Showing papers in "Foot and Ankle Clinics of North America in 2005"
TL;DR: The Achilles tendon is the strongest tendon in the human body and there has been a general increase in popularity of sporting activities, but the number and incidence of the Achilles tendon overuse injuries and complete, spontaneous ruptures has increased in the industrialized countries during the last decades.
Abstract: The Achilles tendon is the strongest tendon in the human body. Because most Achilles tendon injuries take place in sports and there has been a general increase in popularity of sporting activities, the number and incidence of the Achilles tendon overuse injuries and complete, spontaneous ruptures has increased in the industrialized countries during the last decades. The most common clinical diagnosis of Achilles overuse injuries is tendinopathy. The basic etiology of the Achilles tendinopathy is known to be multi-factorial. Although histopathologic studies have shown that ruptured Achilles tendons have clear degenerative changes before the rupture, many Achilles tendon ruptures take place suddenly without any preceding signs or symptoms.
477 citations
TL;DR: The Achilles tendon is the strongest and largest tendon in the body, and is the conjoined tendon of the gastrocnemius and the soleus muscles, and may have a small contribution from the plantaris.
Abstract: The Achilles tendon is the strongest and largest tendon in the body. It is the conjoined tendon of the gastrocnemius and the soleus muscles, and may have a small contribution from the plantaris. The muscles and the Achilles tendon are in the posterior, superficial compartment of the calf. Through the Achilles tendon, they are the main plantar flexors of the ankle. The Achilles tendon is subjected to the highest loads in the body, with tensile loads up to ten times body weight during running, jumping, hopping, and skipping. This article discusses the anatomy of the Achilles tendon.
153 citations
TL;DR: Electric and electromagnetic fields regulate extra-cellular matrix synthesis and stimulate repair of fractures and nonunions and increase bone formation in models of endochondral ossification, which results in an increase in cartilage and bone.
Abstract: Electric and electromagnetic fields regulate extra-cellular matrix synthesis and stimulate repair of fractures and nonunions. Studies of electric and electromagnetic fields suggest they (1) regulate proteoglycan and collagen synthesis and increase bone formation in models of endochondral ossification, (2) accelerate bone formation and repair, (3) increase union rates in fractures previously refractory to healing, and (4) produce results equivalent to bone grafts. Electric and electromagnetic fields regulate the expression of genes in connective tissue cells for extra-cellular matrix proteins, which results in an increase in cartilage and bone. They also increase gene expression for and synthesis of growth factors, which may be an intermediary mechanism of activity and may amplify field effects through autocrine and paracrine signaling.
135 citations
TL;DR: Modern techniques of percutaneous repair that are performed under local anesthesia and followed by early functional rehabilitation are becoming increasingly common, and should be considered when managing patients with Achilles tendon ruptures.
Abstract: Achilles tendon ruptures are common, and their incidence is increasing. The evidence for best management is controversial, and, in selected patients, conservative management and early mobilization achieves excellent results. Surgery is associated with an increased risk of superficial skin breakdown; however, modern techniques of percutaneous repair that are performed under local anesthesia and followed by early functional rehabilitation are becoming increasingly common, and should be considered when managing such patients.
98 citations
TL;DR: For active patients who have severe hallux rigidus, arthrodesis and biologic interposition arthroplasties have shown good results and KellerArthroplasty is reserved for low demand patients; prosthetic replacements are not recommended at this time.
Abstract: Numerous surgical procedures are available for the treatment of hallux rigidus. The choice of a particular one depends on the severity of the disease, patient activity level, and expectations about the surgery. Cheilectomy is recommended for early disease and may be associated with an osteotomy of the proximal phalanx. For active patients who have severe hallux rigidus, arthrodesis and biologic interposition arthroplasties have shown good results. Keller arthroplasty is reserved for low demand patients; prosthetic replacements are not recommended at this time.
