Showing papers in "Foot & Ankle International in 1987"
TL;DR: The plantar pressure distributions for a large heterogeneous sample of feet were collected during barefoot standing using a capacitance mat and showed that the heel carried 60%, the midfoot 8%, and the forefoot 28% of the weightbearing load.
Abstract: The plantar pressure distributions for a large heterogeneous sample of feet (N = 107) were collected during barefoot standing using a capacitance mat. From these data, the function of the foot during standing was characterized. Peak pressures under the heel (139 kPa) were, on average, 2.6 times greater than forefoot pressures (53 kPa). Forefoot peak pressures were usually located under the second or third metatarsal heads. No significant relationship was found between body weight and the magnitude of peak pressure. The concepts of a transverse arch at the level of the metatarsal heads and a "tripod" theory of load distribution were not substantiated by this study. Load distribution analysis showed that the heel carried 60%, the midfoot 8%, and the forefoot 28% of the weightbearing load. The toes were only minimally involved in the weightbearing process. Examples of unusual distributions are shown; finally, a checklist is provided to aid the clinician in evaluating plantar pressure findings.
369 citations
TL;DR: The increased tension in the plantar aponeurosis in the weightbearing position of the foot occurs with anterior flexion of the leg or with hyperextension of the toes.
Abstract: Structurally the foot is equivalent to a twisted plate. The hindpart is located in the sagittal plane and the forepart in the transverse plane. The transition induced by the twist creates the transverse and the longitudinal arches. Under vertical loading of the foot plate by the tibiotalar column, compressive forces are created on the dorsum and tensile forces on the plantar aspect of the foot plate. The plantar aponeurosis acting as a tie-rod when under tension relieves the tensile forces from the plantar aspect of the foot plate. The increased tension in the plantar aponeurosis in the weightbearing position of the foot occurs with anterior flexion of the leg or with hyperextension of the toes. In the plantigrade position when vertical loading and external rotation are simultaneously applied by the tibiotalar column on the foot, the hindfoot and the midfoot are supinated, and the forefoot is pronated. The medial longitudinal arch is higher, the foot is shorter, and the plantar aponeurosis is relaxed. The...
207 citations
TL;DR: The crossover second toe deformity occurs when the lateral collateral ligament and joint capsule of the second metatarsophalangeal joint deteriorate and the second toe initially deviates in a medial direction but with time deviates dorsally and crosses up and over the great toe.
Abstract: The crossover second toe deformity occurs when the lateral collateral ligament and joint capsule of the second metatarsophalangeal joint deteriorate. The second toe initially deviates in a medial direction but with time deviates dorsally and crosses up and over the great toe. A total of 17 patients (22 toes) were evaluated and 11 patients (15 toes) underwent surgical correction. A 90 degree satisfactory rate was noted at 42 months follow-up.
168 citations
TL;DR: A cadaver study revealed that the deltoid ligament is the primary restraint against valgus tilting of the talus, with superficial and deep components being equally effective in this regard.
Abstract: A cadaver study done to evaluate function of the deltoid ligament and its major subdivisions, the superficial and deep components, revealed that the deltoid ligament is the primary restraint against valgus tilting of the talus, with superficial and deep components being equally effective in this regard. The deep deltoid ligament appeared to be the secondary restraint against both lateral and anterior talar excursion, with the lateral malleolus and supporting ligaments being the primary restraint.
154 citations
TL;DR: Peroneus brevis brevis tendon transfer has been utilized in 40 individuals during the last 13 years and is superior to other methods of treatment and is particularly advantageous in the sports-oriented individual.
