Most Downloaded Articles

   
 
SYMPOSIUM-Invited Article
Mandeep S Dhillon, Kamal Dureja, Sandeep Patel, Tungish Bansal

How We do It. Trimalleolar Fractures: Fixing the Posterior Malleolus by Posterolateral Approach

[Year:2017] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:51] [Pages No:63-68][No of Hits : 1965]


ABSTRACT

The understanding of trimalleolar fractures and, in particular, the posterior malleolus fragment has drastically evolved over the last decade. There has been a tilt in favor of fixing almost all posterior malleolus fragment in contrast to the old school thought of the 20th century. The concept of stability offered by posterior malleolus fixation to the syndesmotic stability is well understood now. Posterolateral approach has almost evolved as a gold standard approach for posterior malleolus fixation.

Keywords: Ankle fracture, Posterior malleolus, Posterolateral approach ankle.

How to cite this article: Dhillon MS, Dureja K, Patel S, Bansal T. How We do It. Trimalleolar Fractures: Fixing the Posterior Malleolus by Posterolateral Approach. J Foot Ankle Surg (Asia- Pacific) 2017;4(2):63-68.

Source of support: Nil

Conflict of interest: None


 
Review Article
Mandeep S Dhillon, John Ebnezar, Rakesh John

Foot and Ankle Surgery: The Indian Scenario in 2016

[Year:2017] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:54] [Pages No:40-44][No of Hits : 1852]


ABSTRACT

In this review, we try to analyze the current scenario of foot and ankle surgery in India, with special emphasis on the problems faced by the indigenous population and also the challenges faced by foot and ankle surgeons of our country. Chronic infections of the foot (like tuberculosis, leprosy), neglected or mismanaged trauma cases (which usually result from a lack of awareness in the people regarding foot and ankle problems), foot and ankle problems faced by sportspersons, geriatric population, etc., form the crux of the discussion in this article.

Keywords: Foot ankle surgery, Geriatrics, Health care, Leprosy, Polio, Sports, Tuberculosis.

How to cite this article: Dhillon MS, Ebnezar J, John R. Foot and Ankle Surgery: The Indian Scenario in 2016. J Foot Ankle Surg (Asia-Pacific) 2017;4(1):40-44.

Source of support: Nil

Conflict of interest: None


 
SYMPOSIUM-Case Report
Rajiv Shah, Shivam R Shah

Diabetic Ankle Fractures: Does Management Differ? A Case-based Presentation

[Year:2017] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:51] [Pages No:77-83][No of Hits : 1569]


ABSTRACT

Fractures in diabetics pose a great management challenge as diabetes mellitus affects fracture healing at the cellular level. With a steep rise in the number of diabetics the world over, there also is a rise in the incidences of ankle fractures. Nonoperative as well as operative management of ankle fractures in diabetics is fraught with a high rate of complications. With the help of history and clinical examination, the clinician must classify the case as either a complicated or an uncomplicated diabetes presentation. Case-based discussion for both these types of diabetic ankle fractures is offered in this article, and we propose a lucid management algorithm.

Keywords: Charcot neuroarthropathy, Complicated diabetes, Diabetic ankle fracture, Tibiotalocalcaneal nail, Uncomplicated diabetes.

How to cite this article: Shah R, Shah SR. Diabetic Ankle Fractures: Does Management Differ? A Case-based Presentation. J Foot Ankle Surg (Asia-Pacific) 2017;4(2):77-83.

Source of support: Nil

Conflict of interest: None


 
SYMPOSIUM-Original Article
Mandeep S Dhillon, Lokesh Kumar, Siddhartha Sharma, Nikhil Mehta

The Lauge-Hansen Classification for Ankle Fractures: Is it Relevant in 2017?

[Year:2017] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:51] [Pages No:53-56][No of Hits : 1461]


ABSTRACT

Despite being one of the commonest fractures, classifications of ankle injuries are still debated, with modern surgeons decrying the use of the so-called antiquated system based on injury mechanisms. Despite glaring lacunae, especially with lack of reproducibility using modern methods, and an understanding that many fractures which we now see routinely may not fit into this classification, the Lauge-Hansen classification is still worth preserving. It clarifies some, if not most deforming forces, allows us to understand the ankle injury in a three-dimensional concept, both on the medial and lateral sides, and allows an understanding of reduction methods. The limitations in its use are the lack of prognostication ability, the fact that most reductions are now done open, and the recognition of some transitional and posterior malleolar injuries unclassifiable by it. Not being alphanumeric is another disadvantage in the computer age. Nevertheless, it is an important landmark in the history of orthopedics, and in the development of our understanding of ankle fractures. Even in 2017, it is too important a piece of work to be discarded, and modern orthopedic students are encouraged to gain an understanding of this classification system, and to combine it with the newer ones to get an overall picture of the ankle injury.

Keywords: Ankle fractures, Danis-Weber classification, Fracture classification, Lauge-Hansen, Malleoli.

How to cite this article: Dhillon MS, Kumar L, Sharma S, Mehta N. The Lauge-Hansen Classification for Ankle Fractures: Is it Relevant in 2017? J Foot Ankle Surg (Asia-Pacific) 2017;4(2):53-56.

Source of support: Nil

Conflict of interest: None


 
Case Report
Vishnu Senthil, Vivek Pandey, Kiran Acharya

Rare Lytic Lesions of the Talus: A Diagnostic Challenge

[Year:2017] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:54] [Pages No:49-52][No of Hits : 1149]


ABSTRACT

Patients presenting with prolonged ankle pain following trivial trauma should be clinically and radiologically investigated. We present two young adults with incidentally diagnosed lytic lesion of talus. They underwent extended curettage and biopsy. Histopathological examination proved as aneurysmal and simple bone cyst and went for a secondary procedure of bone grafting. We want to emphasize the importance of differential diagnosis in the management of lytic lesions and complete removal of tumor.

Keywords: Aneurysmal bone cyst, Ankle trauma, Curettage, Simple bone cyst, Talus.

How to cite this article: Senthil V, Pandey V, Acharya K. Rare Lytic Lesions of the Talus: A Diagnostic Challenge. J Foot Ankle Surg (Asia-Pacific) 2017;4(1):49-52.

Source of support: Nil

Conflict of interest: None


 
RESEARCH ARTICLE
Gyaneshwar Tank, Rohit Gupta, Amit Gupta, Ravikant Rohila

Comparative Study of Platelet-rich Plasma and Corticosteroid Injection in the Treatment of Plantar Fasciitis

[Year:2017] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:51] [Pages No:84-89][No of Hits : 924]


ABSTRACT

Introduction: Platelet-rich plasma (PRP) is promoted nowadays as an ideal autologous biological blood-derived product. It enhances wound healing, bone healing, tendon healing and is currently being widely used.

Aims and objectives: A prospective cohort study was done to assess the efficacy of autologous PRP injection and to compare it with corticosteroid injection in treatment of plantar fasciitis (PF).

Materials and methods: Eighty patients were included in the study and divided into two groups. Group I (30 patients) received PRP injection and group II (50 patients) were given steroid injection. Patients were clinically assessed at different intervals. Functional outcome was evaluated on the basis of visual analog scale (VAS) and foot and ankle ability measure (FAAM) scores. Planter fascia thickness was assessed pre- and postinjection by ultrasound.

Results: Platelet-rich plasma and corticosteroid injection groups at the initial visit had VAS score of 8.44 and 8.38 respectively which was reduced to 1.46 and 3.02 at the end of 6 months. The PRP and corticosteroid injection groups at the initial visit had FAAM score of 29.9 and 31.6 respectively which increased to 83.4 and 69.1 at the end of 6 months. After injection, the PRP group had significant reduction (35.90%) in the thickness of plantar fascia as compared to corticosteroid group (28.67%).

Conclusion: Treatment of PF with PRP extract reduces pain and significantly increases function, exceeding the effect of steroid on long-term follow-up.

Keywords: Foot ankle ability measure score, Plantar fasciitis, Platelet-rich plasma, Visual analog scale.

How to cite this article: Tank G, Gupta R, Gupta A, Rohila R. Comparative Study of Platelet-rich Plasma and Corticosteroid Injection in the Treatment of Plantar Fasciitis. J Foot Ankle Surg (Asia-Pacific) 2017;4(2):84-89.

Source of support: Nil

Conflict of interest: None


 
RESEARCH ARTICLE
Satish R Gawali, Shashikant B Kukale, Pramod V Nirvane, Raman O Toshniwal

Management of Fracture of Posterior Malleolus, Trimalleolar Fracture, Fracture Dislocations, and Syndesmosis Injury of Ankle Joint

[Year:2017] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:51] [Pages No:90-96][No of Hits : 825]


ABSTRACT

Background: Malleolar fractures of ankle are usually complex injuries, as they are associated with significant ligament and soft tissue injury-injury to syndesmosis and injury to medial and lateral collateral ligaments. The open reduction and internal fixation is not feasible until recovery of significant soft tissue injury and subsidence of edema. Malleolar fractures are articular fractures and have associated subluxation and dislocation of talus. The aims of treatment are to restore normal anatomy and provide sufficient stability for early movements.
Malleolar fractures more often require open reduction. Our study aimed to know efficacy and outcome of operative management of them.

Materials and methods: From January 2013 to March 2015, 35 patients with syndesmotic ankle injury and trimalleolar ankle fractures admitted to the Government Medical College, Latur, India, were operated and followed up prospectively.

Results: Mean age of patients is 35 years (25-60 years). Fracture union was seen radiologically in 3 to 4 months depending on fracture geometry. We achieved good to excellent results of 90%.

Conclusion: We conclude that malleolar fractures encountered in clinical practice need thorough assessment and meticulous surgical intervention, as they are associated with injury to ligament complex, i.e., ligament is a key structure in the stability of ankle mortise. Abduction and external rotation types of injuries are the most common types to be seen. We achieved stable fixation and performed early mobilization of the ankle joint, which limits the complications of mainly ankle stiffness. Each malleolus has got its inherent associated complications and calls for special attention for identifying associated conditions, such as syndesmotic injury, talus dislocation in posterior malleolar fractures, irreducible ankle dislocation with trimalleolar fracture, and entrapped fibula behind tibia with irreducible dislocation.

Keywords: Irreducible fracture dislocations, Malleolar fracture, Syndesmosis injury, Trimalleolar fracture.

How to cite this article: Gawali SR, Kukale SB, Nirvane PV, Toshniwal RO. Management of Fracture of Posterior Malleolus Trimalleolar Fracture, Fracture Dislocations, and Syndesmosis Injury of Ankle Joint. J Foot Ankle Surg (Asia-Pacific) 2017;4(2):90-96.

Source of support: Nil

Conflict of interest: None


 
Original Article
Mannan Ahmed, Sanjeev Jindal, Vivek Bansal, Rajesh Kapila, Radhe S Garg

Evaluation of Outcome of Management of Distal Tibial Fractures using Distal Tibial Locking Plate

[Year:2017] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:54] [Pages No:5-9][No of Hits : 787]


ABSTRACT

Aim: The modern trend in the management of fractures is fast changing in favor of rigid fixation and early mobilization with minimal period of plaster immobilization. We present a prospective cohort study of fixation of distal tibial fractures with distal tibial locking plate and its evaluation in terms of maintenance of accurate anatomical reduction, stable fixation, with early restoration of functions.

Materials and methods: A total of 25 patients with median age 38.04 years, age range 19 to 70, with distal tibial fracture were treated by using distal tibial locking plate. The outcome was evaluated using American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.

Results: The majority of fractures in this study were extraarticular (64%), while 20% were partial articular fractures and 16% were complete articular fractures. Out of 25 patients, 6 patients had superficial infection and 1 patient had deep infection. Out of 25 cases, 5 cases had union by 16 weeks, 11 cases by 20 weeks, 7 cases had union by 30 weeks, and 2 cases had nonunion. According to AOFAS score at 6 months, 4 cases had score of 31 to 70 and 21 cases had score of 71 to 100.

Conclusion: The results of our study corroborate with the contemporary literature relevant to distal tibial fracture fixation performed with various locking plates. Therefore, locking compression plate is a good device to stabilize the fracture of the distal tibial.

Clinical significance: Locking plates are a good device to stabilize the fractures of the distal tibial, especially when used in conjunction with meticulous intraoperative handling of soft tissue and active participation of patients in rehabilitation program. Studying this alternative method expands the present knowledge for the management of distal tibial fractures.

Keywords: American Orthopedic Foot and Ankle Society anklehindfoot score, Arbeitsgemeinschaft Fur Osteosynthesefragen/ Orthopaedic Trauma Association classification, Cohort study, Distal tibial fracture, Distal tibial locking plate

How to cite this article: Ahmed M, Jindal S, Bansal V, Kapila R, Garg RS. Evaluation of Outcome of Management of Distal Tibial Fractures using Distal Tibial Locking Plate. J Foot Ankle Surg (Asia-Pacific) 2017;4(1):5-9.

Source of support: Nil

Conflict of interest: None


 
BOOK REVIEW
Rakesh John, Mandeep S Dhillon

The Foot–Arts, Myths, and Secrets

[Year:2017] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:51] [Pages No:103-104][No of Hits : 719]


ABSTRACT

History, arts, and philosophy are fun subjects! While this topic is debatable, especially among surgeons, Dr Stefan Rammelt and Dr Hans Zwipp have put in an extraordinary effort to compile a unique and one-of-its-kind book about a very unique structure of our body-the foot! As you waft through the pages of this informative as well as entertaining book, you can feel the deep passion that the editors and authors of this book share about the foot. Although orthopedic surgeons are highly knowledgeable about the anatomy, pathomechanics, and surgical treatment of various foot disorders, it is surprising how much we don’t know about the evolution of the foot from prehistorical times to the modern times and the importance of foot in history, language, arts, and folklore!


 
Original Article
Hari O Aggarwal, Manjit Singh, Sanjeev Sareen, Deepak Vashisht

Repair of the Chronic Rupture of tendo Achilles Tendon using Peroneus Brevis Tendon

[Year:2017] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:54] [Pages No:30-34][No of Hits : 702]


ABSTRACT

Aim: To report 20 patients who underwent repair of chronic rupture of tendo Achilles tendon with peroneus brevis tendon.

Materials and methods: Records of 6 women and 14 men aged 26 to 58 (mean, 36) years who underwent repair of chronic rupture of tendo Achilles tendon with peroneus brevis tendon transfer were reviewed. Patients were evaluated at 3, 9, and 12 months using the foot and ankle outcome score (FAOS) questionnaire.

Results: Out of 20 patients, 4 developed superficial skin complications which healed gradually in 3 patients, and 1 patient underwent skin grafting surgery. No patient had a re-rupture of the tendo Achilles tendon. At the 1-year follow-up, all patients achieved good functional outcome in terms of the FAOS.

Conclusion: Repair of chronic rupture of tendo Achilles tendon with peroneus brevis tendon transfer achieved good functional outcome.

Keywords: Tendo Achilles tendon, Chronic rupture, Tendon transfer.

How to cite this article: Aggarwal HO, Singh M, Sareen S, Vashisht D. Repair of the Chronic Rupture of tendo Achilles Tendon using Peroneus Brevis Tendon. J Foot Ankle Surg (Asia-Pacific) 2017;4(1):30-34.

Source of support: Nil

Conflict of interest: None


 
SYMPOSIUM-Review Article
Uttam C Saini, Mandeep S Dhillon, Udai Cheema, Rajesh K Rajnish

Open Fractures of the Ankle: Management Options and Factors influencing Outcomes

[Year:2017] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:51] [Pages No:69-76][No of Hits : 645]


ABSTRACT

Open ankle fractures are rare injuries among all the ankle fractures and commonly occur after high-velocity trauma in road traffic accidents resulting in varying amounts of soft-tissue loss, periosteal stripping, microbial contamination, bone loss, and vascular injury. Management of open ankle fractures remains a daunting task due to the complex osseo-ligamentous complex, relatively thin soft-tissue coverage around the joint, propensity for wound infection and complications, and the risk of impaired functional ability. Management in the emergency trauma room includes initial stabilization of the patient, focused history, and detailed clinical evaluation determining the level and type of injury, extent of wound contamination, soft-tissue and/or bone loss, and neurovascular status of the injured limb followed by radiographic evaluation. Early antibiotics administration and wound assessment, irrigation, aseptic dressing, and temporary splintage form the cornerstone of initial orthopedic stabilization of open fractures. There is a general consensus that all open ankle fractures need early debridement and fixation to restore articular congruity and alignment of fracture fragments although the timing of internal/definitive fixation of open ankle fractures is still debatable. Common complications include superficial and deep infections, marginal skin necrosis, compartment syndrome, nonunion/malunion, and secondary osteoarthritis. Timely interventions improve orthopedic outcomes in these patients.

Keywords: Ankle fractures, Debridement, Flap cover, Foot fractures, Open fractures.

How to cite this article: Saini UC, Dhillon MS, Cheema U, Rajnish RK. Open Fractures of the Ankle: Management Options and Factors influencing Outcomes. J Foot Ankle Surg (Asia- Pacific) 2017;4(2):69-76.

Source of support: Nil

Conflict of interest: None


 
Review Article
Zile S Kundu, Milind Tanwar, Kuldeep Singh, Bikramjeet Singh

Clinical Assessment, Risk Factors, and Classification of Diabetic Foot: An Overview

[Year:2017] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:54] [Pages No:35-39][No of Hits : 628]


ABSTRACT

Diabetes mellitus is one of the commonest medical conditions prevalent all over the globe. This is associated with many complications due to its progressive involvement of various organ systems. The basic mechanism includes gradual onset of neuropathies, vasculopathies, retinopathies, reduced immune systems, and thus increased incidence of infections. Foot involvement is quite common in diabetics. This should be prevented and treated early with a team approach. Every effort should be made to prevent ulcer formation and further complications like deep-seated infection and gangrene. For proper understanding, the basic concepts regarding the risk factors, pathogenesis, classification, and proper assessment/ examination are of paramount importance. This study outlines these aspects, which will help in prevention of dreadful complications and early treatment of the diabetic foot.

Keywords: Classification, Clinical, Diabetic foot, Risk factors.

How to cite this article: Kundu ZS, Tanwar M, Singh K, Singh B. Clinical Assessment, Risk Factors, and Classification of Diabetic Foot: An Overview. J Foot Ankle Surg (Asia-Pacific) 2017;4(1):35-39.