89 citations
TL;DR: In this article, a review covers preclinical models that evaluate the efficacy of mesenchymal stem cells (MSC) loaded scaffolds in large bone defects as a potential substitute for autologous and allogeneic bone grafts.
Abstract: Mesenchymal stem cells (MSCs), derived from adult bone marrow, are multi-potent stem cells capable of differentiating along several lineage pathways. From a small bone marrow aspirate, MSCs can be readily isolated and easily expanded. Therefore, MSCs are thought to be a readily available source of cells for many tissue engineering and regenerative medicine applications. This review covers preclinical models that evaluate the efficacy of MSC-loaded scaffolds in large bone defects as a potential substitute for autologous and allogeneic bone grafts. This review also covers new approaches to clinical use of MSC technology.
86 citations
TL;DR: The normal and pathologic imaging features of the Achilles tendon are reviewed, the potential usefulness and limitations of various imaging techniques in the noninvasive assessment of the tendon are highlighted, and the potential impact of imaging findings on clinical patient care is highlighted.
Abstract: The Achilles tendon is the most commonly injured tendon in the foot and ankle; injuries commonly are related to sports/athletic activities. Imaging modalities that are used most commonly in the diagnostic assessment of the Achilles tendon include conventional radiography, ultrasonography, and MRI. This article reviews the normal and pathologic imaging features of the Achilles tendon, and highlights the potential usefulness and limitations of various imaging techniques in the noninvasive assessment of the tendon and the potential impact of imaging findings on clinical patient care.
85 citations
TL;DR: The anatomy of Achilles insertional tendinopathy is discussed from the anatomy of to its management, and overuse and poor training habits are considered to be the main etiology of Achilles Insertional Tendinopathy.
Abstract: There has been significant progress in our understanding of Achilles insertional tendinopathy since Clain and Baxter divided Achilles tendon disorders into noninsertional and insertional tendinopathy in 1992. In this article we specifically concentrate on Achilles insertional tendinopathy. Classically, overuse and poor training habits are considered to be the main etiology of Achilles insertional tendinopathy. This article discusses Achilles insertional tendinopathy from the anatomy of to its management.
83 citations
TL;DR: The use of PRP in orthopedic applications is highlighted, ranging from PRP preparation to in vitro and in vivo studies to clinical research.
Abstract: Platelet-rich plasma (PRP), derived from autologous blood, is defined as a volume of plasma that has a platelet concentration that typically is five times greater (approximately 1,000,000/microl) than physiologic levels. PRP serves as a reservoir of critical growth factors, including platelet-derived growth factor, transforming growth factor-beta, and insulin-like growth factor-I. Although there is an abundance of literature pertaining to dental applications, this article highlights the use of PRP in orthopedic applications, ranging from PRP preparation to in vitro and in vivo studies to clinical research.
79 citations
TL;DR: Assessment and treatment ofCalcaneus fractures has improved significantly and the use of CT scanning has allowed a greater understanding of the pathologic anatomy of these fractures, and has provided for prognostic classification systems with respect to outcome.
Abstract: Calcaneus fractures are a significant burden to society. Assessment and treatment of these injuries has improved significantly. The use of CT scanning has allowed a greater understanding of the pathologic anatomy of these fractures, and has provided for prognostic classification systems with respect to outcome. The treatment options are diverse and are reviewed.
79 citations
TL;DR: Different techniques can be used to repair or reconstruct the rupture, including tendo-Achilles advancement or flap reconstruction; local tendon transfer; and autologous, autograft, or synthetic implantation.
Abstract: Neglected Achilles tendon ruptures, although uncommon, are debilitating injuries. The optimal management is surgical. Many different techniques can be used to repair or reconstruct the rupture, including tendo-Achilles advancement or flap reconstruction; local tendon transfer; and autologous, autograft, or synthetic implantation. Comparison of different techniques is difficult.
TL;DR: The medial approach to triple arthrodesis is a reliable procedure, and can be used with a predictable outcome in patients who are at risk for wound healing complications for correction of hindfoot valgus deformity.
