Foot & ankle international
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Comparative Study
Stabilization of Lisfranc joint injuries: a biomechanical study.
Lisfranc joint injuries are often misdiagnosed, leading to significant morbidity. Methods for anatomic reduction of the tarsometatarsal joint include closed reduction with casting or surgical stabilization with either Kirschner wires and/or cortical screw fixation. Controversy exists as to which fixation technique offers optimal stability. In the present study, the biomechanical stability of three fixation methods was tested: (1) four Kirschner wires, (2) three cortical screws plus two Kirschner wires, and (3) five cortical screws. ⋯ Cortical screw fixation provides a more rigid and stable method of fixation for Lisfranc injuries as compared to Kirschner wire fixation. This fixation method allows maintenance of anatomic reduction and possibly earlier mobilization with a decreased risk of posttraumatic arthrosis.
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Plantar fasciitis is a relatively common disorder of the foot, yet little is known about its prevalence, what types of physicians see patients with the disorder, or how, on a national scale, patients are typically managed. The purpose of this study was to generate national estimates of the volume of patient visits and characteristics of care given to patients diagnosed with plantar fasciitis by medical doctors. ⋯ This research suggests that plantar fasciitis is a relatively common disorder that is seen by several physician specialties. The disorder is not managed in a consistent way. Rather, there appears to be a large amount of variation in the way that these patients are managed. These findings support the argument that additional research is needed to identify effective interventions for plantar fasciitis and to determine if physician specialty influences treatment outcome.
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Comparative Study
Associated deformities and hypermobility in hallux valgus: an investigation with weightbearing radiographs.
Hallux valgus has been reported to recur after surgical correction in patients subsequently diagnosed with hypermobility of the first ray, pronation of the foot, and pes planovalgus. An objective means of assessing the foot for these deformities preoperatively may avert a poor outcome. This investigation evaluated the efficacy of full-length weightbearing radiographs to recognize associated deformities in patients with hallux valgus before surgery. ⋯ Weightbearing radiographs permit the recognition of associated malalignments of the foot in patients with hallux valgus. The comparisons performed in this study identified deformities consistent with pes planovalgus and hypermobility of the first ray in patients with moderate to severe hallux valgus. The results of our study support a recommendation for a thorough evaluation of full-length, biplanar weightbearing radiographs via the measurement of midfoot and first ray alignment for concomitant deformities of the foot in patients with hallux valgus.
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The main principle for treatment of ankle fractures is anatomic reduction until bony union is achieved. Old fractures of the ankle with residual diastasis, however, may cause persistent pain, joint effusion, and range-of-motion limitation, and make eventual ankle arthrodesis inevitable. Restoration of the integrity of the ankle mortise is the determining factor for successful repair of this type of ankle fracture. ⋯ At follow-up, which averaged 34 months, greatly improved ambulation and level of joint function was noted for all patients, and follow-up x-ray confirmed good ankle mortise geometry. The short-term results for these patients were good, with further follow-up planned to determine efficacy long term. In conclusion, reconstructive corrective-elongation osteotomy is a worthwhile procedure for old ankle fracture with malunion, and it can also postpone degenerative change in the ankle joint.
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Numerous studies have addressed biomechanical characteristics of circular external fixation of long bones. The objective of the present study was to evaluate stabilization of a simulated foot model using external fixation with either calcaneal tensioned stopper wires or half-pins. ⋯ The results of the present mechanical testing can be utilized as a useful guideline for the optimization of circular external fixation of the foot.