Source of support: Nil

Conflict of interest: None


 
Editorial
Rajiv Shah

Ankle Fracture Symposium

[Year:2017] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:51] [Pages No:iv][No of Hits : 622]


ABSTRACT

Ankle fractures are one of the most commonly treated injuries in day to day practice. Yet the understanding of these complex injuries still remain unclear. Many controversies surrounding ankle fractures are still unresolved. Advances in the field have always been with an attempt to make complexities simpler. With this symposium, based on current literature; we aim to bring out many recent facets of ankle fracture management.


 
Original Article
Sanjay Agarwala, Pranshu Agrawal, Anshul S Sobti

Surgical Management of Haglund’s Syndrome in Nonathletes: A Retrospective Review

[Year:2017] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:54] [Pages No:19-22][No of Hits : 574]


ABSTRACT

Aim: The present study was carried to retrospectively analyze the outcomes of patients with Haglund’s syndrome treated with author’s preferred technique and to compare and validate its results by comparing with the available literature.

Materials and methods: Twenty-four patients who had undergone surgery for Haglund’s syndrome between 2008 and 2014 were identified retrospectively from records and included in the study cohort. Visual analog scale (VAS) score and American Orthopedic Foot and Ankle Score (AOFAS) were computed preoperatively and at each follow-up, the records of which were available through patient notes. The mean follow-up period was 32 months (12–55 months).

Results: The VAS score improved from a mean of 6.9 to 0.5 at 6 weeks follow-up and to 0.12 at 12 weeks follow-up. The mean AOFAS increased from 55.54 ± 7.26 to 91.20 ± 6.84 at 12 weeks follow-up. None of the patients had any significant complications. At 1 year follow-up, all the patients had returned to their predisease activity level.

Conclusion: Open surgical management with an individualized approach provides good to excellent outcomes with minimal complication rates.

Keywords: Achilles tendinopathy, Haglund’s, Heel pain.

How to cite this article: Agarwala S, Agrawal P, Sobti AS. Surgical Management of Haglund’s Syndrome in Nonathletes: A Retrospective Review. J Foot Ankle Surg (Asia-Pacific) 2017;4(1):19-22.

Source of support: Nil

Conflict of interest: None


 
Case Report
Karan R Choudhry, Vishal N Mandlewala

Recurrence of Giant Cell Tumor of Posterior Tibialis Tendon

[Year:2017] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:54] [Pages No:45-48][No of Hits : 512]


ABSTRACT

Aim: To present a case of recurrence of giant cell tumor of the tendon sheath (GCT TS) and its management.

Background: The GCT TS is a solitary benign soft tissue tumor of the limbs. It usually appears as an enlarging painless mass and has a synovial origin. The GCT TS is approximately 1.6% of all soft tissue tumors. The GCT TS of tibialis posterior is very rare, and recurrence has not been reported.

Case report: A 21-year-old male patient presents with complaint of swelling over right ankle since 3 years. Patient was operated for swelling 10 years back, and histological examination revealed GCT TS. Patient was asymptomatic for 3 years after operation and then developed swelling since last 3 years. On local examination, hypertrophic scar mark 1 × 4 cm was present at right medial malleolus. Ultrasonography of right medial malleolus and magnetic resonance imaging were done for further evaluation. Under spinal anesthesia and tourniquet control, medial approach was taken extending from 7 cm above the medial malleolus posterior to the tibia up to the talar head. Tissue was cleared and was sent for histopathology, which confirmed the diagnosis of GCT TS. Patient is on regular follow-up since then, and there has not been any recurrence.

Conclusion: Though rare, recurrence of GCT TS can occur, and it should be properly investigated and completely excised. Clinical significance: Though recurrence of GCT TS is rarely reported, it needs to be dealt with a high index of suspicion and treated aggressively.

Keywords: Excision, Giant cell tumor, Recurrence, Tibialis posterior tendon sheath.

How to cite this article: Choudhry KR, Mandlewala VN. Recurrence of Giant Cell Tumor of Posterior Tibialis Tendon. J Foot Ankle Surg (Asia-Pacific) 2017;4(1):45-48.

Source of support: Nil

Conflict of interest: None


 
Original Article
Ashu Rastogi, Anil Bhansali

Diabetic Foot Infection: An Indian Scenario

[Year:2016] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:56] [Pages No:71-79][No of Hits : 3954]


ABSTRACT

Introduction: Diabetes mellitus is assuming epidemic proportions and with that an increasing burden of diabetic foot complications. Diabetic foot infections (DFIs) contribute not only to morbidity, amputation, and increased health-care costs but also to mortality.

Aim: To review the literature regarding the epidemiology and management of DFIs in India.

Results: The socioepidemiology of diabetic foot and its complications in India is different from the West. There is a considerable delay in seeking a physician for foot problems, as patients continue invalidated and indigenous methods of treatment. At presentation, most of the foot ulcers are chronic, harbor infection, and neuropathic in origin compared to the West with predominantly neurovascular ulcers. A predominance of Gram-negative bacterial species is reported in DFIs, with Pseudomonas aeruginosa as the most common isolated organism. An initial empirical antibiotic choice covering Gram-negative bacteria is suggested.

Conclusion: There are very few studies on the countrywide prevalence of foot complications from India. In India, DFIs behave differently from the West because of sociocultural and economic differences. We need indigenous ways for prevention and management of DFIs in India.

Keywords: Amputation, Antibiotics, Diabetic foot, Diabetic foot infection, Foot ulcer, IWGDF, Osteomyelitis, Peripheral arterial disease.

How to cite this article: Rastogi A, Bhansali A. Diabetic Foot Infection: An Indian Scenario. J Foot Ankle Surg (Asia-Pacific) 2016;3(2):71-79.

Source of support: Nil

Conflict of interest: None


 
Original Article
Satish R Gawali, Shashikant B Kukale, Pramod V Nirvane, Raman O Toshniwal

Management of Fractures of Distal third Tibia by Interlock Nailing

[Year:2016] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:63] [Pages No:15-22][No of Hits : 2321]


ABSTRACT

Introduction: Most of the distal third tibia is subcutaneous and has precarious blood supply. Fractures of the distal third tibia have comminution at the fracture site, as it is metaphyseal cancellous bone with a thin shell of cortex , and have associated significant soft tissue injury. Generally, skin condition is not satisfactory due to ecchymosis, blebs, swellings, wounds, etc. All these factors contribute to delayed union, nonunion, and malunion.

The present study is about the ability to maintain a mechanically stable reduction in the distal third tibia with intramedullary nail, when lower 4 cm of tibia not fractured. If associated with fibula fracture (in lower 10 cm), it is always fixed as a rule to give stability to syndesmosis and stability to same-level tibia fracture.

Materials and methods: From January 2013 to March 2015, 60 patients of distal tibia fracture admitted to Government Medical College and Hospital, Latur, were operated and followed up prospectively.

Results: Mean age of patients was 35 years (25-50). Fracture union was seen radiologically within 3 to 4 months, depending on fracture geometry.

Conclusion: We conclude that results of fractures of distal third tibia not extending into lower 4 cm of tibia treated with interlock nailing were found satisfactory. Meticulous planning and placement of nail at the center of a wide metaphysis in the anteroposterior and lateral is mandatory to avoid varus, valgus, and posterior tilt. Polar screw or temporary K-wire during surgery is very helpful. Same-level fibula fracture fixation with a plate or square nail is very effective for stability of reduction.

Keywords: Fibula fixation, Fracture distal third tibia, Interlock tibia nailing.

How to cite this article: Gawali SR, Kukale SB, Nirvane PV, Toshniwal RO. Management of Fractures of Distal third Tibia by Interlock Nailing. J Foot Ankle Surg (Asia-Pacific) 2016;3(1):15-22.

Source of support: Nil

Conflict of interest: None


 
Review Article
Rakesh Sharma, Rajesh Kapila, Ashwani K Sharma, Jagsir Mann

Diabetic Foot Disease—Incidence and Risk Factors: A Clinical Study

[Year:2016] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:63] [Pages No:41-46][No of Hits : 1174]


ABSTRACT

Diabetic foot disease is one of the most common, yet dreaded long-term complication of diabetes mellitus, especially in developing countries. It is the single-most common cause of nontraumatic lower limb amputations. Various studies worldwide have shown an incidence of diabetic foot to be 15 to 25%. Elderly males who are smokers and have habit of alcohol intake and have long duration of type 2 diabetes are at major risk for this problem. The other significant risk factors are: Poor glycemic control, neuropathy, angiopathy, nephropathy, and retinopathy. Management of diabetic foot disease involves a multidisciplinary approach. The present study was conducted with the aim to know about the prevalence of the incidence of diabetic foot disease in diabetic patients and to enumerate the different risk factors associated with it for the occurrence of diabetic foot disease in such patients at the time of presentation.

Over a period of 1 year, a prospective study involving 1,016 diabetic patients as per World Health Organization (WHO) criteria were screened for diabetic foot disease. All cases were graded as per University of Texas classification. Incidence of diabetic foot disease was calculated and the risk factors were identified through proper history taking, clinical evaluation, and specialized tests as and when required.

Some of the common risk factors identified in our study were: Elderly males from poor families having long-term type 2 diabetes and who were smokers and alcoholics. Many of these patients had other systemic complications of diabetes in the form of neuropathy, retinopathy, angiopathy, and nephropathy as well. A very important, yet easily modifiable risk factor was poor glycemic control. Our conclusion from the study is being that the diabetic foot disease is much common than anticipated in diabetes mellitus patients; it is on the rise and the resultant morbidity is very crippling to the affected individuals. Therefore it is very important to identify the risk factors and educate patients about them, especially the modifiable risk factors, so that its incidence and the morbidity can be brought down significantly.

Keywords: Angiopathy, Diabetes, Diabetic foot disease, Neuropathy.

How to cite this article: Sharma R, Kapila R, Sharma AK, Mann J. Diabetic Foot Disease―Incidence and Risk Factors: A Clinical Study. J Foot Ankle Surg (Asia-Pacific) 2016;3(1):41-46.

Source of support: Nil

Conflict of interest: None


 
Review Article
Sundararajan Silvampatti, HS Nagaraja, S Rajasekaran

Midfoot Charcot Arthropathy: Overview and Surgical Management

[Year:2016] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:56] [Pages No:97-106][No of Hits : 1053]


ABSTRACT

Midfoot Charcot arthropathy is a progressive deforming condition characterized by recurrent ulceration leading to high morbidity and amputation with lack of timely intervention. Nonoperative treatment is largely reserved for acute phase disease. Recent trend in management is early surgical interventions which could alter deforming forces and prevent deformity progression, as well as surgeries which provide osseously stable plantigrade foot. However, there are no clear-cut evidencebased guidelines regarding timing of interventions and method of techniques in surgical stabilization. This study discusses about surgical technique in the management of midfoot Charcot.

Keywords: Early surgery, External fixation, Fusion bolts, Internal fixation, Midfoot charcot.

How to cite this article: Silvampatti S, Nagaraja HS, Rajasekaran S. Midfoot Charcot Arthropathy: Overview and Surgical Management. J Foot Ankle Surg (Asia-Pacific) 2016;3(2):97-106.

Source of support: Nil

Conflict of interest: None


 
Original Article
Senthil Rajagopalan, Pradeep Moonot, Anurag Sangar, Heath Taylor

Revision Ankle Syndesmosis Fixation: Functional Outcome after TightRope® Fixation

[Year:2016] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:63] [Pages No:23-27][No of Hits : 1009]


ABSTRACT

Introduction: Syndesmotic injuries present a challenge to orthopedic surgeons. Malreduction of the syndesmosis has been reported to cause instability and secondary osteoarthritis and is correlated with poor subjective and objective outcomes. There are very few studies that report the outcome after revision fixation of these injuries. Previous studies have reported varying techniques for revision syndesmosis reconstruction, including screw fixation and tendon transfers.

We present the results of the use of the TightRope® suture for revision syndesmosis fixation. This implant has the advantage of maintaining physiological motion whilst allowing for healing of syndesmotic ligaments and prevents the need for further surgery to remove screws in already scarred soft tissues.

Materials and methods: We retrospectively analyzed 124 patients who required syndesmotic stabilization from January 2000 until December 2009. Eight of these 124 patients required surgical revision of their failed syndesmosis fixation, each of which was stabilized with the TightRope® Suture. All eight patients were followed up and their outcomes assessed. Seven of the eight patients in our study had technically sound initial fixation of the syndesmosis. Four of the eight patients had syndesmotic separation after screw removal 10 weeks after primary fixation.

Results: In our study, 6 of the 8 patients had good or satisfactory outcomes based on American Orthopedic Foot and Ankle Society (AOFAS) scores. In spite of accurate revision fixation of the syndesmosis, two patients required further surgery. One patient had conversion to an ankle fusion because of persistent syndesmotic widening and ongoing pain after revision surgery. Another patient required syndesmotic arthrodesis as a result of persistent pain.

Conclusion: TightRope® suture fixation is a good method of syndesmosis stabilization in patients requiring revision surgery. Randomized studies would be required to compare the effectiveness of this method of fixation with screw fixation.

Keywords: Ankle, Fracture, Revision, Syndesmosis, Tight rope.

How to cite this article: Rajagopalan S, Moonot P, Sangar A, Taylor H. Revision Ankle Syndesmosis Fixation: Functional Outcome after TightRope® Fixation. J Foot Ankle Surg (Asia- Pacific) 2016;3(1):23-27.

Source of support: Nil

Conflict of interest: None


 
How I Do It
Mandeep S Dhillon, Sharad Prabhakar, Nitesh Gahlot, Bhava RJ Satish

Minimally Invasive Management of Fracture Calcaneum

[Year:2016] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:63] [Pages No:47-52][No of Hits : 839]


ABSTRACT

Modern usage of minimally invasive methods has been applied to fractures of the calcaneus with good effect in the 21st century. The Essex-Lopresti maneuver has been modified, distraction devices are being judicially used, and the advent of image intensifiers and small joint arthroscopes have allowed accurate visualization of the reduced fracture as well as joint surfaces. It is important to understand that the three-dimensional (3D) anatomy, Böhler and Gissane angles, and heel height have to be restored. The surgeon should be ready to convert to an open procedure at any time. We describe here the method we use in our institute, and this is one of the many methods of managing this complex injury.

Keywords: Calcaneus fracture, Kirschner wire fixation of calcaneus fractures, Minimally invasive surgery, Percutaneous reduction.

How to cite this article: Dhillon MS, Prabhakar S, Gahlot N, Satish BRJ. Minimally Invasive Management of Fracture Calcaneum. J Foot Ankle Surg (Asia-Pacific) 2016;3(1):47-52.

Source of support: Nil

Conflict of interest: None


 
Case Report
Himmat Dhillon, Prateek Behera, Sharad Prabhakar, Sidak Dhillon, Mandeep S Dhillon

Stress Fracture of the Fibular Sesamoid Bone of the Foot in Cricket: An Unusual Injury in Bowlers

[Year:2016] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:63] [Pages No:59-62][No of Hits : 820]


ABSTRACT

An unusual case of fibular sesamoid stress fracture in the back foot of a bowler is presented. The diagnosis was delayed due to the lack of awareness of the support medical staff of the cricketer. Special radiological views and computed tomographic scans confirmed the diagnosis; nonoperative measures cured the pain, but this recurred on subsequent bowling activities. The current player gave up the game, but the literature supports operative intervention in cases that fail conservative regimens. This case is presented to highlight the occurrence of this rare injury in fast bowlers, and we recommend careful examination of the foot when it is the trailing foot, because this has significant forefoot dorsiflexion during the stance phase.

Keywords: Cricket injury, Fast bowler, Fibular sesamoid, Sesamoid fracture, Stress fracture.

How to cite this article: Dhillon H, Behera P, Prabhakar S, Dhillon S, Dhillon MS. Stress Fracture of the Fibular Sesamoid Bone of the Foot in Cricket: An Unusual Injury in Bowlers. J Foot Ankle Surg (Asia-Pacific) 2016;3(1):59-62.

Source of support: Nil

Conflict of interest: None


 
Review Article
Thomas E Serena, Raphael A Yaakov, Eliot N Mostow

Use of Cellular and Tissue-based Product in the Treatment of Diabetic Foot Ulcers

[Year:2016] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:56] [Pages No:92-96][No of Hits : 657]


ABSTRACT

Introduction: The prevalence of diabetes has been rising sharply and the rise in chronic wounds parallels this trend. Lower extremity ulcers present a serious complication for people with diabetes. While debridement of necrotic tissue and off-loading plays an important role in wound healing, many patients with diabetic foot ulcers (DFUs) fail to heal with standard of care (SOC) alone. Unresolved ulcers can lead to complications, such as osteomyelitis and amputation. There continues to be a need for the evaluation of novel wound therapies that can accelerate wound healing and lower the cost of care associated with DFUs. This paper presents recent evidence for the use of cellular and/or tissue-based products (CTPs) and offers an approach for selecting an appropriate CTP.

Materials and methods: A systematic literature search was conducted using PubMed, Embase, Medline, Cochrane library, and NHS Economic Evaluation Database. Full-length articles in English were assessed for relevance to select studies on effectiveness and economic evaluations. Additionally, Google Scholar was used to gather relevant literature on commonly used CTPs, including Apligraf®, EpiFix®, and Dermagraft®.

Findings: Results from randomized controlled trials (RCTs) provided evidence for the superior efficacy of CTPs over SOC alone in treatment of chronic DFUs. In recent studies evaluating commonly used CTPs, significantly higher number of DFUs achieved complete closure with EpiFix® when compared to either Apligraf® or Dermagraft®. While cost-effectiveness studies continue to be limited, current literature suggests that CTPs can decrease the long-term costs associated with the care of DFUs by increasing the healing rate, reducing recovery time, and lowering the risk of infection and complications. Cellular and/or tissue-based products (CTPs) may result in higher average number of ulcer-free months and lower average number of amputations or resections compared to SOC alone.

Keywords: Advanced wound care, Bioengineered skin, Cellular and/or tissue-based products, Cost-effectiveness, Diabetic foot ulcers, Human skin equivalent, Value analysis.

How to cite this article: Serena TE, Yaakov RA, Mostow EN. Use of Cellular and Tissue-based Product in the Treatment of Diabetic Foot Ulcers. J Foot Ankle Surg (Asia-Pacific) 2016;3(2):92-96.