Abstract: Between 1995 and 2002 the authors treated 17 patients who had a rigid hindfoot valgus deformity, and for whom a triple arthrodesis was planned, using a single medial incision. The indication for surgery was pain that was refractory to shoe wear, orthotic, and brace modifications. The severity of the hindfoot deformity itself was not a sufficient indication for this procedure. All 17 patients were examined a mean of 3.5 years following surgery (1-8 years). Subtalar and talonavicular arthrodesis was achieved in all patients and calcaneocuboid arthrodesis was achieved in 15 of 17 patients (2 asymptomatic pseudoarthrosis). The medial approach to triple arthrodesis is a reliable procedure, and can be used with a predictable outcome in patients who are at risk for wound healing complications for correction of hindfoot valgus deformity.
TL;DR: A choice of metatarsal osteotomies for correction of hallux deformities based on clinical and biomechanical research is presented.
Abstract: A variety of metatarsal osteotomies has been described since the first report by Gernet in 1836. Many of these osteotomies were abandoned throughout the years. Because one procedure is not capable of correcting all types of hallux valgus deformities, an algorithm, as a guideline, is preferable. This article presents a choice of metatarsal osteotomies for correction of hallux deformities based on clinical and biomechanical research.
TL;DR: As the biology of tendinopathy is being clarified, more effective management regimens may come to light, improving the success rate of both conservative and operative management.
Abstract: Although Achilles tendinopathy has been extensively studied, there is a clear lack of properly conducted scientific research to clarify its etiology, pathology and optimal management. Emerging non-operative management and heavy load eccentric strengthening protocols based on these theories have yielded encouraging early results. Operative management traditionally produced good to excellent results, but randomized controlled studies comparing different surgical procedures and prospective evaluation of patient outcomes are necessary to truly establish the efficacy of these procedures. As the biology of tendinopathy is being clarified, more effective management regimens may come to light, improving the success rate of both conservative and operative management.
TL;DR: An update on recently developed conservative treatment methods for the management of chronic Achilles tendinopathy is given.
Abstract: Chronic Achilles tendinopathy is difficult to treat, and results, even after surgical management, are variable. The few studies that reported long-term results indicated a poor outcome. Also, surgery requires prolonged rehabilitation, and, depending on the patient's occupation, a varying period of sick leave from work. This article gives an update on recently developed conservative treatment methods for the management of chronic Achilles tendinopathy.
TL;DR: This article discusses work done with cadaver specimens and using invasive methods in vivo that has enhanced the understanding of the mechanics of the subtalar joint and its function during gait.
Abstract: Knowledge of the location of the subtalar joint axis in individual patients would permit clinical assessment of the forces and moments that produce frontal-plane foot and ankle deformities. Biomechanical analysis of the subtalar joint is hindered, however, by the inaccessibility of the talus, which makes locating the joint axis difficult, and by the high degree of intersubject anatomic variation. This article discusses work done with cadaver specimens and using invasive methods in vivo that has enhanced our understanding of the mechanics of the subtalar joint and its function during gait. Also reviewed are investigations of the actions of muscles that cross the subtalar joint.
TL;DR: There is a variety of techniques, approaches, and armamentarium to consider, depending on the clinical presentation and host factors, and this article reviews these presents the author's personal experience.
Abstract: Metatarsalphalangeal (MTP) arthrodesis remains the gold standard for arthritis and salvage of the painful first MTP joint. There is a variety of techniques, approaches, and armamentarium to consider, depending on the clinical presentation and host factors. This article reviews these presents the author's personal experience.
TL;DR: The mechanism of activation of matrix metalloproteinases (MMPs) is poorly understood, and their precise role in tendinopathy is unclear as discussed by the authors, but they are involved in remodelling of the extracellular matrix (ECM) of tendons.