Abstract: Peroneus brevis tendon transfer has been utilized in 40 individuals during the last 13 years. All cases consisted of complete Achilles tendon ruptures. In 34 cases the rupture was in the distal one-third of the tendon substance, in four cases bony avulsion of the calcaneal tuberosity occurred, and in two cases there was a diffuse tear in the proximal two-thirds of the tendon near the musculotendinous junction. The middle-aged athlete sustained the majority of these injuries during sports. Eleven patients were less than 30 years old, 23 patients were 30 to 40 years old, and six were over 40 years old. Five patients had reruptures that involved prior nonoperative treatment of cast immobilization, and one had undergone simple direct suture. This repair has been used in acute, chronic, and recurrent ruptures of the tendoachillis. Thirty-three patients presented within 1 week of injury, and seven after more than 1 week. A. Perez Teuffer personally described the preferred technique in 1971 and subsequently published in 1978. The transfer of the peroneus brevis is combined with a direct end-to-end suture of the triceps surae tendon that allows a secure reconstruction with the foot at a right angle. The peroneus brevis tendon is detached from the base of the fifth metatarsal and then tunnelled through the distal Achilles tendon stump. The distal portion of the tendon transfer is then drawn proximally along the medial calcaneal tendon border. The proximal triceps surae tendon is pulled distally and secured to the peroneal tendon.(ABSTRACT TRUNCATED AT 250 WORDS)
135 citations
TL;DR: The role of quantitative biomechanical measurements in the evaluation of the running patient is discussed, and the assertion is made that bilateral asymmetry in many of these measures is a fairly common finding.
Abstract: The role of quantitative biomechanical measurements in the evaluation of the running patient is discussed. Many techniques are now available to provide insight into the external mechanics of lower extremity action during running, and results from such measurements are presented for symptom-free subjects at distance running speeds. Details of stride length, stride time, and foot placement are first presented followed by a discussion of kinematic data, including stick figures, angle-time graphs, and angle-angle diagrams for the sagittal plane motion of the hip, knee, and ankle joints. The measurement of rearfoot motion, as an approximation of coronal plane subtalar joint movements, is also discussed. Results from acceleration, force, and pressure measurements are considered, and the assertion is made that bilateral asymmetry in many of these measures is a fairly common finding. There are, at present, few reports in the literature of the application of biomechanical techniques to the evaluation of patients with running injuries. It is anticipated that there will be rapid developments in this area in the future and that this will provide considerable insight into the etiology, diagnosis, and treatment of running injuries.
116 citations
TL;DR: The sex- and age-specific incidence has been calculated for ankle fractures from the first part of the 1950s and compared with the 1980s, a 30-year interval, during which time interval ankle fractures had become more common, particularly those with extensive skeletal involvement, such as the stage IV supination-eversion fractures.
Abstract: The sex- and age-specific incidence has been calculated for ankle fractures from the first part of the 1950s and compared with the 1980s, a 30-year interval. The fractures were also classified according to Lauge-Hansen. Altogether 1784 fractures were found. During that time interval ankle fractures had become more common, particularly those with extensive skeletal involvement, such as the stage IV supination-eversion fractures, which today have an incidence pattern more typical of a fragility fracture in elderly women.
107 citations
TL;DR: Five different intertarsal arthrodeses were simulated in 15 fresh cadaver feet/ankles utilizing external fixation and the prearthrodesis range of motion measurements were found to be dorsiflexion (DF), 27°; plantarflexion (PF), 57°; total inversion (INVT), 29°; eversion total (EVT), 22°; hindfoot varus (VRH), 16° ; hindfoot valgus (VLH
Abstract: Five different intertarsal arthrodeses were simulated in 15 fresh cadaver feet/ankles utilizing external fixation. Pin placement was verified radiographically. Range of motion measurements were performed before pin placement, after pin placement, and after simulated arthrodesis. The deficit in foot motion created by selected limited intertarsal fusions was then measured.The prearthrodesis range of motion measurements were found to be dorsiflexion (DF), 27°; plantarflexion (PF), 57°; total inversion (INVT), 29°; eversion total (EVT), 22°; hindfoot varus (VRH), 16°; hindfoot valgus (VLH), 12°.The deficits in motion after arthrodesis were as follows. Ankle (tibiotalar): DF, 50.7%; PF, 70.3%; INVT, 8.7%; EVT, 9.4%; VRH, 34.6%; VLH, 27.8%. Hindfoot arthrodesis (Tibiotalar calcaneal): DF, 53%; PF, 71.3%; INVT, 49.5%; EVT, 47.6%, VRH, 100%; VLH, 100%. Pantalar (Tibotalar calcanea cuboid navicular): DF, 62.8%; PF, 82.2%; INVT, 71.7%; EVT, 67.4%; VRH, 100%; VLH, 100%. Triple (Talocalcaneal cuboid navicular): DF, 1...
