. ⋯ Syndesmotic injury fixation has traditionally used screws to provide a rigid construct in which healing can take place. We believe a less rigid fixation method, such as suture-button fixation, provides a more physiologic type of healing of the syndesmosis.
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Comparative Study
Sciatic nerve blockade: a survey of orthopaedic foot and ankle specialists in North America and the United Kingdom.
Sciatic nerve blocks are used to reduce post-operative pain and allow early discharge for patients undergoing foot and ankle surgery. This study aimed to identify the utilization of this procedure in the US and UK and to establish the standard of care with respect to the level of anesthesia that the patient is under and use of ultrasound localization when performing sciatic nerve blocks. ⋯ This study represents a current practice review of sciatic nerve blocks performed amongst senior foot and ankle surgeons. Although no absolute consensus has been reached as to the use of ultrasound or whether the patient needs to be awake for the procedure, it is clear that the standard of care does not mandate either of these. The differences between US and UK practice are probably cultural and do not appear to affect the number of complications encountered.