Abstract: Disorganized, haphazard ineffective healing is a constant feature of chronic tendinopathy. Normal tendon is composed mostly of type I collagen. Tendinopathic tendons, conversely, have a greater proportion of type III collagen, which is associated with tendon rupture. Matrix metalloproteinases (MMPs) are involved in remodelling of the extracellular matrix (ECM) of tendons, because they are either up- or down-regulated in tendinopathy. A balance between MMPs and tissue inhibitors of metalloproteinases is required to maintain tendon homeostasis. The mechanism of activation of MMPs is poorly understood, and their precise role in tendinopathy is unclear.
TL;DR: Ankle joint distraction is a viable alternative to ankle arthrodesis or ankle replacement as discussed by the authors, which is a congruent, painful, mobile, and arthritic ankle joint that is treated with this technique can achieve good to excellent results.
Abstract: Ankle joint distraction is a viable alternative to ankle arthrodesis or ankle replacement. A congruent, painful, mobile, and arthritic ankle joint that is treated with this technique can achieve good to excellent results. Attention to the principles (anterior osteophyte resection, equinus contracture release, and ankle joint realignment procedures) is as important for a successful outcome as the accurate application of the hinged ankle joint distraction technique itself.
TL;DR: Technical considerations that are required for successful orthotic management of disease of the first ray are reviewed and examples of orthotic prescriptions for specific disease entities are included to facilitate communication between the orthopedist and orthotist.
Abstract: Most disease conditions that affect the hallux are amenable to conservative treatment. Most of the literature that addresses the treatment of hallux rigidus, bunions, sesamoid problems, and arthritis focus on surgical management, although operative indications stress the need for attempted conservative treatment of these processes. This article reviews the technical considerations that are required for successful orthotic management of disease of the first ray. Mechanical terminology and principles of management are reviewed and examples of orthotic prescriptions for specific disease entities are included to facilitate communication between the orthopedist and orthotist.
TL;DR: The underlying factor contributing to Avascular necrosis of the first metatarsal head is examined as well as its long-term management.
Abstract: Avascular necrosis of the first metatarsal head is uncommon. It is most often seen following a distal metatarsal osteotomy for hallux valgus. In this setting surgery has usually involved extensive periarticular dissection as well. Although many cases may be subclinical, in its most pronounced form it is a powerful cause of failure of bunion surgery. This article examines the underlying factor contributing to this problem as well as its long-term management.
TL;DR: This long-term follow-up of an extended case series of 37 patients who underwent the index operation demonstrated a high rate of patient satisfaction, and significant improvement in Foot Function Index scores.
Abstract: Metallic proximal phalangeal hemiarthroplasty has been described for the surgical treatment of moderate to severe hallux rigidus. This long-term follow-up of an extended case series of 37 patients who underwent the index operation demonstrated a high rate (93%) of patient satisfaction, and significant improvement in Foot Function Index scores.
TL;DR: Tumor-like conditions, such as cysts, reactive lesions, and osteomyelitis, must be considered during evaluation and treatment is often observation or curettage of benign lesions and resection or amputation for malignancies.
Abstract: Approximately 3% of osseous tumors occur in the foot and ankle. Solitary bone cysts, chondroblastoma, intraosseous lipoma, osteoid osteoma, chondrosarcoma, and Ewing's sarcoma seem to have a predilection for the calcaneus. Biopsy is often a crucial step in management. Tumor-like conditions, such as cysts, reactive lesions, and osteomyelitis, must be considered during evaluation. Treatment is often observation or curettage of benign lesions and resection or amputation for malignancies.
TL;DR: The clinical use of BMPs is now in its infancy and understanding the mechanism and the appropriate application of these proteins is necessary for all practicing orthopedic surgeons to understand their role in fracture healing.
Abstract: Recently, several prospective randomized clinical trials have resulted in the publication of critical studies on the efficacy of recombinant human morphogenetic proteins BMP-2 (rhBMP-2) and BMP-7 (OP-1) in spinal fusion and fracture healing. The clinical use of BMPs is now in its infancy and understanding the mechanism and the appropriate application of these proteins is necessary for all practicing orthopedic surgeons. This article will revisit some of the early studies using rhBMPs and review the current literature on their role in fracture healing.