101 citations
TL;DR: A classification of fractures of the proximal part of the fifth metatarsal and a plan of treatment based on clinical and roentgenographic criteria that were developed to define acute fractures, delayed unions, and nonunions are described.
Abstract: Fractures of the proximal part of the fifth metatarsal can be separated into two types: those involving the tuberosity, and those involving the proximal part of the diaphysis distal to the tuberosity. Recently it has been recognized that the latter group, Jones' fractures, may be difficult to treat. Although reports in the literature have indicated the potential difficulties in the treatment of Jones' fractures, prevailing guidelines for their management are ambiguous. Apparently the varied clinical and roentgenographic manifestations of these fractures have not been correlated with their response to treatment. In this paper we describe a classification of these fractures and a plan of treatment based on clinical and roentgenographic criteria that were developed to define acute fractures, delayed unions, and nonunions. The treatment of choice for acute fractures is immobilization of the limb in a toe to knee cast with nonweight-bearing. Fractures with delayed union may eventually heal if they are treated conservatively, but an active athlete with delayed union or an established nonunion will benefit from operative intervention. The procedures of choice are medullary curettage and bone grafting, and closed axial intramedullary screw fixation using a 4.0-mm ASIF malleolar screw.
98 citations
TL;DR: The primary purpose of this paper was to determine the exact role, if any, in subtalar motion on tibiotalar contact in angular deformities of the tibia and to achieve this objective the subtalars joint was transfixed thereby eliminating its perceived compensatory movement.
Abstract: It is a well known entity that fractures of the tibia heal with some component of angular deformity. Ankle and subtalar joints may compensate for small degrees of angular deformities, but the exact amount of malunion that can be accepted without development of late sequalae has yet to be determined. Two recent studies from this institution have concluded that contact changes at the tibiotalar joint tend to be greater with distal third tibial fracture deformities compared to proximal and middle with the ankle in neutral, 5 degrees dorsiflexion, and 20 degrees of plantar flexion. Anterior and posterior bow deformities produced a greater change in contact area of the tibiotalar joint than with valgus or varus deformities. This phenomena may be possibly explained by the subtalar motion in the horizontal plane which averages 23 degrees. Thus, it was the primary purpose of this paper to determine the exact role, if any, in subtalar motion on tibiotalar contact in angular deformities of the tibia. To achieve this objective the subtalar joint was transfixed thereby eliminating its perceived compensatory movement. Six cadaveric lower extremities were disarticulated at the knee joint and stripped of soft tissue preserving capsular and ligamentous structures. A custom universal joint was used to create various angulatory deformities at proximal, middle, and distal third levels of the tibia.(ABSTRACT TRUNCATED AT 250 WORDS)
96 citations
TL;DR: Excision of the involved bone is the recommended treatment for displaced fractures and for less severe conditions such as sesamoiditis, osteochondritis, and nondisplaced fractures, if conservative management fails to relieve symptoms.