Source of support: Nil

Conflict of interest: None


 
Review Article
Rajeev Vohra, Avtar Singh, Kanwar K Singh, Inderdeep Singh, Navjot Singh, Abhishek Bansal

Management of Open Injuries of the Foot: Current Concepts

[Year:2016] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:63] [Pages No:28-40][No of Hits : 622]


ABSTRACT

Open fractures of the foot are rare, and a few surgeons see the whole spectrum of these injuries. When confronted with open injuries of the foot, the decision to salvage the foot needs to be taken after thorough assessment of bony and soft tissue injuries and the associated life-threatening injuries. Foot and ankle surgeon, plastic surgeon, and vascular surgeon must work as a team to provide a pain-free functional and plantigrade foot that fits into a conventional shoe or a brace.

Aggressive debridement and wound management remains the cornerstone of modern surgical treatment. If debridement and wound management can convert a contaminated traumatic wound into a clean surgical wound, which can be adequately covered within 7 to 10 days, then definitive skeletal fixation is advised. In the presence of severe soft tissue and bony injuries, the reconstruction needs to be staged and planned to match the unique personality of the patient and injury.

Amputation can be a positive step toward decreasing the overall morbidity in the presence of severe injury and poor host biology. Despite appropriate treatment, the prognosis of the patient with severe open foot injuries remains guarded.

Keywords: Foot, Fractures, Open.

How to cite this article: Vohra R, Singh A, Singh KK, Singh I, Singh N, Bansal A. Management of Open Injuries of the Foot: Current Concepts. J Foot Ankle Surg (Asia-Pacific) 2016;3(1): 28-40.

Source of support: Nil

Conflict of interest: Nonexya


 
Original Article
David C Hatch, Vlad Sauciuc, Emily C Wagler, Brian Schenavar, David Armstrong

Negative Pressure Wound Therapy: Past, Present, and Future

[Year:2016] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:56] [Pages No:80-87][No of Hits : 609]


ABSTRACT

From antiquity to today, tissue repair and wound healing have played a central role in health. Over the past generation, negative pressure wound therapy (NPWT) has shown itself to be a valuable adjunct in wound healing, with effects that are superior to many traditional wound treatment modalities. Applications of NPWT are widespread, with use seen in management of severe soft tissue loss, prevention of surgical site infections, treatment of diabetic foot ulcers, and improving skin graft survival. This article reviews the biology, mechanics, and therapeutic effects of NPWT, while also discussing social and economic aspects of use. Finally, various possible adjustments and modifications to NPWT are addressed, all of which contribute to the continual evolution of NPWT at the frontier of modern wound healing and surgery.

Keywords: Negative pressure wound therapy, Vacuumassisted closure; Wound healing.

How to cite this article: Hatch DC, Sauciuc V, Wagler EC, Schenavar B, Armstrong D. Negative Pressure Wound Therapy: Past, Present, and Future. J Foot Ankle Surg (Asia-Pacific) 2016;3(2):80-87.

Source of support: Nil

Conflict of interest: None


 
Case Report
SS Jha

Ankle Fusion in grossly deformed “Idiopathic Charcot’s Neuroarthropathy”

[Year:2016] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:56] [Pages No:117-120][No of Hits : 581]


ABSTRACT

This typical case aged 65 years is reported with history of injury in childhood, clinically has progressed to ankle fusion following surgery 7 years early with multiple screws. Anti-tumor necrosis factor / methotrexate is recommended early in management to prevent progression of inflammatory pathology.

Keywords: Arthrodesis, Charcot’s neuroarthropathy, Diabetic neuropathy.

How to cite this article: Jha SS. Ankle Fusion in grossly deformed “Idiopathic Charcot’s Neuroarthropathy”. J Foot Ankle Surg (Asia-Pacific) 2016;3(2):117-120.

Source of support: Nil

Conflict of interest: None


 
Case Report
Viswanathan Chathoth, Sriram Sankaranarayanan

A Rare Case of Primary Synovial Chondromatosis of the Ankle

[Year:2016] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:63] [Pages No:53-55][No of Hits : 581]


ABSTRACT

Synovial chondromatosis is a condition where the synovial lining of joints, tendons, or bursa undergoes metaplasia into cartilaginous loose bodies. Primary synovial chondromatosis of the ankle joint is very rare and less commonly reported in literature. We report a case of primary synovial chondromatosis of the ankle that we encountered in our clinic. A 33-year-old male patient presented with a history of multiple swellings around his right ankle joint, along with dull aching pain. Both the clinical examination and X-rays were suggestive of primary synovial chondromatosis of the ankle. We performed an open loose body removal and synovectomy of the ankle. Histopathology confirmed the diagnosis of primary synovial chondromatosis. We report this case owing to its rarity of presentation.

Keywords: Ankle, Loose body removal and synovectomy, Synovial chondromatosis.

How to cite this article: Chathoth V, Sankaranarayanan S. A Rare Case of Primary Synovial Chondromatosis of the Ankle. J Foot Ankle Surg (Asia-Pacific) 2016;3(1):53-55.

Source of support: Nil

Conflict of interest: None


 
Original Article
Govind Shivram Kulkarni, Milind Govind Kulkarni, Sunil Govind Kulkarni, Vidisha Sunil Kulkarni, Ruta Milind Kulkarni

Retrograde Tibial Nailing for Arthrodesis of Ankle and Subtalar Joints

[Year:2015] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:49] [Pages No:60-70][No of Hits : 2235]


ABSTRACT

Introduction: When ankle and subtalar joints are arthritic and painful they both need fusion. Principles of treatment by fusion are removal of cartilage till bleeding of subchondral bone, keeping the joint surfaces congruous, proper positioning of the foot and ankle and stable fixation.

Materials and methods: During the last 10 years, 16 cases of retrograde nailing were done. Eight cases were post-traumatic, one was tuberculosis, three for Charcot joint and three for osteoarthritis of the ankle joint, and one case of rheumatoid arthritis. All patients had severe pain instability, varying degrees of deformities and antalgic gain. Two cases were treated with supracondylar femoral interlocking nail. Nine cases were treated with antegrade tibial nail as retrograde nail. Nine cases were treated with retrograde tibial nails with posteroanterior calcaneal screws. Two cases were treated with special nails newly designed by Smith and Nephew. Initially, older the calcaneus had two latero-medial screws. Newer designs of nail have two posteroanterior screws, passing from calcaneal tuberosity through the nail-one towards cuboid and the other towards talus. These two screws have increased the stability of the construct and improved the outcome. Mann’s technique of ankle fusion was used. Fibular strut was used as bone graft and fixed by one screws into the tibia and the other into talus. Indian tibia is smaller in diameter with a narrow intramedullary canal. Indian tibia need to have a nail with a smaller diameter.

Results: When supracondylar femoral and antegrade tibial nails were used, 4 out of 5 failed. When newer design nails with posteroanterior calcaneal screws were used, outcome improved 2 out of 11 failed.

Conclusion: Newer design of retrograde tibial nails with two posteroanterior screws have greatly improved the outcome of pantalar arthrodesis.

Keywords: charcot joint, Pantalar arthrodesis, Post-traumatic arthritis, Retrograde tibial nail.

How to cite this article: Kulkarni GS, Kulkarni MG, Kulkarni SG, Kulkarni VS, Kulkarni RM. Retrograde Tibial Nailing for Arthrodesis of Ankle and Subtalar Joints. J Foot Ankle Surg (Asia- Pacific) 2015;2(2):60-70.

Source of support: Nil

Conflict of interest: None


 
Original Article
Saravanan Sanniyasi, Jagan Balu, Cunnigaiper Dhanasekharan Narayanan

Fungal Infection: A Hidden Enemy in Diabetic Foot Ulcers

[Year:2015] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:49] [Pages No:74-76][No of Hits : 1582]


ABSTRACT

Diabetic foot ulcers are on the rise and increasingly associated with amputations. Fungal infections have recently been implicated in the nonhealing nature of these wounds. One hundred five patients treated as in-patients with nonhealing diabetic ulcers in a tertiary care hospital were included in this prospective study. Wound swabs and deep tissue biopsies were taken from these ulcers for fungal stain and culture and bacterial culture. Once the fungal stain or the culture study is positive, oral Fluconazole was started. Nineteen patients grew fungus in the ulcer, commonest species being Candida tropicalis (10.5%). The most common bacterial organism isolated with fungal infection is Pseudomonas followed by Enterococcus. Patients on prolonged antibiotic therapy showed statistically significant increase in fungal infection. Patients who underwent amputation within 15 days of admission were higher in fungal culture positive group, due to progression of ulcer in spite of antibiotic therapy. There is a definite correlation between incidence of amputation and fungal infection in whom antifungal therapy was not started, though not statistically significant. Fourteen patients, who did not undergo amputation, had faster wound healing and lesser progression of disease, with none of them requiring amputation after initiating antifungal therapy. Our study reveals that there is a definite relation between fungal infections and nonhealing nature of diabetic ulcers. Further randomized trials are necessary to substantiate this finding.

Keywords: Amputation, Antifungal therapy, Diabetic foot, Fungal infection.

How to cite this article: Sanniyasi S, Balu J, Narayanan CD. Fungal Infection: A Hidden Enemy in Diabetic Foot Ulcers. J Foot Ankle Surg (Asia-Pacific) 2015;2(2):74-76.

Source of support: Nil

Conflict of interest: None


 
Case Report
Rajesh Rachha, Anand Gorva

Os Intermetatarseum Revisited: A Case Report of Rare Variant and Review of Literature

[Year:2015] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:50] [Pages No:47-50][No of Hits : 1563]


ABSTRACT

Os intermetatarseum is the rarest accessory bone of the foot. It is usually found between 1st and the 2nd metatarsal bases arising typically from the base of the 2nd metatarsal. Only a few symptomatic cases have been reported in the literature, which were either unilateral or bilateral and radiographically they were of different shapes and sizes. We present a large, bilaterally symmetrical and unusual variant of os intermetatarseum. To our knowledge, such large, bilaterally symmetrical, fully formed os intermetatarseum, fusing to both metatarsals has not been described before. The case report also describes the surgical anatomy during the excision of os intermetatarseum and review of the literature to date.

Keywords: Os intermetatarseum, Accessory bone of the foot, Metatarsal bar, Deep peroneal nerve compression.

How to cite this article: Rachha R, Gorva A. Os Intermetatarseum revisited: A Case Report of Rare Variant and Review of Literature. J Foot Ankle Surg (Asia-Pacific) 2015;2(1): 47-50.

Source of support: Nil

Conflict of interest: None


 
Original Article
Sanjay Agarwala, Anshul Shyam Sobti

Lateral Wall Decompression for Malunited Calcaneal Fractures

[Year:2015] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:49] [Pages No:80-85][No of Hits : 1252]


ABSTRACT

Aim: The purpose of this case series is to reintroduce Kashiwagi decompression as a viable treatment option for malunited calcaneal fractures, delineate the operative technique, and discuss its advantages.

Materials and methods: From August 2004 to May 2013, 18 patients with Sanders type I malunited calcaneal fractures with lateral heel pain and impingement were treated with the lateral wall decompression technique. The functional outcome was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale.

Results: Eleven patients were males and seven were females, with an average age of 48.4 years. Ten patients had left feet fracture and eight had right feet fracture. Among all the 18 patients with a ‘poor’ score at baseline, 2 (11.11%) scored ‘excellent’, 11 (61.11%) scored ‘good’ and 3 (16.67%) scored ‘fair’ during postoperative evaluation. The average time to return to daily activities was 10.2 weeks (8-12.5 weeks).

Conclusion: Lateral wall osteotomy and decompression effectively addresses the pathology in cases of lateral abutment due to a malunited calcaneal fracture. This technique has advantages of ensuring a reliable resolution with good clinical outcomes and produces fewer postoperative complications.

Clinical significance: Malunion is a common complication with calcaneal fracture. It affects normal function. In malunited calcaneal fractures, the lateral wall of the calcaneum forms a lateral wall exostosis that causes both subfibular impingement and peroneal tendinopathy or displacement. There is need for a viable treatment option for malunions with lateral wall exostosis after calcaneal fractures. This study describes a surgical technique as a solution for the above.

Keywords: Case series, kashiwagi decompression, kashiwagi syndrome, lateral wall exostosis, peroneal tendinopathy or displacement, Sanders type I malunited calcaneal fractures, subfibular impingement.

How to cite this article: Agarwala S, Sobti AS. Lateral Wall Decompression for Malunited Calcaneal Fractures. J Foot Ankle Surg (Asia-Pacific) 2015;2(2):80-85.

Source of support: Nil

Conflict of interest: None


 
Case Report
Sundararajan Silvampatti, AR Pradeep, S Rajasekaran

Neglected Stress Fracture of Navicular Bone: A Case Report and Literature Review

[Year:2015] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:50] [Pages No:38-40][No of Hits : 1205]


ABSTRACT

Navicular fractures are the most common stress fractures of tarsal bones, with calcaneum fractures accounting for almost all of the remainder. Diagnosis is commonly delayed and these fractures carry on with a risk of displacement and nonunion, thus affecting the outcome.
A 17-year-old university level female athlete presented with pain along the anteromedial aspect of her foot suffering since one- and half-year without a history of specific trauma. On evaluation, she was found to have stress fracture of navicular bone which was neglected and has gone for nonunion.
Satisfactory outcome was achieved by open reduction and internal fixation with cancellous screw and iliac crest strut grafting followed by appropriate rehabilitation.

Keywords: Stress fracture, Navicular, strut graft, cancellous screw.

How to cite this article: Silvampatti S, Pradeep AR, Rajasekaran S. Neglected Stress Fracture of Navicular Bone: A Case Report and Literature Review. J Foot Ankle Surg (Asia-Pacific) 2015;2(1): 38-40.

Source of support: Nil

Conflict of interest: None


 
Original Article
Rakesh Dalal, Hari Kovilazhikathu Sugathan, Rajesh Rachha

Proximal Medial Tibial Bone Graft Harvesting in Foot and Ankle Surgery

[Year:2015] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:50] [Pages No:27-30][No of Hits : 1099]


ABSTRACT

Cancellous bone graft harvesting from proximal tibia is usually by a lateral approach. We describe our technique and results in harvesting proximal tibia bone graft by a medial approach in foot and ankle surgery. Our results confirm that medial proximal tibial bone graft harvesting is a relatively safe and easy procedure to obtain adequate amount of autogenous cancellous bone graft. Donor site morbidity was found to be very low and fusion rate was found to be excellent in a variety of foot and ankle surgeries.

Keywords: Proximal medial tibia, Bone graft harvesting, Foot and ankle.

How to cite this article: Dalal R, Sugathan HK, Rachha R. Proximal Medial Tibial Bone Graft Harvesting in Foot and Ankle Surgery. J Foot Ankle Surg (Asia-Pacific) 2015;2(1):27-30.

Source of support: Nil

Conflict of interest: None


 
Original Article
Gautam D Salunkhe

Percutaneous Repair for the Treatment of Rupture of the Achilles Tendon: A Study of 20 Cases

[Year:2015] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:49] [Pages No:51-59][No of Hits : 1069]


ABSTRACT

Background: Despite many techniques used for repair of the ruptured Achilles tendon, uncertainty of healing of the surgical wound remains a problem. This mainly determines the success of the surgery. The long-term results generally result in healing of the rupture, but poor healing of the wound occurs repeatedly. This causes apprehension in advising surgery over a conservative approach.

Objectives: To study the outcome of 20 cases of acute rupture of the Achilles tendon treated by the percutaneous technique.

Materials and methods: From March 2004 to March 2012, 20 cases of acute Achilles tendon rupture were treated by percutaneous repair by the method of Ma and Griffith. Modifications were used in distal end and delayed repairs. Immobilization was used after surgery. Postoperative complications were observed, and results assessed using the Leppilahti score after 6 months. Follow-up was done for 2 years.

Results: Percutaneous repair had significantly good results in 95% cases. There were two cases of sural nerve hypoesthesia, which was a minor problem and in no way hampered the longterm result. There were no re-ruptures. Patient satisfaction was high in terms of final result and cosmesis.

Conclusion: Percutaneous repair is a safe and reliable method for repair of the Achilles tendon rupture. It has a minor complication rate, and is advisable over open surgery.

Keywords: Achilles tendon rupture, Percutaneous repair, Wound healing.

How to cite this article: Salunkhe GD. Percutaneous Repair for the Treatment of Rupture of the Achilles tendon: A Study of 20 Cases. J Foot Ankle Surg (Asia-Pacific) 2015;2(2):51-59.

Source of support: Nil

Conflict of interest: None


 
Original Article
Abhay Shankar Dube, Manvender Gaur, Avinash Rastogi, Rajat Kapoor

Correlation of Foot Bimalleolar Angle with Pirani Scoring System in Clinical Evaluation of Congenital Talipes Equinovarus

[Year:2015] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:50] [Pages No:17-21][No of Hits : 1045]


ABSTRACT

The correlation of anteromedial foot bimalleolar angle with Pirani score evaluated prospectively in 120 children (204 feet) with congenital talipes equinovarus (CTEV). The patients were divided into groups I, II and III based on clinical severity before casting, having the Pirani score 0 to 2, 2.5 to 4 and 4.5 to 6 respectively. Mean foot bimalleolar angle 75.75°, 67.62° and 58.28° of groups I, II and III respectively was correlated by standard deviation with their Pirani scores to evaluate the severity difference among the groups before initiation of the casting treatment. The change in clinical severity or Pirani score was further correlated with the change in mean foot bimalleolar angle at the time of completion of casting and before bracing. The foot bimalleolar angle is an objective, quantitative and reproducible method which can be used to classify, prognosticate and to monitor the progress of the treatment.

Background: The prospective observational study on role of foot bimalleolar angle against the Pirani scoring in clinical evaluation of club foot in 120 children (204 feet) with mean age of 5.4 months treated by Ponseti technique of casting.

Keywords: Congenital talipes equinovarus, Foot bimalleolar angle, Pirani scoring and Podogram.

How to cite this article: Dube As, Gaur M, Rastogi A, Kapoor R. Correlation of Foot Bimalleolar Angle with Pirani Scoring System in Clinical Evaluation of Congenital Talipes Equinovarus. J Foot Ankle Surg (Asia-Pacific) 2015;2(1):17-21.