TL;DR: Joint replacement of the hallux metatarsophalangeal joint has not enjoyed the same success as hip and knee arthroplasties; patients who have hallux rigidus have more success than patients who has hallux valgus or rheumatoid arthritis.
Abstract: Joint replacement of the hallux metatarsophalangeal joint has not enjoyed the same success as hip and knee arthroplasties. Silastic implants have achieved a high patient satisfactory rate but have caused many complications, including silicone synovitis and lymph node inflammation. Metal and polyethylene hemiarthroplasties and total toe replacements seem to be more promising although results are preliminary. Problems with these implants seem to be related to soft tissue instability of the joint; patients who have hallux rigidus have more success than patients who have hallux valgus or rheumatoid arthritis. Severe complications can be treated with removal and synovectomy or arthrodesis, depending on the length and alignment of the foot, as well as the functional demands of the patients. It would be beneficial to have more data on these implants so that improvements can be made in design and patient selection.
TL;DR: In this article, the authors gave an up-to-date account on their personal views of managing complications following Achilles tendon rupture, tendinopathy, and delayed rupture, and gave a detailed account of the complications that arise from the management of these conditions.
Abstract: Ailments of the Achilles tendon are on the increase and present in athletic and sedentary patients. The management of tendinopathy and rupture is not codified; Achilles tendon rupture and tendinopathy can be managed conservatively or surgically. Tackling the complications that arise from the management of these conditions provides a formidable challenge to the surgeon. Rupture, rerupture, disordered scarring with potential keloid formation, nerve damage (especially the sural nerve), poor healing, infection, bleeding and hematoma formation, wound dehiscence, deep vein thrombosis (DVT), and loss of function have been reported. This article gives an up-to-date account on our personal views of managing complications following Achilles tendon rupture, tendinopathy, and delayed rupture.
TL;DR: In this article, the authors describe different locations and three types of osteotomies according to the required final correction of the hallux valgus deformity of the great toe proximal phalanx.
Abstract: As the final step of correction of hallux valgus deformity, the great toe proximal phalanx osteotomy is useful. It is popular in France and throughout Europe. Our purpose is to distinguish and to describe different locations and three types of osteotomies according to the required final correction of the hallux valgus.
TL;DR: In this paper, the authors review their experience with malunion and nonunion of proximal and distal first metatarsal osteotomies and outline the treatment options when such complications occur.
Abstract: The purpose of this article is to review our experience with malunion and nonunion of proximal and distal first metatarsal osteotomies and to outline the treatment options when such complications occur.
TL;DR: Since early work done in the 1950s on the "piezoelectricity of bone," a growing body of basic science and clinical evidence suggests the use of electrical bone stimulation as an adjunct in the treatment of foot and ankle nonunions, fusions, and Charcot arthropathy.
Abstract: Since early work done in the 1950s on the "piezoelectricity of bone," a growing body of basic science and clinical evidence suggests the use of electrical bone stimulation as an adjunct in the treatment of foot and ankle nonunions, fusions, and Charcot arthropathy. Both implantable designs (that allow for direct constant stimulation of bone) and nonimplantable (such as pulsed and combined electromagnetic fields) devices have been studied. Ongoing research continues to support the potential usefulness of these modalities.
TL;DR: The stages of tendon healing are outlined, and the possible strategies for optimizing tendon healing and repair, such as cytokine therapy, gene therapy, and tissue engineering are reviewed.
Abstract: Tendon disorders can be debilitating for patients and are difficult to manage. Current management strategies offer symptomatic relief, but may not result in definitive disease resolution. Despite remodeling, the biochemical and mechanical properties of healed tendon tissue never match those of intact tendon. This article outlines the stages of tendon healing, and reviews the possible strategies for optimizing tendon healing and repair, such as cytokine therapy, gene therapy, and tissue engineering.