Abstract: The sesamoids of the great toe, which are small and seemingly insignificant bones, can be the site of disabling pathology for the athlete. Sesamoiditis, osteochondritis, partite sesamoids with stress fractures, displaced fractures, and osteomyelitis have all been reported in the athlete. Bursitis beneath the tibial sesmoid and flexor hallucis brevis tendonitis also occur in the athlete and may be confused with sesamoid injury. Excision of the involved bone is the recommended treatment for displaced fractures and for less severe conditions such as sesamoiditis, osteochondritis, and nondisplaced fractures, if conservative management fails to relieve symptoms.
TL;DR: The extraosseus and intraosseous circulation to the first ray was evaluated by means of vascular injection techniques and revealed an extensive capsular network that is more consistent and abundant on the dorsal and lateral aspects of the joint.
Abstract: The extraosseus and intraosseous circulation to the first ray was evaluated by means of vascular injection techniques. The first metatarsal and metatarsophalangeal joint receive their blood supply from the first dorsal metatarsal artery, the first plantar metatarsal artery, and the superficial branch of the medial plantar artery. These three source arteries provide variable numbers of branches to the base, shaft, and head of the first metatarsal. Ramifications of branches to the head form an extensive capsular network that is more consistent and abundant on the dorsal and lateral aspects of the joint.The source of intraosseous vascularity consists of a diffuse network of fine periosteal arteries enveloping the diaphysis of the metatarsal, a single nutrient artery that perforates the first metatarsal at the lateral aspect of the shaft distally, and a system of metaphyseal and capital arteries that appear to constitute a major source of blood supply to the metatarsal head.
TL;DR: The study has shown the calcaneofibular ligament as an important structure in stabilizing the talocalcaneal joint.
Abstract: In the evaluation of the role of the calcaneofibular ligament in stabilizing the talocalcaneal joint, an experimental set-up was prepared. In 10 osteoligamentous specimens, the talocalcaneal motion was measured under a constant well defined moment by using a specially constructed apparatus. By using a moment of 1.5 Nm, increment in adduction in the talocalcaneal joint after section of the calcaneofibular ligament was found between 3.1 degrees and 4.6 degrees, still increasing with dorsiflexion. This increment, shown to constitute 61 to 77% of the total increment in adduction in the hindfoot after section of the calcaneofibular ligament, was found to increase gradually with dorsiflexion. The study has shown the calcaneofibular ligament as an important structure in stabilizing the talocalcaneal joint. Increment in adduction in the hindfoot after section of the calcaneofibular ligament was shown primarily to take place in the talocalcaneal joint.
TL;DR: A total of 45 patients with the painful heel syndrome without evidence of an associated inflammatory arthritis, seven of whom had pain in both heels, were studied using technetium-99 isotope bone scans and lateral and 45° medial oblique radiographs of both feet.
Abstract: A total of 45 patients with the painful heel syndrome without evidence of an associated inflammatory arthritis, seven of whom had pain in both heels, were studied using technetium-99 isotope bone scans and lateral and 45 degrees medial oblique radiographs of both feet. Of the 52 painful heels 31 (59.6%) showed increased uptake of tracer at the calcaneum. Patients with scans showing increased uptake tended to have more severe heel pain and responded more frequently to a local hydrocortisone injection. On plain x-ray, 39 of 52 painful heels (75%) and 24 of the 38 opposite nonpainful heels (63%) showed plantar spurs, compared with five of 63 (7.9%) heels in 59 age- and sex-matched controls. No evidence of stress fractures was seen.
TL;DR: Fig. 1.
Abstract: Fig. 1. McMaster's impingement lesion.\" 1924 1914 1915 192
TL;DR: Contact index II (ratio of contact width to the total width of the foot) which is simple, reliable, and correlates with contact index I has been used to assess flat foot and is found to be more common than bilateral flat foot.