Source of support: Nil

Conflict of interest: None


 
Case Report
Rajesh Kapila, Partap singh Verka, Radhe sham Garg, Mannan Ahmed

Lateral Swivel Dislocation of the Hindfoot: A Case Report and Literature Review

[Year:2015] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:50] [Pages No:41-43][No of Hits : 908]


ABSTRACT

Lateral swivel dislocation, a subtype pattern of dislocations occurring at mid tarsal joint is a rare type of injury. A medially or laterally directed force applied to the forefoot causes dislocation of the talonavicular joint but not subtalar joint. The calcaneum alongwith the remaining foot swivels on the intact interosseous talocalcaneal ligament. The present case report is a more rare lateral swivel type of dislocation of talonavicular joint in a 25-year-old male. The article also presents a comprehensive review of literature and management of such type of injuries of the hindfoot .

Keywords: lateral swivel dislocation, medial swivel dislocation, subtalar dislocation, talonavicular dislocation.

How to cite this article: Kapila R, Verka Ps, Garg Rs, Ahmed M. Lateral Swivel Dislocation of the Hindfoot: A Case Report and Literature Review. J Foot Ankle Surg (Asia-Pacific) 2015;2(1): 41-43.

Source of support: Nil

Conflict of interest: None


 
Case Report
Nirmal Raj Gopinathan, Mandeep S Dhillon, Balaji Saibaba, Siva Swaminathan Santhanam, Rajendra Kumar Kanojia

Ethibond Suture Granuloma following Tibialis Anterior Tendon Transfer Mimicking Osteomyelitis of Foot

[Year:2015] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:49] [Pages No:97-100][No of Hits : 780]


ABSTRACT

Tibialis anterior tendon transfer is routinely done for the correction of dynamic supination deformity of foot in children with congenital talipes equinovarus (CTEV). Surgeons commonly make use of a nonabsorbable suture-‘ethibond number 2’ for anchoring the transferred tendon to the new recipient site. We would like to report a case of suture granuloma following tibialis anterior tendon transfer in a 4 years old child, presenting with a swelling and discharging sinus clinically mimicking osteomyelitis. Unlike osteomyelitis, the patient did not have fever or pain clinically, nor was any organism detected microbiologically. The clinical presentation and the successful management of the case have been described in detail along with relevant review of literature.

Keywords: Club foot, Ethibond, Suture granuloma, Tendon transfer.

How to cite this article: Gopinathan NR, Dhillon MS, Saibaba B, Santhanam SS, Kanojia RK. Ethibond Suture Granuloma following Tibialis Anterior Tendon Transfer Mimicking Osteomyelitis of Foot. J Foot Ankle Surg (Asia-Pacific) 2015;2(2):97-100.

Source of support: Nil

Conflict of interest: None


 
Original Article
Ashwani Sadana, Chandra Prakash Pal, Karuna Shankar Dinkar

An Assessment of the Results of Controlled Fractional Distraction by Joshi’s External Stabilization System in Club Foot

[Year:2015] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:50] [Pages No:13-16][No of Hits : 752]


ABSTRACT

Club foot is amongst the most common of congenital deformities. Its incidence is 1 to 2 per 1000 live births. At birth, the diagnosis can be made by observing the foot for forefoot adduction, hindfoot inversion and equinus deformity. The study was conducted to evaluate the role of controlled fractional distraction in the management of neglected club feet by Joshi’s external stabilization system (JESS). Total of 18 cases (22 feet) were studied, which were corrected by JESS. All cases were evaluated clinically, radiologically, podographically, and Pirani scoring system, both, before and after the correction. Severity of the deformities and clinical correction was assessed by Pirani score. All patients achieved good clinical results as per Pirani score, radiological evaluation showed that all subjects achieved the normal range of values.

Keywords: Club foot, Inversion, JESS, Pirani, Adduction, Neglected.

How to cite this article: Sadana A, Pal CP, Dinkar KS. An Assessment of the Results of Controlled Fractional Distraction by Joshi’s External Stabilization System in Club Foot. J Foot Ankle Surg (Asia-Pacific) 2015;2(1):13-16.

Source of support: Nil

Conflict of interest: None


 
Original Article
Jambu Nageswaran, Ganesan Ganesan Ram, Samuel Chittaranjan Bedford

Ankle Hindfoot Scale vs Comprehensive Srmc Scoring System in Acute Achilles Tendon Rupture

[Year:2015] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:49] [Pages No:77-79][No of Hits : 741]


ABSTRACT

The existing scoring system like American Orthopaedic Foot and Ankle Society (AOFAS)-ankle hindfoot scale, Leppilahti et al scoring system, Achilles tendon total rupture score, foot and ankle outcome score, the physical activity scale (PAS) questionnaire and Tegner activity score were not designed to evaluate all the parameters following surgical treatment of Achilles tendon rupture. Hence, we developed a comprehensive score called the comprehensive Sri Ramachandra Medical College (SRMC) scoring system. We compared the results of 60 patients who were surgically treated for acute Achilles tendon rupture using our comprehensive SRMC scoring system with the most commonly used AOFAS-ankle hindfoot scale.

Results: We found that there was 6.7% poor results using our scoring system, whereas no poor results using AOFAS scoring system mainly because our scoring system also assesses quality of life, patient satisfaction and tendon strength. Similarly, there was 10% fair results in our scoring system compared to 3.3% in AOFAS scale indicating that our scoring system is more sensitive. Comprehensive SRMC scoring system was found to be reliable statistically as per alpha method (α = 0.7787) and was statistically significant at p < 0.001.

Conclusion: Comprehensive SRMC scoring system was found to be superior to AOFAS scale specifically for analyzing Achilles tendon repair. Poor results are likely to be picked up by our scoring system which has been shown in our results.

Keywords: Acute Achilles tendon rupture, Parameters of AOFAS-Ankle hindfoot scale, Parameters of comprehensive SRMC scoring system.

How to cite this article: Nageswaran J, Ram GG, Bedford SC. Ankle Hindfoot Scale vs Comprehensive Srmc Scoring System in Acute Achilles Tendon Rupture. J Foot Ankle Surg (Asia- Pacific) 2015;2(2):77-79.

Source of support: Nil

Conflict of interest: None


 
Original Article
Bing Xie, Da-peng Zhou, Jing Tian

First and Second Metatarsal Wire and Button Fixation with First and Fifth Bunionectomies for Correction of Splay Foot

[Year:2015] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:50] [Pages No:1-7][No of Hits : 732]


ABSTRACT

Splay foot is a common foot deformity causing pain and disability. Various osteotomy techniques have been recommended for correction of the intermetatarsal angle, with variable success rates. Knowing that wire and button fixation device can provide strong and stiff repair, the aim of the present study was to assess the clinical and radiographic outcomes following 1st and 2nd metatarsal wire and button fixation with 1st and 5th bunionectomies in patients with symptomatic splay foot. The preoperative and postoperative radiological measurements and American Orthopaedic Foot and Ankle Society (AOFAS) scores were statistically assessed in 12 patients (19 feet) with symptomatic splay foot using Wilcoxon signed rank test. The postoperative hallux valgus angle, 1st and 2nd intermetatarsal angle, and maximum distance between 1st and 5th metatarsal heads decreased significantly (p < 0.05). The AOFAS score improved significantly from 49.0 ± 6.0 to 82.0 ± 5.0 points (p < 0.05). The overall postoperative radiological and clinical outcomes in patients with symptomatic splay foot suggest that the technique of 1st and 2nd metatarsal wire and button fixation with 1st and 5th bunionectomies is safe, feasible and effective for surgical treatment of splay foot deformity.

Keywords: Hallux valgus, Splay foot, Tailor’s bunion.

How to cite this article: Xie B, Zhou D-P, Tian J. First and Second Metatarsal Wire and Button Fixation with First and Fifth Bunionectomies for Correction of Splay Foot. J Foot Ankle Surg (Asia-Pacific) 2015;2(1):1-7.

Source of support: Nil

Conflict of interest: None


 
Original Article
Sudhir Singh, Dharmendra Kumar, Alok Kumar Yadav

Ottawa Ankle Rule: An Indian Perspective

[Year:2015] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:50] [Pages No:8-12][No of Hits : 714]


ABSTRACT

Introduction: Foot and ankle injuries are common clinical conditions treated by orthopedic surgeons accounting for 6 to 12% of the patients seen in emergency. Currently, almost all patients with foot and ankle injuries undergo radiographic examination to exclude fractures; however, fewer than 15% of these patients actually have fractures, thus, most of these radiographs are unnecessary. Unwarranted radiographic examination increases the demands on the healthcare system and also results in prolonged patient waiting times. Ottawa ankle rule (OAR) evolved to reduce the number of radiography and waiting time for patients in emergency department by excluding fractures using only clinical examination. Although, it has good sensitivity but it has not been much popular and not included in medical curriculum.

Aim: The aim of the study is to implement the OAR in an Indian tertiary care trauma setup with two different levels of clinical examiners (1st year postgraduate junior resident and senior resident) and report the finding.

Materials and methods: This prospective study was done in the Department of Orthopedics, for a period of 15 months. Clinical examiners were shown and given a video presentation about the Oar and a printed copy of the rules were provided to all. Clinical diagnosis of both levels of clinical examiners were evaluated and analyzed.

Results: Three hundred cases met our inclusion criteria. In first clinical examination done by junior resident, 115 clinically significant fractures were suspected while senior resident suspected 69 fractures. Radiography showed 5 cases with missed fractures. Accuracy of OAR by JR is 82.33% and by SR is 97.0%.

Conclusion: Ottawa ankle rule are very effective and can identify all clinically relevant fractures of ankle and foot with increased accuracy and sensitivity when applied by a trauma specialists. Although, these rules can also be applied by general doctors so as to help them to screen patients who need radiography in acute ankle injury, but it is more sensitive when it is applied by specialist doctor.

Keywords: Clinical decision rules, Ottawa ankle rule, Ankle injury.

How to cite this article: Singh S, Kumar D, Yadav AK. Ottawa Ankle Rule: An Indian Perspective. J Foot Ankle Surg (Asia- Pacific) 2015;2(1):8-12.

Source of support: Nil

Conflict of interest: None


 
Case Report
Vaibhav Bagaria, Amit Nemade, Nilesh Joshi

Achilles Tendon Rupture Secondary to Kite String (Manja) Injury: A Rare Etiology seen in Two Cases

[Year:2015] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:49] [Pages No:90-93][No of Hits : 709]


ABSTRACT

Achilles tendon is the strongest and the thickest tendon of the human body. Due to its superficial location and stress, it has to face due to loading, the tendon is susceptible to injuries and ruptures. This is aggravated due to the precarious blood supply in the region and also age-related changes that occur in the tendon. Of the specific causes age-related and steroid induced tendinosis and sports injuries are the commonest mechanism of injury. Kite playing is a very common sport in the Indian subcontinent, which involves the use of a string (manja) often coated with powdered glass to fly the kite. Many grievous injuries are reported due to its use especially in two wheeler riders. However, to the best of our knowledge a kite thread injury causing Achilles tendon tear due to direct impact has so far not been reported. In this case series, we describe two cases that had such injury and a brief note on specifics of management of this case is described.

Keywords: Achilles tendon rupture, Manja, Tendon repair.

How to cite this article: Bagaria V, Nemade A, Joshi N. Achilles Tendon Rupture Secondary to Kite String (Manja) Injury: A Rare Etiology seen in Two Cases. J Foot Ankle Surg (Asia-Pacific) 2015;2(2):90-93.

Source of support: Nil

Conflict of interest: None


 
Case Report
Mithun Shriniwas Jakkan, Vikas Madhav Agashe, Rajeev Soman, Alan Almeda

Subcutaneous Foot Phaeohyphomycosis due to Alternaria alternata

[Year:2015] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:50] [Pages No:44-46][No of Hits : 679]


ABSTRACT

Alternaria alternata, a saprophytic pigmented fungus, usually manifests in immunocompromised hosts. A case of 53-year-old male who underwent renal transplant 4 years back with recurrent foot swelling and previously misdiagnosed and treated for actinomycosis is presented. The swelling was completely excised, staining and culture diagnosed it to be Alternaria alternata infection which responded very well to oral voriconazole.

Keywords: Phaeohyphomycosis, A. alternata, Voriconazole.

0 Abbreviations: ITS: Internal transcribed spacer, MIC: Minimum inhibitory concentration.

How to cite this article: Jakkan MS, Agashe VM, Soman R, Almeda A. Subcutaneous Foot Phaeohyphomycosis due to Alternaria alternata. J Foot Ankle Surg (Asia-Pacific) 2015;2(1):44-46.

Source of support: Nil

Conflict of interest: None


 
Original Article
Sanjay Agarwala, Ganesh Mohrir, Anshul Shyam Sobti

Novel Semi-open Technique for Repair of Acute Rupture of Achilles Tendon

[Year:2015] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:50] [Pages No:22-26][No of Hits : 624]


ABSTRACT

Background: The most common complication of open repair of Achilles tendon is skin necrosis and wound problems, especially in the distal part, where the blood supply to the skin is precarious. Minimally invasive and percutaneous techniques have become popular as they overcome this problem but these techniques put the sural nerve at risk and have high incidence of rerupture. We have devised a semi-open technique, which incorporates the advantages of both techniques and at the same time avoids their complications. The aim of this study was to evaluate the outcome of this technique.

Materials and methods: Twenty-two patients with acute Achilles tendon rupture were operated with this new technique. The operative technique included incision up to the tendon gap, no distal extension and a percutaneous passage of nonabsorbable suture through the distal stump with approximation and plantaris augmentation. The results were compared on the basis of functional results (Leppilahti score), cosmetic results, patient satisfaction and complications encountered.

Results: Fifteen patients had excellent (68.%) and seven had good (32%) results according to the Leppilahti score. Our average scar length was 6.2 cm and all patients were fully satisfied with their results and rehabilitation. There was one case of superficial infection and no cases of rerupture or sural nerve injury.

Conclusion: This new semi-open technique serves as a perfect combination of open and percutaneous surgeries, providing excellent functional and cosmetic results and minimizing the incidence of complications at the same time.

Keywords: Tendoachilles, Rupture, Repair, Percutaneous, Semi-open.

How to cite this article: Agarwala S, Mohrir G, Sobti AS. Novel Semi-open Technique for Repair of Acute Rupture of Achilles Tendon. J Foot Ankle Surg (Asia-Pacific) 2015;2(1):22-26.

Source of support: Nil

Conflict of interest: None


 
Review Article
Hui Chu, Hang Yu, Kejun Zhu, Ding Ren, Xibing Xu, Hong Huang

Analysis of the Operative Treatment for Pilon Fracture

[Year:2015] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:49] [Pages No:86-89][No of Hits : 617]


ABSTRACT

Background: Pilon fracture is common clinical joint fracture and difficult to treat. It has high requirements on reduction and fixation. The selection of treatments is challengeable. In order to recover the ankle function maximize, there are many treatments proposed in paper recently, but no further studies. Therefore, patients of our hospital with Pilon fracture were followed up and the treatments were compared by different operations.

Materials and methods: Eighty-eight patients from August 2003 to October 2010 treated with conservative treatment, open reduction and internal fixation, external fixation combined with limited open reduction and internal fixation and external fixation were retrospectively analyzed.

Results: Seventy-eight cases were followed up in 88 patients, 66 cases were treated with operation. Postoperative complications: malunion in 7 cases, wound infection and delayed healing in 5 cases, delayed union in 2 cases and traumatic arthritis in 4 cases. At the same time, ankle function of type III Pilon fracture after operation was scored by Tornetta.

Conclusion: choose a suitable operation style and time according to Pilon fracture type and degree of soft tissue and use external fixator combined with limited internal fixation for fracture reduction properly, a good clinical effect can be achieved after surgery.

Keywords: external fixation, limited internal fixation, pilon fracture.

How to cite this article: Chu H, Yu H, Zhu K, Ren D, Xu X, Huang H. Analysis of the Operative Treatment for Pilon Fracture. J Foot Ankle Surg (Asia-Pacific) 2015;2(2):86-89.

Source of support: Nil

Conflict of interest: None


 
Review Article
Nirmal Raj Gopinathan, Mandeep Singh Dhillon, Balaji Saibaba

Hindfoot Infections: What to do and How?

[Year:2015] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:50] [Pages No:31-37][No of Hits : 536]


ABSTRACT

Hindfoot infections though uncommon, pose a major cause of orthopedic concern in view of their delayed diagnosis and lack of adequate expertise in their successful management. If untreated, these infections can cause significant morbidity and functional impairment which can even culminate in amputation. Successful management of this otherwise disabling condition warrants a thorough knowledge about the various etiopathological factors, the myriad clinical presentations, available diagnostic modalities and specific management strategies-medical and/or surgical. Timely diagnosis and appropriate intervention is the key for eradicating hindfoot infections and restoring the patient’s functional status.

Keywords: Infection, Hindfoot, Calcaneum, Talus, Management.

How to cite this article: Gopinathan NR, Dhillon MS, Saibaba B. Hindfoot Infections: What to do and How? J Foot Ankle Surg (Asia-Pacific) 2015;2(1):31-37.

Source of support: Nil

Conflict of interest: None


 
Original Article
Hu Mu, Xu Xiangyang, Bi Gang

Isolated Fractures of the Sustentaculum Tali: Injury Characteristics and Surgical Technique for Reduction Management

[Year:2014] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:48-51][No of Hits : 5495]


ABSTRACT

Isolated fractures of sustentaculum tali are rare and often missed at an initial visit. They can be difficult to manage and may have implications for future hindfoot function. This article describes sustentacular fracture patterns and characteristics, and a method of surgical treatment via a medial approach to the calcaneus. During the last 6 years, 11 recent isolated sustentacular fractures without calcaneal posterior facet involvement were surgically-treated at our hospital. Of these all underwent open reduction and internal fixation via medial approach to the calcaneus. Patient charts, X-ray radiographs and CT scans were reviewed for injury characteristics and associated musculoskeletal injures. Five patients had intra-articular middle facet involvement, and two had subtalar joint subluxation. By cannulated screws reduction was maintained through fractures rigidly fixation. Isolated fracture of the sustentaculum tali is tend to be ignored and easily misdiagnosed as acute ankle sprain. Open reduction and internal fixation of this fractures was reliable and should be procedure via medial approach.

Keywords: Sustentaculum tali, Calcaneus, Fracture, Open reduction and internal fixation, Foot injuries.

How to cite this article: Mu H, Xiangyang X, Gang B. Isolated Fractures of the Sustentaculum Tali: Injury Characteristics and Surgical Technique for Reduction Management. J Foot Ankle Surg (Asia-Pacific) 2014;1(2):48-51.