Abstract: The objective index as developed by Qaura, Deodhar, and Jit, in 1980 was used to estimate the incidence of flat foot (pes planus) in 990 school pupils (532 females and 458 males) between the ages of 5 and 14 years. The ratio of contact area to the total area of the middle of the footprint (contact index 1) (4/10), usually measured with a planimeter, is accepted as the true representative of the condition of arches. In this field study, contact index II (ratio of contact width to the total width of the foot) which is simple, reliable, and correlates with contact index I has been used to assess flat foot. The mean for the contact index and standard deviation have been calculated. Feet have been considered as normal up to 1 SD around the mean value of the index and values greater or lesser than this have been considered abnormal. Furthermore, mean +/- 1 SD to 2 SD has been considered as possible flat foot, whereas mean +/- 3 SD and above has been taken as definite flat foot. On the whole, bilateral flat foot is not common among children of school age in Port Harcourt (0.60%). It is, however, more common in females (0.75%) than males (0.44%). Unilateral flat foot (2.22%) is found to be more common than bilateral flat foot. Early introduction to the use of shoes may predispose to flat foot. We were not in a position to say if any of the subjects found with flat foot would have a painful foot.(ABSTRACT TRUNCATED AT 250 WORDS)
TL;DR: Three commercially available systems for measuring the pressure distribution under the foot have been compared by measuring ten “normal” subjects with these different techniques to show the differences between the equipment and the results and help investigators interested in foot problems to choose the best system for their particular needs.
Abstract: The measurement of the pressure distribution under the foot can provide permanent records which can be used to monitor patients' progress and the effects of surgical operations. It can be utilized in the assessment of foot disorders and the results of treatment. It is also of value in the study of the function of the normal foot. Three commercially available systems have been compared by measuring ten “normal” subjects with these different techniques. The results are not directly comparable but are described to show the differences between the equipment and the results and help investigators interested in foot problems to choose the best system for their particular needs.
TL;DR: When indications point to the need for repair of the lateral ligament of the ankle, the following simplified technique for primary or late repair is offered.
Abstract: When indications point to the need for repair of the lateral ligament of the ankle, the following simplified technique for primary or late repair is offered. It has been reported previously in Foot & Ankle but, upon repeated request, it is now produced in \"Technique Tips.\" Surgery is carried out under a blanket of antibiotic medication.\" I use Kefsol 1 g i.m. one-half hr preoperatively and 1 g i.v. every 6 hr for 48 to 72 hr postoperative y. Throughout the surgery, the assistant frequently 'Irrigates the wound with a mixture of 50,000 units of bacitracin and 500,000 units of polymyxin B sulfate dissolved in 200 cc of sterile water. Anesthesia is usually spinal and a thigh tourniquet is used.
TL;DR: A retrospective analysis of 36 congenital vertical tali in 21 patients whose average follow-up of 14 years was considered to be unusually lengthy found that subtalar and talotibial motion were frequently restricted, with or without prior arthrodesis.
Abstract: To ascertain whether one type of treatment of the congenital vertical talus was superior to others, we conducted a retrospective analysis of 36 congenital vertical tali in 21 patients whose average follow-up of 14 years was considered to be unusually lengthy. Ten patients (48%) had an underlying primary diagnosis, and 13 patients (62%) had at least one other secondary congenital abnormality. None of the surgical techniques produced significantly better results than any other one according to criteria involving shoewear, range of motion, and degree of pain. Subtalar and talotibial motion were frequently restricted, with or without prior arthrodesis. Pain generally was not an immediate or long-term problem. To maintain maximal foot mobility, we recommend a one-stage soft tissue correction alone in the child under 3 years of age. In older, untreated children or those in whom conservative treatments have failed, a subtalar or triple arthrodesis may be necessary.
TL;DR: The operation was effective in improving symptoms, cosmesis, function, function and in decreasing the deformity and the overall patient satisfaction rate was 77%.
Abstract: A prospective study of the Keller procedure for hallux valgus was carried out on 44 female patients (75 feet) with an average age of 66 years. The average follow-up was 31 months (range, 12–64 months). The operation was effective in improving symptoms (joint pain and bunion tenderness), cosmesis, function (footwear and level of activity) and in decreasing the deformity. The operation did not have an influence on metatarsal calluses. Cock-up deformity was common postoperatively but did not affect the results. The overall patient satisfaction rate was 77%.
TL;DR: A curved, oblique plantar incision in the proximal aspect in the medial longitudinal arch was used to release the plantar fascia in eight feet with recalcitrant plantar fasciitis, representing a significant improvement over previously reported surgical approaches.
Abstract: A curved, oblique plantar incision in the proximal aspect in the medial longitudinal arch was used to release the plantar fascia in eight feet with recalcitrant plantar fasciitis. Seven feet became...
TL;DR: A surgical technique has a biomechanically sound fixation and a shortened bone healing time with minimum complications and is described for optimal correction of metatarsus quintus valgus.
Abstract: The direct approach to the fifth metatarsophalangeal joint for the treatment of metatarsus quintus valgus often has been unsuccessful, mainly because of technical difficulties in the osteotomy of the narrow fifth metatarsal neck and the fixation of the unstable head fragment. Complications such as delayed union, nonunion, or recurrence have been reported. This paper describes a surgical technique for optimal correction of this deformity. The technique has a biomechanically sound fixation and a shortened bone healing time with minimum complications. Results of 12 patients presenting severe deformities are reported, with 1-year average follow-up.
TL;DR: The accessory navicular is commonly considered an asymptomatic variant, but when traumatized, it can become the source of clinical symptoms, causing avulsion or a painful pseudarthrosis to develop.
Abstract: The accessory navicular is commonly considered an asymptomatic variant, but when traumatized, it can become the source of clinical symptoms. The accessory naviculars were divided into Types I, IIa and b, and III based on their appearance and location with relationship to their parent navicular. Only Type IIa and b accessory naviculars have a synchondrosis. The synchondrosis of Type IIa and b can undergo tension, shear, and compression forces causing avulsion or a painful pseudarthrosis to develop.
TL;DR: Six professional ballet dancers in whom the os trigonum was removed for symptomatic talar compression syndrome were removed, caused by the trauma of the en pointe position of toe dancing, and remained asymptomatic.
Abstract: Ballet dancers frequently stand on the tips of their toes in the en pointe and demi-pointe positions, resulting in compression of the posterior structures of the ankle during repeated plantar flexion of the foot, producing the talar compression syndrome. This mechanism may result in posterior block or impingement of an os trigonum or Stieda's process. When the dancer attempts to force the foot into plantar flexion, the os trigonum or the Stieda's process may be impinged between the calcaneus and the posterior edge of the tibia. Pain and tenderness are localized at the posterolateral aspect of the ankle behind the peroneal tendons. In nondancing members of the population, these conditions are usually asymptomatic. It is the requirement of the classical dance for a well-pointed foot that produces symptoms. We are reporting up to 7 years follow-up of six professional ballet dancers in whom we removed the os trigonum for symptomatic talar compression syndrome, caused by the trauma of the en pointe position of toe dancing. Two patients had bilateral operations. All six patients returned to professional dancing within a few months and remained asymptomatic. The anatomy of this condition is reviewed, as well as the diagnosis and treatment.
TL;DR: A modified Watson-Jones tenodesis using a split of the peroneus longus for correction of chronic lateral ankle instability has been used in a series of 43 ankles, finding functional stability was achieved in most cases.
Abstract: A modified Watson-Jones tenodesis using a split of the peroneus longus for correction of chronic lateral ankle instability has been used in a series of 43 ankles. The range of follow-up varied between 2 and 10 years (median 56 months). Functional stability was achieved in most cases. One of the major aims of this study was to analyze the different aspects related to persisting symptoms. The need of a standardized rating system for comparison of the results of the various types of reconstruction procedures is emphasized.
TL;DR: MRI demonstrated a complete disruption of the posterior tibial tendon, despite the absence of the commonly associated clinical findings in the patient presented.