Source of support: Nil

Conflict of interest: None


 
Review Article
Gershon Volpin, Zvi Cohen, Genadi Kirshner, Haim Shtarker

Displaced Intra-articular Calcaneal Fractures: Current Concepts and Modern Management

[Year:2014] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:40] [Pages No:24-31][No of Hits : 2956]


ABSTRACT

The calcaneal fractures are usually the result of high-energy injuries, falls from height and road traffic accidents and constitutes about 2% of all fractures. 60 to 75% of them are displaced intra-articular fractures and 90% of them are usually in males, mainly in industrial workers.there is still controversy regarding classification and treatment. The purpose of this review is to present the modern surgical modalities for these type of fractures.

Keywords: Calcaneus, Calcaneal fractures, Foot, Ffractures, High energy fractures, Ilizarov, ORIF.

How to cite this article: Volpin G, Cohen Z, Kirshner G, Shtarker H. Displaced Intra-articular Calcaneal Fractures: Current Concepts and Modern Management. J Foot Ankle Surg (Asia-Pacific) 2014;1(1):24-31.

Source of support: Nil

Conflict of interest: None


 
Original Article
Waheeb AK Al-azzani, Tarique Sabah, Vishal Paringe, Declan O'Doherty

Evaluation of Ankle Tightrope Syndesmosis Fixation

[Year:2014] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:40] [Pages No:1-4][No of Hits : 2735]


ABSTRACT

Introduction: Ankle sprains are among the most common of bone and joint injuries. Historically, distal tibiofibular syndesmotic injuries have been treated using syndesmotic metal screws to prevent diastasis. However, the use of screws meant that physiological micro-movement between the tibia and fibula was lost which often results in loosening and breaking of the screws. Tightrope fixation was a new technique that has been developed to overcome these complications and allowed some degree of flexibility similar to that offered by natural ligaments. The aim of our study was to evaluate such injuries.

Materials and methods: We conducted a retrospective study reviewing all clinical records of cases of patients with injuries of the distal tibofibular syndesmosis treated with the ankle tightrope (Arthrex Inc) in our institution between January 2008 and January 2011.

Results: A total of 42 patients were reviewed. We encountered five cases with complications (12%). Of those: three required removals due to prominent knot, one soft-tissue irritation and one with uncomplicated wound infection.

Conclusion: Our study, one of the largest so far evaluating complications of tightrope fixation, demonstrates that one in eight patients treated with tightrope will experience complication.

Keywords: Ankle, Syndesmosis, Distal tibiofibular syndesmosis, Instability, TightRope.

How to cite this article: Al-azzani WAK, Sabah T, Paringe V, O’Doherty D. Evaluation of Ankle Tightrope Syndesmosis fixation. J Foot Ankle Surg (Asia-Pacific) 2014;1(1):1-4.

Source of support: Nil

Conflict of interest: None


 
Review Article
Hajo Thermann

Total Ankle Arthroplasty: Why does It fail?

[Year:2014] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:41-47][No of Hits : 2669]


ABSTRACT

Over the past 10 years, total ankle arthroplasty (TAA) has been established as an alternative to treat osteoarthritis of the ankle. In this review, problems occurring after TAA will be analyzed and solutions presented. Furthermore, my own 18 years experience regarding the failure or poor success of a TAA implantation will be illustrated. The range of revision options from leaving the prosthesis to a complete modification as well as the explantation with subsequent arthrodesis will be presented algorithmically. Another problem of the poor success of prosthetic implants exists in the flat learning curve resulting from the surgeons’ lack of routine coupled with the difficult pathology with deformity and stiffness of the ankle.

Keywords: Total ankle replacement, malposition of ankle replacement, Revision.

How to cite this article: Thermann H. Total Ankle Arthroplasty: Why does it fail? J Foot Ankle Surg (Asia-Pacific) 2014;1(2):41-47.

Source of support: Nil

Conflict of interest: None


 
Original Article
G Raghunandan

Management of Neglected Achilles Tendon Ruptures with Flexor Hallucis Longus Transfer

[Year:2014] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:40] [Pages No:5-8][No of Hits : 2564]


ABSTRACT

From July 2000 to July 2012, we have treated 48 cases with neglected Achilles tendon ruptures in Government General Hospital, Kurnool, India, with modified flexor hallucis longus (FHL) transfer. Thirty-three patients had achillodynia and 29 had local steroid infiltration. Thirty-six patients presented with ruptures in hypovascular zone II and, in 31, repair was after 3 weeks, graded as late (Inglis). The patients were managed based on a standardized evaluation and surgical protocol. The technique of FHL transfer was simplified by anchoring the tendon in a vertical transcalcaneal tunnel. The results were evaluated by Quigley's method, 100 point scoring system of Leppilahti, and recently updated with AOFAS hind foot score. The follow-up ranged from 2.5 to 12.2 years. The follow-up suggested that patients with FHL transfer showed significantly lower mean wound healing times and weight-bearing time and functional recovery times when compared with patients who had peroneal transfer, for neglected ruptures. The results are presented, analyzed and discussed.

Keywords: Achilles tendon, Peroneus brevis, Flexor hallucis longus, tendinosis, tendon transfer.

How to cite this article: Raghunandan G. Management of Neglected Achilles Tendon Ruptures with Flexor Hallucis Longus Transfer. J Foot Ankle Surg (Asia-Pacific) 2014;1(1):5-8.

Source of support: Nil

Conflict of interest: None


 
Original Article
Christopher E Gross, Beau J Kildow, Selene G Parekh

Reconstruction of Chronic Peroneal Tendon Tears

[Year:2014] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:60-64][No of Hits : 2548]


ABSTRACT

Peroneal tendon tears are one of many causes of chronic lateral ankle pain. The goal of surgery is to restore function and provide dynamic stabilization. Surgical repair is indicated for tears comprising of less than 50% of the cross-sectional area of the tendon. If the peroneal tear is greater than 50% and the tissue bed remains mobile, an allograft reconstruction may be performed. In this case report, reconstruction using a peroneal tendon allograft was performed on a 21-year-old female with chronic lateral ankle pain and weakness after retearing her peroneal brevis 10 weeks status postprimary repair. Technique involved excising the portion of diseased tendon and anastomosing the proximal and distal ends to a peroneal tendon allograft. Six weeks postoperation, patient regained full range of motion and strength with minimal pain.

Keywords: Peroneal, Allograft, Reconstruction, Chronic lateral ankle pain.

How to cite this article: Gross CE, Kildow BJ, Parekh SG. Reconstruction of Chronic Peroneal Tendon Tears. J Foot Ankle Surg (Asia-Pacific) 2014;1(2):60-64.

Source of support: Nil

Conflict of interest: None


 
Original Article
Siddhartha Sharma, Mandeep S Dhillon, Gaurav Sharma, Rakesh John

Nutcracker Cuboid Fractures are never Isolated Injuries

[Year:2014] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:40] [Pages No:9-11][No of Hits : 2279]


ABSTRACT

Background: Cuboid fractures are rare injuries, and treatment methods are ill-defined. The term ‘nutcracker’ fracture denotes a comminuted fracture of the cuboid which can lead to significant lateral column shortening and pain if treated improperly. The published literature discusses these injures with implications of such fractures being isolated injuries, and little mention is made of the complex forefoot injuries associated. We believe that such fractures cannot occur in isolation and due attention is often not paid to associated foot instabilities/injuries which may be subtle at times. To validate our hypothesis, we present our evaluation of 12 such cases, all of which were part of a complex foot injury pattern and emphasize on appropriate treatment of associated foot injuries in such cases.

Materials and methods: From the trauma database of a level I trauma center, all cases of cuboid fracture were retrospectively identified, investigated for mechanism of injury, radiographs were reviewed, associated injuries in the foot were documented, and treatment methods applied were recorded.

Results: We identified 12 cases of cuboid fracture. There were 10 males and 2 females, mean age being 20.2 years (14-32 years). No cuboid fracture was found to be an isolated injury, and associated foot injuries included calcaneus fracture in 3 cases, Lisfranc injury in 3 cases and complex midfoot-forefoot injury in 6 cases. Eight cases (66.7%) were open and 4 (33.3%) were closed. Complications included superficial wound infection in 2 cases, deep infection in 1 case and reflex sympathetic dystrophy along with nonunion of the 1st and 2nd metatarsals in one case.

Conclusion: Our results substantiate the hypothesis that nutcracker cuboid fractures cannot occur in isolation and represent one part of a complex, high energy foot injury. In addition to maintaining length of the lateral column and fixing the cuboid, due attention must also be paid to the associated foot injuries, especially the medial column, so as to have a properly aligned, functional and painless foot.

Keywords: Cuboid fracture, nutcracker fracture, midfoot injuries.

How to cite this article: Sharma S, Dhillon MS, Sharma G, John R. Nutcracker Cuboid Fractures are never Isolated Injuries. J Foot Ankle Surg (Asia-Pacific) 2014;1(1):9-11.

Source of support: Nil

Conflict of interest: None


 
Original Article
Mandeep S Dhillon, Nitesh Gahlot

Are Results of Surgical Treatment for Calcaneal Fractures better than Nonoperative Treatment?

[Year:2014] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:40] [Pages No:17-23][No of Hits : 2230]


ABSTRACT

The methods of treatment of displaced intra-articular calcaneal fractures (DIACFs) have always been surrounded by controversies, whether operative treatment is better or conservative. Some randomized controlled trials (RCTs) have been published comparing the operative vs conservative management options for DIACFs, but the conclusions are varied, with some of them supporting operative treatment while others showing equivocal results. To get some clarity on this subject, we reviewed 9 RCTs and 4 meta-analyses to evaluate the evidence that was present for both operative and nonoperative methods of management. Most studies report equivocal outcomes of operatively and nonoperatively managed DIACFs when looked at; however on stratification of groups, the evidence seemingly points towards better functional results in the operated patients who do not develop a complication, but poorer outcomes in patients with more severe injury patterns (higher Sanders’ Type). Complications were associated with both groups; no differentiation between closed and open fractures is made in most studies, leading to slightly higher rate of complications in the operated group (probably due to open cases inclusion); nevertheless the difference was not found significant. Despite a high level of interest in calcaneal fractures, the current evidence in published literature does not support a specific management protocol for DIACFs, although detailed analysis points to importance of patient selection, surgeon experience and soft tissue status. As of today, there is a need for larger randomized trials, which should also clarify the role of extensile approach vis a vis Minimally Invasive Surgery, to address this question and bring out a conclusive answer.

Keywords: calcaneal fracture, operative management, displaced intra-articular calcaneal fractures (DIACFs), randomized controlled trials, meta-analysis.

How to cite this article: Dhillon MS, Gahlot N. Are Results of Surgical Treatment for Calcaneal Fractures better than Nonoperative Treatment? J Foot Ankle Surg (Asia-Pacific) 2014; 1(1):17-23.

Source of support: Nil

Conflict of interest: None


 
Original Article
Qian-bo Chen, Xiao-kang Tan, Chen-song Yuan, Xu Tao, Hong-hui Cao, Jian-zhong Xu, Kang-lai Tang

Minimally Invasive Reconstruction of Anterior Talofibular Ligament with Partial Peroneus Brevis Tendon in the Treatment of Chronic Lateral Ankle Instability

[Year:2014] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:40] [Pages No:12-16][No of Hits : 2106]


ABSTRACT

Background: Chronic lateral ankle instability causes significant problems in physical activity and accelerates development of osteoarthritic changes. Many procedures were designed to reconstruct the anterior talo-fibular ligament (ATFL) in the treatment of chronic lateral ankle instability. Although most of them were effective, but brought big trauma and sacrifice of some tendons.

Objective: To design a minimally invasive ATFL reconstruction with partial peroneus brevis tendon and evaluate its clinical outcomes.

Study design: Nonrandomized controlled clinical trial.

Materials and methods: From 2004 to 2012, 29 patients of chronic lateral ankle instability were treated with minimally invasive ATFL reconstruction with partial peroneus brevis tendon. A 3 cm curved incision was made to explore the ATFL origin and its insertion. Half peroneus brevis tendon was taken to reconstruct the ATFL through the bone tunnel from the insertion of CFL to the insertion of ATFL in the fibular, and then fixed to ATFL insertion location on the talus. All patients were followed-up by radiology and clinical examination at least two years. Their ATFLs were always evaluated by standard stress X-ray examination and magnetic resonance imaging (MRI) prior to surgery and every 1 year after the operation. Functional results were assessed in terms of Karlsson score and the American Orthopaedic Foot and Ankle Society (AOFAS) anklehind foot score.

Results: The average follow-up period was 57.9 months (24- 114 months). The majority of results (93.1%) were satisfactory. The mean Karlsson score improved from 41.7 prior to surgery to 88.6 and AOFAS from an average 47.2 preoperatively to 91.7 postoperatively at the final follow-up visit. Paired t-tests showed improvements of great significance (p < 0.01). The ligaments were proved be reconstructed well in all patients by MRI. It showed the negative talar tilt sign postoperatively by stress X-rays. There was no recurrence of lateral ankle instability.

Conclusion: The minimally invasive ATFL reconstruction with partial peroneus brevis tendon has advantages of small trauma, good reconstruction and excellent clinical outcomes, thus, is a safe and effective method for the treatment of chronic lateral ankle instability.

Keywords: Ankle instability, Reconstruction, Lateral collateral ligament, Chronic instability.

How to cite this article: Chen Q, Tan X, Yuan C, Tao X, Cao H, Xu J, Tang K. Minimally Invasive Reconstruction of Anterior Talofibular Ligament with Partial Peroneus Brevis Tendon in the Treatment of Chronic Lateral Ankle Instability. J Foot Ankle Surg (Asia-Pacific) 2014;1(1):12-16.

Source of support: Nil

Conflict of interest: None


 
Case Report
J Mangwani, A Patel, W Al-Jundi, A Askari, D Moore

Nontraumatic Osteochondral Lesion of the Talar Head: A Case Report and Description of Operative Technique for Arthroscopic Debridement

[Year:2014] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:40] [Pages No:34-37][No of Hits : 1822]


ABSTRACT

Osteochondral lesions of the talar dome are well described. To our knowledge, there are no published reports of osteochondral lesion of the talar head. We report the case of a 16-year-old girl who presented with a nontraumatic osteochondral lesion of talar head, which was treated with arthroscopic debridement and bone marrow stimulation. At 6-month follow-up, the patient was symptom free and the radiograph showed signs of healing of the lesion.

Keywords: Osteochondral lesion, talar head, arthroscopy, debridement.

How to cite this article: Mangwani J, Patel A, Al-Jundi W, Askari A, Moore D. Nontraumatic Osteochondral Lesion of the Talar Head: A Case Report and Description of Operative Technique for Arthroscopic Debridement. J Foot Ankle Surg (Asia-Pacific) 2014;1(1):34-37.

Source of support: Nil

Conflict of interest: None


 
Original Article
Kushal Nag, Ken Jin Tan

Lateral Ankle Ligament Repair: Evolution of Technique from Open to Arthroscopy

[Year:2014] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:65-68][No of Hits : 1773]


ABSTRACT

One of the most common injuries of the lower extremity is the lateral ankle sprain. In recent years, with greater emphasis on physical fitness, the chronically painful and unstable lateral ankle is an increasing common clinical finding presenting to the outpatient clinic. If residual instability and pain is still present after a course of physiotherapy, the patient should be presented with surgical options to restore ankle stability. Several surgical techniques have been described for the treatment of chronic ankle instability. Recently, some authors have developed arthroscopic suture anchor techniques to repair the lateral ankle ligaments with excellent results. The authors’ aim is to give an overview of the various techniques for repair or reconstruction of the lateral ligament complex with special emphasis on the arthroscopic lateral ligament reconstruction.

Keywords: Ankle ligament repair, Arthroscopy, Surgical technique.

How to cite this article: Nag K, Tan KJ. Lateral Ankle Ligament Repair: Evolution of Technique from Open to Arthroscopy. J Foot Ankle Surg (Asia-Pacific) 2014;1(2):65-68.

Source of support: Nil

Conflict of interest: None


 
Case Report
Federico G Usuelli, Giorgio Lastroni, Miriam Grassi, Francesco Malerba

Talectomy in a Neglected Club Foot in Zambia: A Low Cost One Step Option in a Developing Country

[Year:2014] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:40] [Pages No:32-33][No of Hits : 1613]


ABSTRACT

Talectomy was first described in 1608, but the enthusiasm for this procedure peaked in the 1920s.
Nowadays, it is considered only as a salvage procedure and it is used extremely rarely. Ponseti treatment and multiple stage surgery are both better alternatives than talectomy, but they require a long follow-up pieriod, which could not be affordable for all patients in any developing countries.
Our equipe has been involved in a charity program in Zambia and we are presenting as a case report the clinical results of a talectomy performed to a 12 years old male child, affected by a severe neglected clubfoot.
The surgery was performed through an anterior approach, the patient was casted for 4 weeks.
At 6 months follow-up, he presented a good limb alignment with apparently a good function and a residual 20 degrees of range of motion.
Ponseti treatment and multiple-step surgery should be both preferred to talectomy, which, anyway, sometimes for social reasons, represents a viable alternative to those treatments.

Keywords: talectomy, club-foot, one-step surgery, equinusvarus deformity, Ponseti, medial release.

How to cite this article: Usuelli FG, Lastroni G, Grassi M, Malerba F. Talectomy in a Neglected Club Foot in Zambia: A Low Cost One Step Option in a Developing Country. J Foot Ankle Surg (Asia-Pacific) 2014;1(1):32-33.

Source of support: Nil

Conflict of interest: None


 
Case Report
Inderjeet Singh Rikhraj, Harmeet Singh

Iatrogenic Transfer Metatarsalgia managed by the Lapidus Procedure: A Report of Two Cases

[Year:2014] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:40] [Pages No:38-40][No of Hits : 1461]


ABSTRACT

Corrective surgery for Hallux Valgus requires that we balance the 1st metatarsal head with those of the lesser metatarsals. Failure of achieving this balance would result in a transfer metatarsalgia to the lesser metatarsal heads, frequently the 2nd metatarsal. We report of 2 such cases that presented with a transfer metatarsalgia to the head of the 2nd metatarsal. The Lapidus procedure was done to achieve the balance of the 1st metatarsal head with the rest of the lesser metatarsals in both cases. Both patients reported complete relief of pain and improvement in the AOFAS MTP-IP scores.