Abstract: Magnetic resonance imaging (MRI), a useful technique of studying soft tissues of the body, can be very effective in assessing the integrity of tendons. Usually a patient with a complete tear of the posterior tibial tendon has characteristic physical findings. In the patient presented, MRI demonstrated a complete disruption of the posterior tibial tendon, despite the absence of the commonly associated clinical findings. In view of the difficulties encountered with attempted tenography of the completely torn posterior tibial tendon, MRI provides a sensitive alternative diagnostic technique.
TL;DR: Except for one infection, fair and poor results were due to residual rather than recurrent deformity, and the potential problems of increased nonunion, severe compromise of foot length, and recurrence of deformity were not observed in this series.
Abstract: A total of 19 triple arthrodeses were performed in 13 children aged 10 years or less for severe hindfoot deformities after failure of soft tissue releases. This was considered a salvage procedure and an alternative to talectomy. The average age at surgery was 8.4 years and average follow-up was 4 years. There were 68% excellent and good results, 16% fair, and 16% poor results. The nonunion rate was 7% of joints. Average shortening of the foot was 0.81 in but was not significant when compared with a group of clubfoot control patients. Except for one infection, fair and poor results were due to residual rather than recurrent deformity.Triple arthrodesis may be indicated in the young child for residual hindfoot deformity as an alternative to talectomy. The potential problems of increased nonunion, severe compromise of foot length, and recurrence of deformity were not observed in this series.
TL;DR: It is recommended that release of the flexor hallucis longus, flexor digitorum longus and intrinsic tendons be performed at the base of each toe as part of the procedure to correct spastic equinovarus deformities in the adult neurologically impaired patient.
Abstract: In the treatment of spastic equinovarus foot deformities in adults with neurologic impairment, various surgical procedures are used including the split anterior tibialis tendon transfer and tendo achillis lengthening. Release of the flexor hallucis longus and flexor digitorum longus tendons in the midfoot is routinely included with these procedures to correct or prevent toe curling. In follow-up, residual toe curling has been observed in some patients despite release of the long toe flexor tendons. This study was undertaken to investigate this problem and its consequences, treatment, and treatment success.Forty-one feet in 34 consecutive patients were examined for residual toe curling an average of 2.5 years postoperatively. Thirty-two feet (78%) were noted to have significant flexion deformities of the lesser toes. The residual toe curling caused pain in 72% of the feet and was associated with callosities on the dorsum of the toes in 59%. The incidence of residual toe curling secondary to spasticity of t...
TL;DR: Fusion of the first metatarsophalangeal joint seemed better than resection alone, indicating that stability should be the primary goal for surgical intervention of the rheumatoid forefoot.
Abstract: Forefoot surgical outcomes were evaluated in 26 patients with rheumatoid arthritis. A total of 45 procedures were reviewed with emphasis on first ray intervention. Disease duration and aggressiveness of preceding medical therapy were combined to establish a disease severity index. Patients operated were predominantly in the midrange of disease severity. Subjective data on the relief of pain, callus, and deformity were favorable but this benefit was not long lasting inasmuch as patients were most satisfied in the period immediately following surgery and less so as time elapsed from intervention. Fusion of the first metatarsophalangeal joint seemed better than resection alone, indicating that stability should be the primary goal for surgical intervention of the rheumatoid forefoot.
TL;DR: In the population of patients who sustain this injury, the plantari is absent in 60% of patients, a statistically significant difference when compared to the absence of the plantaris tendon of less than 10% in reported cadaveric studies.
Abstract: Many surgeons treat closed subcutaneous rupture of the Achilles tendon with primary surgical repair. Reinforcement of the primary repair can be accomplished easily using the plantaris tendon. Unfortunately, in the population of patients who sustain this injury, the plantaris is absent in 60% of patients. This is a statistically significant difference when compared to the absence of the plantaris tendon of less than 10% in reported cadaveric studies.