Keywords: Balance, 1st metatarsal head, Lapidus.

How to cite this article: Rikhraj IS, Singh H. Iatrogenic Transfer Metatarsalgia managed by the Lapidus Procedure: A Report of Two Cases. J Foot Ankle Surg (Asia-Pacific) 2014;1(1):38-40.

Source of support: Nil

Conflict of interest: None


 
Forthcoming

Forthcoming Foot and Ankle Conferences 2015-16

[Year:2014] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:][No of Hits : 1407]


ABSTRACT

American Academy of Orthopaedic Surgeons and the American Orthopaedic Foot and Ankle Society

Traumatic and Sports Injuries of the Foot and Ankle
February 26-28, 2014
Rosemont, Illinois, USA www.aaos.org/3343


 
Original Article
Rakesh B Dalal, Ricci Gary Edward Plastow, Rajesh Rachha

Reverse Scarf Osteotomy for Hallux Varus following Surgery for Hallux Valgus

[Year:2014] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:52-54][No of Hits : 1294]


ABSTRACT

Hallux varus is a much rarer deformity in clinical practice than hallux valgus. It can be congenital, associated with inflammatory arthropathy or iatrogenic due to overcorrection in hallux valgus surgery. There have been many treatments suggested but no gold standard has been found. We will describe a simple surgical procedure involving the scarf osteotomy to reverse the overcorrection of hallux valgus.

Keywords: Hallux, Varus, Scarf, Osteotomy.

How to cite this article: Dalal RB, Plastow RGE, Rachha R. Reverse Scarf Osteotomy for Hallux Varus following Surgery for Hallux Valgus. J Foot Ankle Surg (Asia-Pacific) 2014;1(2):52-54.

Source of support: Nil

Conflict of interest: None


 
Case Report
Sonam Sharma, Sansar Sharma

Concomitant Madura Foot and Tuberculosis in a Child: A Diagnostic Dilemma!

[Year:2014] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:69-71][No of Hits : 1195]


ABSTRACT

Madura/Mycetoma foot is an uncommon infection in children seldom described in literature, especially as a coinfection with extrapulmonary tuberculosis. We report a unique case of concomitant madura foot caused by actinomadura madurae and tuberculosis in a child from a known endemic area of Haryana, India which posed a diagnostic and therapeutic challenge.

Keywords: Madura foot, Tuberculosis, Concomitant.

How to cite this article: Sharma S, Sharma S. Concomitant Madura Foot and Tuberculosis in a Child: A Diagnostic Dilemma! J Foot Ankle Surg (Asia-Pacific) 2014;1(2):69-71.

Source of support: Nil

Conflict of interest: None


 
Original Article
Sanjay Agarwala, Anshul Shyam Sobti, Ganesh Mohrir

Neutralized Chemical Matricectomy with the Winograd Method in the Management of Ingrowing Toenail

[Year:2014] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:55-59][No of Hits : 1105]


ABSTRACT

Background: Ingrowing toenail is a common condition provoking pain, inflammation and functional limitation. Many surgical methods have evolved over the years for its treatment. The most important aspect of treatment of this problem is to prevent recurrence. The purpose of this paper was to study the effectiveness of combining the standard Winograd technique with neutralized chemical matricectomy to reduce the chances of recurrence and expedite postoperative recovery.

Materials and methods: Between 2006 and 2013, 33 patients (18 males, 15 females); with mean age 37.39 years (range 16 to 65 years) with 38 ingrowing toenails were treated with the standard Winograd technique combined with phenol matricectomy. The patients were evaluated in subsequent follow-ups for postoperative relapse, pain score (VAS) and time return to daily activities and ability to wear footwear and overall satisfaction. The mean follow-up period was 3.57 years (range 2 to 7 years).

Results: A total of 94.73% patients were satisfied with the overall outcome. The average return to normal shoe-wear was 1.54 weeks and the average return to normal activity was 1.18 weeks. Recurrence was seen in two patients (5.26%), 5 and 6 months after surgery. Four patients had delayed healing. None of the patients had any deep infection or neurovascular complications.

Conclusion: The Winograd technique when combined with neutralized phenol matricectomy is associated with a very low recurrence and infection rate. It allows early postoperative recovery and good cosmetic results with a high level of patient satisfaction.

Keywords: Ingrown toenail, Nails, Winograd technique.

How to cite this article: Agarwala S, Sobti AS, Mohrir G. Neutralized Chemical Matricectomy with the Winograd Method in the Management of Ingrowing Toenail. J Foot Ankle Surg (Asia-Pacific) 2014;1(2):55-59.

Source of support: Nil

Conflict of interest: None


 
Case Report
Rattan Lal Mittal

Obstinate Club Foot with Triple Plus Dislocations

[Year:2014] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:72-77][No of Hits : 1036]


ABSTRACT

Resistant/rigid club foot, a common orthopedic problem, still remains an unsolved problem, especially, when we come across deformities in older children, adolescents or adults, after multiple surgeries and sometimes unique cases, like this one. This case had unique pathoanatomy, due to congenital factors, increasing age and persisting with vengeance in spite of two earlier surgeries. Before planning another surgery, it was imperative to diagnose the actual cause, i.e. the unique pathoanatomy. Various other surgical options were not expected to give the desired result due to this unique pathoanatomy. The author has been in club foot research since long and the concept of this research has been based on pathoanatomy and its total correction. During this research process, there have been numerous need based modifications from time to time, based on applied interpretations of pathoanatomy, to make it effective in all resistant club feet, at any age, including adolescents and adult, which have been used in a large series with adequate follow-up in the past 25 to 30 years, with gratifying results. The landmark modifications have been: giving a generic name obstinate club foot given to every imaginable rigid club foot of any age, a substitute for multiple names found in literature; surgical technique named as dolarz technique incorporating Z-plasties in dorsolateral rotation skin flap (DOLAR); a modification of the earlier technique already reported in the literature and not likely to succeed. Besides the skin flap, the modified extended deeper extensive soft tissue and osseous release was named as subtotal subtalar release (SSR). Treatment of the present case was by Dolarz technique, with some newer modifications. Each step was more extensive focusing on triple plus dislocations, including an innovative sliding osteotomy of cuboid for complete correction. Awareness for diagnosis and good preoperative planning was essential for gratifying result.

Keywords: Obstinate club foot, Recurrent and rigid, Subtotal subtalar release, Dolarz surgical technique, Club foot.

How to cite this article: Mittal RL. Obstinate Club Foot with Triple Plus Dislocations. J Foot Ankle Surg (Asia-Pacific) 2014;1(2):72-77.

Source of support: Nil

Conflict of interest: None


 
Invited Article
Rajiv Shah

Economical Set-up for Foot and Ankle Practice for Underdeveloped Countries

[Year:2014] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:78-80][No of Hits : 892]


ABSTRACT

Elements of ideal but economical foot and ankle set up for developing countries are a consulting and waiting room with dedicated space for dressings and radiography. Set up needs to have facilities for weightbearing radiographs and foot lab. Foot lab shall have gadgets like monofilament, biothesiometer, vascular Doppler, Harris met and foot scan if possible. The team shall consist of dressing, foot lab and radiography technicians, medical social worker and counsellor. The medical care team shall have on panel services of diabetologist, general and vascular surgeons, plastic surgeon, physiotherapist, orthotist and internal physician. This team shall run various clinics, like adult, pediatric, sports and diabetic foot and ankle clinics. Clinic must take up events for social obligation and must brand itself through the knowledge spreading events as well as through the efforts of prevention.

Keywords: Foot and ankle, Underdeveloped countries, Center of excellence.

How to cite this article: Shah R. Economical Set-up for Foot and Ankle Practice for Underdeveloped Countries. J Foot Ankle Surg (Asia-Pacific) 2014;1(2):78-80.

Source of support: Nil

Conflict of interest: None


 
Editorial
Mandeep S Dhillon, Kang-lai Tang

Coming together for Progress

[Year:2014] [Month:January-June] [Volumn:1 ] [Number:1] [Pages:40] [Pages No:vi][No of Hits : 835]


ABSTRACT

Coming together for progress

Progress by definition is a variable term; although the dictionary definition is ‘forward or onward movement toward a destination’, many times progress is defined by change, or to put it more scientifically, by evolution. That is what we see today in the Asian Foot and Ankle surgery sphere, with the coming together of two like-minded academic bodies, and the merger giving birth to a scientific journal of international standards.


 
Editorial
Vaibhav Bagaria, Mandeep Dhillon

Looking Beyond, Thinking Ahead: Use of Three-dimensional Patient Optimized Surgical Tools in Foot and Ankle Surgeries

[Year:2014] [Month:July-December] [Volumn:1 ] [Number:2] [Pages:40] [Pages No:vii-viii][No of Hits : 653]


ABSTRACT

Looking Beyond, Thinking Ahead: Use of Three-dimensional Patient Optimized Surgical Tools in Foot and Ankle Surgeries

A once-shuttered warehouse is now a state-of-the art lab where new workers are mastering the 3D printing that has the potential to revolutionize the way we make almost everything-Obama (State of Union Address, 2013).

Obama was making this in reference to potential return of high tech jobs back to US, but he was not far off when he called the technology a revolution that had the ability to transform every thing and indeed the medical field is embracing this with open arms.1 It has started to bring in a new realm of much awaited innovation into the sector that has always thrived on improving accuracy and achieving perfection.


 
REVIEW ARTICLE
Vishal Kumar, Nirmal R Gopinathan, Mandeep S Dhillon, Prasoon Kumar, Aman Hooda

Role of Ultrasonography as a Prognostic Tool for the Treatment of Idiopathic Clubfoot by Ponseti Technique: A Systematic Review of Literature

[Year:2018] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:49] [Pages No:35-38][No of Hits : 203]


ABSTRACT

Introduction: Modern nonoperative treatment of idiopathic clubfoot consists of the Ponseti technique of manipulation and serial casting. Most patients have an excellent long-term outcomes with minimal pain or disability; however, some patients fail to respond or relapse after initial correction. The challenge is to identify such probable resistant or failed cases, and the factors that determine the same. Ultrasonography (USG) is being explored for the diagnosis and follow-up of clubfoot cases.

Research question: Does USG help in prognosticating the effectiveness of Ponseti method in clubfoot correction?

Materials and methods: Based on a PubMed search, articles related to usage of USG as a tool to prognosticate the Ponseti method were evaluated over a period of last 10 years. Five studies were identified and assessed. Based on this evaluation, parameters were extracted that could reliably indicate the prognosis.

Conclusion: Ultrasonography seems to be a cheap and effective tool to identify and calculate factors like tarsal dysplasia, talonavicular (TN) angle, talocuneiform angle (TCu), and the medial malleolus navicular distance (MMND) that could be evaluated before starting treatment and serially during its course. A low MMND and TN angle or a dysplastic talus indicates stiffness and poor prognosis. A serial increase in MMND and TN angle indicates adequate maintenance of correction. So, these parameters measured by USG could be used to prognosticate the effectiveness of the Ponseti method.

Keywords: Clubfoot, Ponseti, Prognosis, Talonavicular, Ultrasonography.

How to cite this article: Kumar V, Gopinathan NR, Dhillon MS, Kumar P, Hooda A. Role of Ultrasonography as a Prognostic Tool for the Treatment of Idiopathic Clubfoot by Ponseti Technique: A Systematic Review of Literature. J Foot Ankle Surg (Asia-Pacific) 2018;4(3):35-38.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Amin Kheiran, Jitendra Mangwani

Addressing Controversies in the Management of Ankle Fractures

[Year:2018] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:49] [Pages No:27-34][No of Hits : 201]


ABSTRACT

Ankle fractures account for approximately 10% of all fractures and are among the most common orthopedic injuries treated surgically. The incidence of these injuries has increased significantly in the last decade, particularly in the elderly population. Regardless of the method of intervention, the primary goal is restoration of normal anatomy to achieve normal biomechanics, painless function, and prevent long-term posttraumatic degeneration. Surgical treatment carries a potential risk of complications, such as nonunion, implant failure, and soft tissuerelated complications. Despite the invention of novel devices, surgical techniques and biomechanical studies for restoration and maintenance of the congruent ankle joint following ankle fractures, several aspects of management of these injuries still remain controversial. The aim of this article is to address these controversies based on the available evidence base.

Keywords: Ankle fracture, Posterior malleolus, Stress views of ankle, Syndesmotic injury, Tightrope.

How to cite this article: Kheiran A, Mangwani J. Addressing Controversies in the Management of Ankle Fractures. J Foot Ankle Surg (Asia-Pacific) 2018;4(3):27-34.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Tribhuwan NS Gaur, Harish Rao

Mirror Foot: A Case Report with Review of Literature

[Year:2018] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:49] [Pages No:43-46][No of Hits : 189]


ABSTRACT

Introduction: Mirror foot is a very rare and complex congenital anomaly. We report the case of a 1- year-old child who was treated surgically. At 3 years follow-up, the results were satisfactory. We report this case for its rarity, unusual presentation, and successful treatment.

Keywords: Excision, Mirror foot, Preaxial polydactyly.

How to cite this article: Gaur TNS, Rao H. Mirror Foot: A Case Report with Review of Literature. J Foot Ankle Surg (Asia-Pacific) 2018;4(3):43-46.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Kuldeep Singh, Zile S Kundu, Bikramjit Singh, Pramod Dakshinamurthy, Sudhanshu Punia, Raj S Potalia

Heel Defect Reconstruction using Local Vascularized Flaps: Results and Clinical Outcomes in 16 Patients

[Year:2018] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:49] [Pages No:16-20][No of Hits : 175]


ABSTRACT

Introduction: The defects in the heel result mainly from trauma followed by burns, infections, and tumor resections. If allowed to heal by secondary intention, it will cause pain, difficulty in shoe wear, and be prone to injuries with trivial trauma. Thus, it becomes a difficult situation for the patient. There has always been a challenge to reconstruct heel for decades for the reconstructive surgeon. It is because of lack of tissue of the same thickness, consistency, and texture to match the heel pad, which is required for the proper propelling action of it. We have reconstructed 16 heels with the help of local flaps, which showed satisfactory results.

Keywords: Flap, Heel defect, Medial plantar artery, Sural artery, V-Y advancement.

How to cite this article: Singh K, Kundu ZS, Singh B, Dakshinamurthy P, Punia S, Potalia RS. Heel Defect Reconstruction using Local Vascularized Flaps: Results and Clinical Outcomes in 16 Patients. J Foot Ankle Surg (Asia-Pacific) 2018;4(3):16-20.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Sundararajan S Ramasamy, Ramakanth Rajagopalakrishnan, Balaji Sambandam, Shanmuganathan Rajasekaran

Role of Calcaneoplasty and Correlation of Haglund's Bump and Spur in Insertional Achilles Tendinopathy and Degenerative Achilles Tendon Rupture

[Year:2018] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:49] [Pages No:5-12][No of Hits : 175]


ABSTRACT

Introduction: Patients with degenerative Achilles tendon rupture and those with a chronic nonresponding Achilles tendinopathy form a major surgical population in foot and ankle surgery. Simple debridement and repair of the tendon will not be sufficient in these patients because the Haglund bump and retrocalcaneal spur, which is seen in both groups, is an important contributing factor. Calcaneoplasty and spur excision are required in addition to get good results. In this study, the clinical significance of Haglund bump and the role of calcaneoplasty and spur excision in treating these related pathologies are discussed.

Materials and methods: This is a retrospective study of two groups of patients. The first group comprised 20 patients with chronic Achilles tendinopathy, who underwent tendo-achilles (TA) detachment debridement and reattachment after calcaneoplasty. The second group comprised 19 patients with degenerative TA rupture, who underwent tendon repair with calcaneoplasty. Postoperative outcomes at 6 months followup were compared between these groups, and a multinomial logistic regression was done to analyze the preoperative variables to predict the strong factor that causes tear.

Results: Mean pre- and postoperative American Orthopedic Foot & Ankle Society (AOFAS) score of the tendinopathy group was 54.25 [standard deviation (SD) = 13.1] and 95.15 (SD = 6.13), whereas it was 45.68 (SD = 13.33) and 93.11 (SD = 4.90) in the tendon rupture group. In both the groups, there was a marked increase in postoperative outcome, but there was no significant difference in between the two groups (p-value = 0.259). Multinomial logistic regression proved Haglund bump, measured using Vega angle, to be the only significant predictor of tendon rupture.

Conclusion: Haglund bump and spur are the significant lesions of the posterior heel pathologies. Surgical treatment of these pathologies should always include calcaneoplasty and spur excision when there is an abnormally prominent Haglund bump as predicted by Vega angle.

Keywords: Calcaneoplasty, Chronic achilles tendinopathy, Degenerative tendo-achilles rupture, Haglund’s bump.

How to cite this article: Ramasamy SS, Rajagopalakrishnan R, Sambandam B, Rajasekaran S. Role of Calcaneoplasty and Correlation of Haglund’s Bump and Spur in Insertional Achilles Tendinopathy and Degenerative Achilles Tendon Rupture. J Foot Ankle Surg (Asia-Pacific) 2018;4(3):5-12.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Kusum Sharma, Nitya Batra, Megha Sharma, Kapil Goyal, Aman Sharma, Mandeep S Dhillon

Diagnosis of Foot and Ankle Tuberculosis

[Year:2018] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:49] [Pages No:21-26][No of Hits : 173]


ABSTRACT

Osteoarticular tuberculosis (OATB) is reported to occur in 1 to 3% of tuberculosis (TB) cases. Involvement of ankle and foot is a rare entity which comprises 10% of the OATB cases. The biggest diagnostic dilemma associated with OATB comes due to the fact that it is paucibacillary in nature. Newer diagnostic techniques like light-emitting diode microscopy, mycobacterial growth indicator tube (MGIT) culture system, and nucleic acid amplification test-based techniques could aid now in a quicker and definitive diagnosis of TB. Despite numerous studies on this based on pulmonary TB, there is paucity of literature on diagnostics in OATB, especially foot and ankle TB. Significant work is needed to evaluate the efficacy of various diagnostic modalities which would help in timely management, thereby contributing to a better prognosis. The present review summarizes the modern diagnostic modalities and typing techniques that could aid in the management of foot and ankle TB.

Keywords: Diagnosis, Foot and ankle tuberculosis, Osteoarticular tuberculosis.

How to cite this article: Sharma K, Batra N, Sharma M, Goyal K, Sharma A, Dhillon MS. Diagnosis of Foot and Ankle Tuberculosis. J Foot Ankle Surg (Asia-Pacific) 2018;4(3):21-26.

Source of support: Nil

Conflict of interest: None


 
Editorial
Siddhartha Sharma, Mandeep S Dhillon

To Fix or not to Fix: Isolated Weber B Fractures of the Ankle

[Year:2018] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:49] [Pages No:iv-v][No of Hits : 166]


ABSTRACT

Ankle fractures have always fascinated orthopedic surgeons since the management options have been debated ever since the AO fracture principles came into vogue. The 1970s shifted the trend toward aggressive interventions, and in the 21st century surgery is preferred for most displaced ankle fractures. Nevertheless, there is significant debate about the management of isolated Weber B fractures, and several controversies remain. The Weber B fracture may or may not disrupt the syndesmosis, as the fracture line runs at the level of syndesmosis and corresponds to the AO/ OTA 44-B1 injury pattern. These fractures may be simple (B1.1), associated with rupture of the anterior syndesmotic ligaments (B1.2), or comminuted (B1.3).


 
CONFERENCE REPORT
S Sundarajan

IFASCON 2017

[Year:2018] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:49] [Pages No:49][No of Hits : 165]


ABSTRACT

The 30th annual Indian Foot and Ankle National Conference (IFASCON 2017) was held in Ganga Hospital, Coimbatore, from August 25 to 27, 2017, organized by Dr S Rajasekaran (organizing chairman) and Dr SR Sundararajan (organizing secretary and president of Indian Foot and Ankle Society). We hosted 9 international faculties and 29 national foot and ankle surgeons from all over India. It was well appreciated and attended by over 220 delegates.


 
ORIGINAL ARTICLE
Pawan Agarwal, Mahendra Singh, Dhananjaya Sharma

Determination of Types of Foot in the Indian Population and Its Association with Ingrowing Toenail

[Year:2018] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:49] [Pages No:13-15][No of Hits : 162]


ABSTRACT

Aim: Ingrown toenail (onychocryptosis) is a common condition affecting great toenail. Several risk factors including foot shape, particularly, Egyptian foot, has been implicated in the pathogenesis. The purpose of this study is to determine the types of foot in normal Indian population and its relationship with incidence of ingrowing toenail.

Materials and methods: A total of 197 healthy adults were included in the study and their foot type was determined by direct observation and classified into one of the three foot types. Consecutive 25 patients (25 feet) undergoing treatment for ingrowing toenails were selected. Each foot was classified into one of the three foot types and analyzed.

Observations: Out of 197 adults, 77 had Egyptian foot, 47 had square foot, and 73 had Greek foot. In the male population, Greek foot (44.0%) was most prevalent and this was statistically significant (p = 0.023). In female subjects, Egyptian foot was the most common and seen in 44.3% (p = 0.1763). In ingrowing toenail group, out of 25 adults 11 had Egyptian foot, 7 had square foot, and 7 had Greek foot.

Conclusion: In the Indian population, the most common foot type is Egyptian foot (39.08%), followed by Greek foot (37.05%) and square foot (23.85%). Though ingrowing toenail is thought to be the more common in Egyptian foot, it is not proved to be a risk factor in this study.

Keywords: Egyptian, Foot shape, Greek, Ingrown toenail.

How to cite this article: Agarwal P, Singh M, Sharma D. Determination of Types of Foot in the Indian Population and Its Association with Ingrowing Toenail. J Foot Ankle Surg (Asia- Pacific) 2018;4(3):13-15.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Mandeep S Dhillon, Siddhartha Sharma, Sharad Prabhakar, Sameer Aggarwal, Devendra K Chouhan

Extruded Talus Injuries: A Cross-sectional Survey of Indian Orthopedic Surgeons

[Year:2018] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:49] [Pages No:1-4][No of Hits : 154]


ABSTRACT

Introduction: Management of extruded talus (ET) injuries poses a dilemma, owing to its rarity as well as the paucity and diversity of the published literature.

Materials and methods: We designed an eight-item questionnaire- based survey, which was administered to Indian orthopedic surgeons.

Results: A total of 379 participants completed the survey, 265 (69.9%) reported having seen or treated a case of ET; 172 participants reported following up their case for >1 year. Of these, 33 cases (8.7%) had a well-retained talus without any evidence of avascular necrosis (AVN), arthrosis, or infection; 104 (27.4%) cases had AVN with or without infection; 42 (11.1%) cases developed ankle arthrosis and the talus was not retained and arthrodesis done in 12 (3.1%) cases. A total of 235 (62%) participants chose AVN as the most feared complication, followed by infection (20.3%, n = 77) and arthroses (7.4%, n = 28); 359 (94.7%) participants preferred primary repositioning of ET; 320 (84.4%) participants were not aware of any studies reporting long-term outcomes of these injuries.

Conclusion: Most Indian surgeons prefer primary repositioning of ET to talectomy and arthrodesis. Avascular necrosis remains the major concern after repositioning. Awareness on long-term outcomes of these injuries is lacking, and more studies reporting long-term outcomes are needed.

Keywords: Extruded talus, Missing talus, Survey, Talar dislocation, Talar extrusion, Talus.

How to cite this article: Dhillon MS, Sharma S, Prabhakar S, Aggarwal S, Chouhan DK. Extruded Talus Injuries: A Crosssectional Survey of Indian Orthopedic Surgeons. J Foot Ankle Surg (Asia-Pacific) 2018;4(3):1-4

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Arup K Daolagupu, Vikash Agarwala, Gaurav Khanted

Osteoid Osteoma of the Talus Neck

[Year:2018] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:49] [Pages No:39-42][No of Hits : 154]


ABSTRACT

Introduction: Osteoid osteoma mainly occurs in long bones (75%) and represents 2 to 11% of all bone tumors of foot and ankle and, most commonly, in talus. Here, we present a case of osteoid osteoma of neck of right talus, which was presented as chronic ankle pain and was treated with curettage and cancellous bone graft.

Case report: A 19-year-old patient presented to us with chronic right ankle pain on anteromedial aspect of dorsum of right ankle with difficulty in walking. Plain radiograph of right ankle joint revealed sclerosis in neck of talus. Both computed tomography (CT) and magnetic resonance imaging (MRI) were suggestive of osteoid osteoma involving superior aspect of talar neck. An incision was made over anteromedial aspect of dorsum of right ankle. Curettage was done and cavity was filled with cancellous bone graft from iliac crest. Patient was advised nonweight bearing for 4 weeks and physiotherapy.

Discussion: There is difficulty in diagnosis of osteoid osteoma of talus. The time delay in diagnosis is about 2.5 to 10 years. In our case, it was about 4 years. Radiograph features include small radiolucent area (nidus) with surrounding sclerosis. A CT is the best method for diagnosis. Rashid et al5 had done subtalar arthrodesis with curettage. Assafiri et al had done arthroscopic resection. In our case, we performed curettage and cancellous bone grafting.

Conclusion: A high index of suspicion of this disease should be held while treating patients with chronic ankle pain. A CT scan is the best method to identify the nidus. Although multiple treatment modalities are available, open resection with curettage and cancellous bone graft showed good result in our case.

Keywords: Cancellous bone grafting, Curettage, Nidus, Osteoid osteoma, Talar neck.

How to cite this article: Daolagupu AK, Agarwala V, Khanted G. Osteoid Osteoma of the Talus Neck. J Foot Ankle Surg (Asia-Pacific) 2018;4(3):39-42.

Source of support: Nil

Conflict of interest: None


 
BOOK REVIEW
Vikas Bachhal, Mandeep S Dhillon

Handbook of Foot and Ankle Orthopedics

[Year:2018] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:49] [Pages No:47-48][No of Hits : 150]


ABSTRACT

The field of foot and ankle orthopedics has remained perhaps somewhat neglected in the past, and has had a paucity of reliable texts for surgeons keen on gaining insights into the underdocumented field, with very little work from Asian authors. On the contrary, the last decade has seen a rapid proliferation of young orthopods who wish to take up the challenge of venturing into the field of foot and ankle orthopedics; their aspirations were limited due to a lack of dependable textbooks focused on the subject and an inadequate compilation of information concentrated in one single digest.


 
Original Article
Rakesh Dalal, Rajesh Rachha, David Leonard, Ajay Chourasia, Saqib Javed

Short Scarf Osteotomy for Hallux Valgus: Short-term and Medium-term Results

[Year:2017] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:54] [Pages No:14-18][No of Hits : 493]


ABSTRACT

Aim: The scarf osteotomy, as popularized by Barouk, is a versatile osteotomy for the correction of moderate and severe hallux valgus deformity. However, this technique requires extensive exposure, fixation, and increased operative time, and is technically demanding. We describe and present our results of a short scarf osteotomy (SSO), which retains all the cuts of a standard scarf but requires a reduced exposure, less metalwork, less operating time, and is more economical.

Materials and methods: All patients who underwent SSO between January 2010 and December 2012 with minimum follow-up of 12 months were eligible for the study. Preoperative, intraoperative, and postoperative radiographs were available for radiological assessment.

Results: In this study, 84 patients and 94 feet were included; 90% of patients were satisfied overall, with 83% of patients recommending this surgery to a friend. The hallux valgus angle improved from a preoperative mean of 30.89° (17.4–46.8) to 12° (4–30) postoperatively (p = 0.0001). The intermetatarsal angle improved from a preoperative mean of 15.05° (10.3–21.1) to 7.14° (4–15.1) postoperatively (p = 0.0001). The average sesamoid coverage improved from grade 2.18 (1–3) preoperatively to 0.57 (0–2) postoperatively (p = 0.0001). The average American Orthopedic Foot and Ankle Score improved from 51.26 (32–88) preoperatively to 91.1 (72–100) postoperatively (p = 0.0001).

Conclusion: We believe that this osteotomy is a novel procedure producing good to excellent results in most cases of hallux valgus. Biologically, the decreased exposure should improve healing and reduce the risk of avascular necrosis. We strongly recommend this osteotomy for most cases of hallux valgus surgery.

Keywords: Hallux, Osteotomy, Scarf, Shor, Valgus.

How to cite this article: Dalal R, Rachha R, Leonard D, Chourasia A, Javed S. Short Scarf Osteotomy for Hallux Valgus: Short-term and Medium-term Results. J Foot Ankle Surg (Asia- Pacific) 2017;4(1):14-18.

Source of support: Nil

Conflict of interest: None


 
RESEARCH ARTICLE
Avadhoot P Kantak

The Metatarsal Axis Deviation Angle: A Novel Angular Measurement for Planning Surgery of Severe Hallux Valgus

[Year:2017] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:51] [Pages No:97-99][No of Hits : 493]


ABSTRACT

Surgical planning for hallux valgus is a complex procedure. Many angular measurements are described to decide on the correct procedure. Primus metatarsus varus is considered as one of the important factors in the causation and persistence of hallux valgus. Intermetatarsal angle (IMA) has been used to assess the first metatarsal varus. However, we identified a normal IMA in some feet with severe hallux valgus; and these feet had metatarsus adductus. Hence, after further investigations, we propose a new angular measurement to detect axis deviation of the first metatarsal. We have called this the metatarsal axis deviation angle (MADA). We also recommend a basal realignment osteotomy in hallux valgus with the MADA of more than 30°.

Keywords: Hallux valgus, Primus metatarsus varus, Surgery.

How to cite this article: Kantak AP. The Metatarsal Axis Deviation Angle: A Novel Angular Measurement for Planning Surgery of Severe Hallux Valgus. J Foot Ankle Surg (Asia- Pacific) 2017;4(2):97-99.

Source of support: Nil

Conflict of interest: None


 
SYMPOSIUM-Invited Article
Jin Su Kim

Anterior Inferior Tibiofibular Ligament Reconstruction with Anchor Sutures compared with Trans-syndesmotic Screw Fixation for Ankle Syndesmotic Injuries

[Year:2017] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:51] [Pages No:57-62][No of Hits : 486]


ABSTRACT

Background: Acute syndesmotic injuries were usually treated with trans-syndesmotic screw fixation. However, screw fixation is too strong compared with the physiologic ankle joint movement. In addition, it needs removal and leads to delayed rehabilitation. We propose the reconstruction of the anterior inferior tibiofibular ligament (AITFL) using suture anchors to substitute trans-syndesmotic screw fixation.

Materials and methods: We compared the results after transsyndesmotic screw fixation and AITFL suture anchor fixation in syndesmotic injuries with or without ankle fracture. Consecutively, the trans-syndesmotic screw (group I) was conducted between June 2011 and June 2013, and since July 2013, suture anchor fixation was performed (group II). Reductions in quality, the American Orthopedic Foot and Ankle Society (AOFAS) score, and the Olerud-Molander ankle score (OMAS) were evaluated.

Results: The final AOFAS score and OMAS in both groups were not significantly different (p = 0.98, 0.67). Tibiofibular overlapping, tibiofibular space, and tibiofibular overlapping ratio to the tibial width in both groups had satisfactory reduction from the standards. Computed tomographic (CT) evaluation also confirmed that both groups had been anatomically reduced in standard. Anteroposterior axis reduction in CT was more accurate in group II. Nonclinically related complications were three broken screws in final follow-up in group I.

Conclusion: Both trans-syndesmotic screws and suture anchor fixation have satisfactory clinical outcomes. The suture anchor fixation for syndesmotic injury does not need removal and is less complicated compared with the trans-syndesmotic screw fixation.

Keywords: Anchor, Ankle, Screw, Syndesmosis.

How to cite this article: Kim JS. Anterior Inferior Tibiofibular Ligament Reconstruction with Anchor Sutures compared with Trans-syndesmotic Screw Fixation for Ankle Syndesmotic Injuries. J Foot Ankle Surg (Asia-Pacific) 2017;4(2):57-62.

Source of support: Nil

Conflict of interest: None


 
Original Article
S Hiranyakumar, Praneeth Revuri, Ashish D Shah

Outcome of Tibio-talo-calcaneal Arthrodesis using Supracondylar Femoral Intramedullary Interlocking Nail

[Year:2017] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:54] [Pages No:23-29][No of Hits : 427]


ABSTRACT

Introduction: Tibiotalar arthritis of foot is a progressive pathology; if left untreated, patients experience excruciating pain at every step while walking/weight bearing. The treatment depends on whether the pain is to be managed conservatively or surgically. This article is intended for the description of a technique performing tibiotalocalcaneal arthrodesis (TTCA) using an indigenous femur supracondylar nail, an intramedullary fixation.

Materials and methods: This article contains a prospective study of 21 patients with a mean age of 46 years, males – 13 and females – 8, who underwent TTCA with intramedullary fixation for the diagnoses of osteoarthrosis (6 patients), rheumatoid arthritis (6 patients), and arthritis secondary to avascular necrosis (AVN) of talus/trauma (9 patients), with a mean follow-up interval of 22 months.

Results: Out of 21 patients, 96.55% union rate was achieved at a mean time to union of 16 weeks, with one patient (3.45%) going for delayed union.

Conclusion: Intramedullary nailing is an excellent method of fixation for TTCA in the appropriately selected patients. Using an indigenous supracondylar femoral nail is a cost-effective method, and this gave equivalent results as that of other intramedullary nails in properly selected patients.

Keywords: Intramedullary fixation, Supracondylar femoral nail, Tibiotalocalcaneal arthrodesis.

How to cite this article: Hiranyakumar S, Revuri P, Shah AD. Outcome of Tibio-talo-calcaneal Ar throdesis using Supracondylar Femoral Intramedullary Interlocking Nail. J Foot Ankle Surg (Asia-Pacific) 2017;4(1):23-29.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Rajesh Simon, Atmaram Gadgil, Denis P Jose

Composite Flexor Hallucis Longus and Free Gracillis Flap for Infected Achilles Tendon

[Year:2017] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:51] [Pages No:100-102][No of Hits : 403]


ABSTRACT

Primary infection of tendo-achilles (TA) is quite uncommon. Here, we are presenting an interesting case of a 42-year-old farmer who developed TA infection following thorn prick injury (3-month-old injury). He presented to us with discharging sinus on posterior aspect of heel. On subsequent debridement, he had 17 cm tendon defect, which was treated with flexor hallucis longus (FHL) tendon and reinforced with free gracillis flap from opposite thigh. However, to the best of our knowledge, combined use of FHL and gracillis tendon has so far not reported.

Keywords: Flexor hallucis longus, Free gracillis flap, Infected tendo-achilles injuries, Open tendo-achilles injuries, Reconstruction of Achilles tendon.

How to cite this article: Simon R, Gadgil A, Jose DP. Composite Flexor Hallucis Longus and Free Gracillis Flap for Infected Achilles Tendon. J Foot Ankle Surg (Asia-Pacific) 2017;4(2):100-102.

Source of support: Nil

Conflict of interest: None


 
Original Article
Tribhuwan NS Gaur, Harish Rao, Garjesh S Rai

Ultrasonography-guided Platelet-rich Plasma Injection in Chronic Plantar Fasciitis

[Year:2017] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:54] [Pages No:1-4][No of Hits : 287]


ABSTRACT

Introduction: Heel pain is a very common problem. The most common cause of heel pain is plantar fasciitis, and this often refractory to conservative treatment leads to disability. Plateletrich plasma (PRP) derived from autologous blood containing high concentration of growth factors helps in tissue healing, so it is postulated to promote native tissue regeneration. The purpose of this work was to study the effectiveness of PRP in the treatment of chronic plantar fasciitis.

Materials and methods: The study was conducted in Orthopedic Department in collaboration with Radiodiagnosis Department at People’s College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India. In this study, there were 44 patients, with 48 feet affected by plantar fasciitis.

Results: All patients were evaluated preinjection and postinjection by visual analog score. There was significant improvement after injection and no adverse reaction was seen.

Conclusion: Platelet-rich plasma is considered as a safe therapeutic option. It also effectively decreases heel pain in chronic plantar fasciitis.

Keywords: Plantar-fasciitis, Platelet-rich plasma, Ultrasonography.

How to cite this article: Gaur TNS, Rao H, Rai GS. Ultrasonography-guided Platelet-rich Plasma Injection in Chronic Plantar Fasciitis. J Foot Ankle Surg (Asia-Pacific) 2017;4(1):1-4.

Source of support: Nil

Conflict of interest: None


 
Editorial
Sharad Prabhakar, Mandeep S Dhillon

Displaced Intraarticular Calcaneus fractures: To Fix or not to Fix? That is the question

[Year:2017] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:54] [Pages No:vi-v][No of Hits : 275]


ABSTRACT

Displaced intraarticular calcaneus fractures (DIACFs) are a source of devastating disability to the patient, a potential hornet’s nest for the average orthopedic surgeon and a potential economic burden on the society. Till today, no single treatment approach is universally applicable to all patients and all fracture types.


 
Original Article
Shiva S Jha

Lower Limb Refractory Ulcers and Postoperative Nonhealing Wound: Review of the Literature

[Year:2017] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:54] [Pages No:10-13][No of Hits : 240]


ABSTRACT

Lower limb ulcers including nonhealing postoperative wounds are challenging problems, especially to orthopedic surgeons. Such ulcers are recognized complications of rheumatoid arthritis but the scenario has changed for the better since the advent of aggressive disease-modifying antirheumatic drugs (DMARDs). Out of different types of lower limb ulcerations including venous, arterial, lymphatic, malignancies, infection, medication induced and inflammatory, autoimmune inflammatory conditions need to be delineated. They can be improved, though slowly with DMARDs. The pathogenesis is multifactorial but most prevalent are vasculitis. The various investigative tools for diagnosing the causes of these ulcers include plethysmography, ultrasound, angiography, computed tomography, magnetic resonance imaging, chromosomal analysis, and, most importantly, skin biopsy. Clinical presentation of the patient still remains the supreme disease tracker. Review of the literature is presented to ascertain the evidence for best clinical practice.

Keywords: Disease-modifying antirheumatic drugs, Immunomodulators, Immunosupressants, Infection, Limb ulcers, Pain, Rheumatoid arthritis, Vasculitis.

How to cite this article: Jha SS. Lower Limb Refractory Ulcers and Postoperative Nonhealing Wound: Review of the Literature. J Foot Ankle Surg (Asia-Pacific) 2017;4(1):10-13.

Source of support: Nil

Conflict of interest: None


 
Book Review
Sandeep Patel, Udai Cheema

Fractures of the Calcaneus

[Year:2017] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:54] [Pages No:53-54][No of Hits : 225]


ABSTRACT

Fractures of the calcaneus are a common entity encountered by treating orthopedicians and pose a variety of challenges at each step starting from the diagnosis, classification, understanding of the three-dimensional anatomy, soft-tissue problems, timing of surgery, whether to operate, and what surgery to offer. Literature is full of articles on the above issues, but very few comprehensive books on calcaneus fractures are available.


 
Original Article
Rakesh Dalal, Hari Kovilazhikathu Sugathan, Rajesh Rachha

Proximal Medial Tibial Bone Graft Harvesting in Foot and Ankle Surgery

[Year:2016] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:63] [Pages No:6-9][No of Hits : 493]


ABSTRACT

Cancellous bone graft harvesting from proximal tibia is usually by a lateral approach. We describe our technique and results in harvesting proximal tibia bone graft by a medial approach in foot and ankle surgery. Our results confirm that medial proximal tibial bone graft harvesting is a relatively safe and easy procedure to obtain adequate amount of autogenous cancellous bone graft. Donor site morbidity was found to be very low and fusion rate was found to be excellent in a variety of foot and ankle surgeries.

Keywords: Bone graft harvesting, Foot and ankle, Proximal medial tibia.

How to cite this article: Dalal R, Sugathan HK, Rachha R. Proximal Medial Tibial Bone Graft Harvesting in Foot and Ankle Surgery. J Foot Ankle Surg (Asia-Pacific) 2016;3(1):6-9.

Source of support: Nil

Conflict of interest: None


 
Case Report
Sundararajan Silvampatti, S Rajasekaran

Irreducible Dislocation of Great Toe Interphalangeal Joint by an Accessory Sesamoid Bone: A Case Report and Review of Literature

[Year:2016] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:63] [Pages No:56-58][No of Hits : 459]


ABSTRACT

Irreducible dislocation of interphalangeal joint is a rare condition with only a few case reports in literature. Here, we report a case with irreducible dislocation of interphalangeal joint due to sesamoid bone interposition, which required open reduction. A 45-year-old male had a fall from height with irreducible dislocation of interphalangeal joint of great toe. Intraoperatively, the interposition of sesamoid bone over the dorsal aspect of proximal phalanx was identified. Displaced volar plate with sesamoid bone was reduced into the position, and the joint was stabilized with k wire. On follow-up, we observed that the patient had no discomfort or pain for 6 months. The displacement of sesamoid bone with volar plate and intact collateral ligaments locks the joint in extension and obstructs the reduction of interphalangeal joint dislocation. One should have the suspicion of possibility of open reduction after observing the interposition of sesamoid bone over the dorsal aspect of the proximal phalanx. Dorsal approach is usually advocated; medial approach can be used if there is wound over the plantar aspect.

Keywords: Dislocation, Sesamoid, Toe, Volar plate.

How to cite this article: Silvampatti S, Rajasekaran S. Irreducible Dislocation of Great Toe Interphalangeal Joint by an Accessory Sesamoid Bone: A Case Report and Review of Literature. J Foot Ankle Surg (Asia-Pacific) 2016;3(1):56-58.

Source of support: Nil

Conflict of interest: None


 
Original Article
Harminder S Sohal, Radhe S Garg, Sanjeev Jindal, Jitendra Wadhwani, Vivek Bansal, Mannan Ahmed

Minifragment T-plate Fixation: An Alternative Method for Medial Malleolus Fracture Fixation

[Year:2016] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:63] [Pages No:10-14][No of Hits : 415]


ABSTRACT

Aim: Modern trend in the management of fractures is fast changing in favor of rigid fixation and early mobilization with minimal period of plaster immobilization. We present a prospective cohort study of fixation of medial malleolus fractures with Minifragment T-plate and its evaluation in terms of maintenance of accurate anatomical reduction, stable fixation, and early restoration of functions.

Materials and methods: A total of 25 patients of median age 45 years (22-70), with medial malleolus fractures were treated by open reduction and internal fixation using Minifragment T-plate. Outcome was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score.

Results: A total of 80% cases had anatomical reduction, 12% had good reduction (<2 mm displacement), 4% had fair reduction (2-5 mm displacement), and 4% had poor reduction (>5 mm displacement). After 6 months follow-up, outcome was excellent in 20 cases (80%), 3 cases (12%) had good result, and 2 cases (8%) had fair result according to AOFAS score. Out of 25 cases, in 2 cases (8%) infection occurred, 6 cases (24%) had limitation of movements, 1 case (4%) had instability at ankle, and 2 cases (8%) had delayed union of fracture.

Conclusion: Weighing the advantages and disadvantages of fixation with Minifragment T-plate, it can be safely concluded that Minifragment T-plate can be an effective alternative option in the management of medial malleolus fractures. At the same time, it is warned that this technique should not be used indiscriminately without technical skill.

Clinical significance: Minifragment T-plate fixation provides rigid fixation along with early return of movements with limited period of immobilization. Studying this alternative method expands the present knowledge for management of medial malleolus fractures.

Keywords: AOFAS Ankle-Hindfoot Score, Cedell and Phillips criteria, Cohort study, Herscovici classification, Medial malleolus fracture, Minifragment T-plate, Modified Kristensen.

How to cite this article: Sohal HS, Garg RS, Jindal S, Wadhwani J, Bansal V, Ahmed M. Minifragment T-plate Fixation: An Alternative Method for Medial Malleolus Fracture Fixation. J Foot Ankle Surg (Asia-Pacific) 2016;3(1):10-14.

Source of support: Nil

Conflict of interest: None


 
Original Article
Giriraj Harshavardhan, Ganesan Ram Ganesan

Correction of Resistant/Relapsed/Neglected Clubfeet by Differential Distraction with a Simple Unconstrained Ilizarov Construct

[Year:2016] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:63] [Pages No:1-5][No of Hits : 398]


ABSTRACT

Introduction: External fixators were used to correct difficult clubfeet by the principle of differential distraction. Following the distraction phase, the fixator was conventionally maintained for a prolonged period to prevent recurrence. The purpose of the study was to analyze whether early removal of the fixator followed by Ponseti’s technique of manipulation is compatible with good result and maintenance of correction at long-term follow-up.

Materials and methods: A total of 21 children with resistant/relapsed/neglected clubfeet in the age group of 2 to 13 years were treated by an unconstrained Ilizarov frame and differential distraction. Once the deformity was clinically corrected, the distraction was stopped and the fixator was removed after 3 weeks. During removal of the fixator, the feet were manipulated according to Ponseti’s principles and if necessary a posterior TendoAchilles lengthening/tenotomy was done to obtain more dorsiflexion. Above-knee plaster casts were applied for a period of 3 weeks. Following removal of casts, measurements were taken for foot abduction orthosis and a below-knee cast was applied till the foot abduction orthosis was ready. The foot abduction orthosis was used at nighttime. Parents were taught to manipulate the feet after each meal.

Results: Good clinical correction was obtained in all feet. At 2 years follow-up, correction was well maintained, implying that there is no risk of recurrence if the fixator is removed early during the static phase. The use of Ponseti’s technique at fixator removal may also help in reducing the risk of recurrence.

Conclusion: Clubfeet can be easily corrected by differential distraction using external fixators. Early removal of fixator followed by the application of Ponseti’s technique of manipulation gives good correction of deformity and does not increase the rates of recurrence.

Keywords: Clubfoot, Differential distraction, External fixator, Ponseti technique/method.

How to cite this article: Harshavardhan G, Ganesan GR. Correction of Resistant/Relapsed/Neglected Clubfeet by Differential Distraction with a Simple Unconstrained Ilizarov Construct. J Foot Ankle Surg (Asia-Pacific) 2016;3(1):1-5.

Source of support: Nil

Conflict of interest: None


 
Case Series
Pradeep Moonot, Arun Bal, Ammar Qureshi

Transposition of Tibialis Anterior to the Cuboid after Tarsometatarsal Amputation

[Year:2016] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:56] [Pages No:107-110][No of Hits : 395]


ABSTRACT

Forefoot and midfoot amputees are prone to develop nonhealing ulcers at the closure site. This mainly occurs due to the limited dorsiflexion ability of the ankle and associated loss of protective function as seen in diabetics. One of the proposed methods to prevent these postamputation ulcers includes tendoachilles lengthening during the procedure. We describe three cases with nonhealing ulcers on the lateral aspect after a midfoot amputation. All of the cases underwent a tibialis anterior transposition to the lateral aspect of the foot to correct the deformity and at the same time also achieved healing of the ulcers.

Keywords: Amputation, Diabetic foot, Midfoot, Tendon transfer, Tibialis anterior, Transmetatarsal.

How to cite this article: Moonot P, Bal A, Qureshi A. Transposition of Tibialis Anterior to the Cuboid after Tarsometatarsal Amputation. J Foot Ankle Surg (Asia-Pacific) 2016;3(2): 107-110.

Source of support: Nil

Conflict of interest: None


 
Original Article
Vinod K Panchbhavi

Ankle Reconstruction in Charcot’s Neuroarthropathy: Challenges and Solutions

[Year:2016] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:56] [Pages No:65-70][No of Hits : 356]


ABSTRACT

Ankle injuries in the presence of neuropathy have potential to cause deformity in the ankle, which can in turn cause ulcerations and infections leading to significant morbidity including loss of limb or even life. These injuries although devastating can start off innocuously and may not be immediately apparent to the patient because of lack of pain. This can lead to a late presentation. Often, the main concern is swelling, for which the patient seeks attention. And even when medical attention is sought, unless the physician is vigilant, the condition can potentially be missed or misdiagnosed as deep vein thrombosis or cellulitis. A sprain or even a fracture in the ankle is not suspected as the patient retains the ability to walk. This condition and its true nature further escapes detection if, as often is the case, a nonweight-bearing radiograph is obtained. Radiographs obtained without the weight-bearing or other stress modality may not reveal the instability at the ankle joint due to ligament damage. A thorough clinical evaluation including assessment for neuropathy and weight-bearing radiographs are necessary for diagnosis. Stable fractures and ankle sprains can be managed conservatively in a cast or boot. Unstable ankle following ligamentous disruption and/or fractures in the vicinity of the ankle needs internal or external stabilization. The stabilization in the presence of neuropathy should be stronger and the protection from weight bearing last longer and twice that used for patients with similar condition but without neuropathy.

Keywords: Ankle, Charcot, Diabetes, Hindfoot nailing, Peripheral neuropathy.

How to cite this article: Panchbhavi VK. Ankle Reconstruction in Charcot’s Neuroarthropathy: Challenges and Solutions. J Foot Ankle Surg (Asia-Pacific) 2016;3(2):65-70.

Source of support: Nil

Conflict of interest: None


 
EDITORIAL
Siddhartha Sharma, Mandeep S Dhillon

The Accessory Navicular in Children and Adolescents: What We know and What We can do

[Year:2016] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:63] [Pages No:v-vi][No of Hits : 252]


ABSTRACT

The navicular, also known as os naviculare or the tarsal scaphoid, derives its name from Latin “navis” or ship. It is interposed between the head of the talus and the cuneiforms, and it forms an important part of the medial longitudinal arch of the foot. The navicular tuberosity, a bony prominence on the medial end of the bone, provides insertion to the tibialis posterior tendon, which is the most important dynamic stabilizer of the medial longitudinal arch of foot.1


 
Book Review
Siddhartha Sharma

Guidelines in Fracture Management–Fractures around the Foot and Ankle

[Year:2016] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:63] [Pages No:63][No of Hits : 232]


ABSTRACT

This book aims to provide an up-to-date review on fractures around the foot and ankle. This book has been conceived under the aegis of the Trauma Society of India, and it has been compiled by two editors with special interest in foot and ankle trauma with the experience of several eminent international and Indian authors. The reader can expect to find comprehensive information on ankle fractures, syndesmotic injuries, pilon fractures, calcaneus fractures, and talar fractures along with chapters dedicated to anatomy, biomechanics, classification, and management.


 
Guest Editorial
Ashu Rastogi, Anil Bhansali

Diabetic Foot: An Outcome of Increasing Longevity

[Year:2016] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:56] [Pages No:v-vi][No of Hits : 210]


ABSTRACT

Diabetic Foot: An Outcome of Increasing Longevity

Diabetes mellitus is considered one of the most challenging disorders among all noncommunicable diseases (NCDs). India has the second largest number of people living with diabetes after China, and according to the International Diabetes Federation, India presently has 69.1 million people with diabetes.1


 
Case Report
Rajiv Shah

Cases of Nonhealing Diabetic Neuropathic Ulcers

[Year:2016] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:56] [Pages No:111-116][No of Hits : 205]


ABSTRACT

How to cite this article: Shah R. Cases of Nonhealing Diabetic Neuropathic Ulcers. J Foot Ankle Surg (Asia-Pacific) 2016;3(2):111-116.

Source of support: Nil

Conflict of interest: None


 
Review Article
Subhash K Wangnoo, Radhika Jindal, Mohammad A Siddiqui

Diabetic Foot Infection Impostors

[Year:2016] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:56] [Pages No:88-91][No of Hits : 197]


ABSTRACT

Diabetic foot complications continue to be the main reason for diabetes-related hospitalization and lower extremity amputations. Most can be cured if managed properly. But improper diagnostic and therapeutic approaches result in many patients needlessly undergoing amputations. There are many other conditions “imposing” as a diabetic foot, which may mislead the diagnosis and management. One should be aware of these conditions and keep a watchful eye for them as well in a diabetic patient. Every ulcer in a diabetic need not be a diabetic foot ulcer. Some of these diabetic foot infection imposters are discussed herewith and these include pyoderma gangrenosum, squamous cell carcinoma in a chronic ulcer, venous ulcer, bullosis diabeticorum, necrobiosis lipoidica diabeticorum, malignant melanoma, thromboangiitis obliterans (TAO), superficial thrombophlebitis, erythema nodosum, and granuloma annulare.

Keywords: Cellulitis, Diabetic foot, Foot ulcer.

How to cite this article: Wangnoo SK, Jindal R, Siddiqui MA. Diabetic Foot Infection Impostors. J Foot Ankle Surg (Asia- Pacific) 2016;3(2):88-91.

Source of support: Nil

Conflict of interest: None


 
Case Report
Deepinderjit Singh, Amit Lakhani, Gagandeep Kaur

Isolated Tuberculosis of Talonavicular Joint of Foot

[Year:2015] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:49] [Pages No:94-96][No of Hits : 451]


ABSTRACT

Tuberculosis of foot is a rare entity, accounting for only 10% of osteoarticular tuberculosis. Its ability to mimic other common disorders can lead to delay in the diagnosis and proper treatment, particularly when it occurs in isolation. Here, we present a rare case of isolated tuberculosis of talonavicular joint of foot in an otherwise healthy male of 26 years.

Keywords: Isolated tuberculosis, Osteoarticular tuberculosis, Talonavicular joint.

How to cite this article: Singh D, Lakhani A, Kaur G. Isolated Tuberculosis of Talonavicular Joint of Foot. J Foot Ankle Surg (Asia-Pacific) 2015;2(2):94-96.

Source of support: Nil

Conflict of interest: None


 
Editorial
Mandeep S Dhillon, Siddhartha Sharma

Subtalar Dislocations, Total Talar Dislocations and the Extruded Talus: A Polynymous Injury or Separate Entities?

[Year:2015] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:50] [Pages No:v-vi][No of Hits : 371]


ABSTRACT

Subtalar dislocations, Total Talar Dislocations and the Extruded Talus:
A Polynymous injury or separate entities?

The talus participates in the formation of three important joints: the ankle (talocrural joint), the subtalar joint and the talonavicular joint. Integrity of these joints is paramount for maintaining normal biomechanics of the foot.


 
Original Article
Manish Khanna, Mithilesh Kumar

Radiographic Analysis of Resistant and Neglected Clubfoot treated by Fixator

[Year:2015] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:49] [Pages No:71-73][No of Hits : 368]


ABSTRACT

Sixteen resistant and neglected clubfoot deformities in patients of age group from 8 months to 11 years were treated with external fixator during December 2012 to November 2013. The radiological evaluation of feet was done to know the alignment of bones to decide the extent of correction required. Results were graded as good.

Keywords: Clubfoot, External fixator, Radiographic analysis.

How to cite this article: Khanna M, Kumar M. Radiographic Analysis of Resistant and Neglected Clubfoot treated by Fixator. J Foot Ankle Surg (Asia-Pacific) 2015;2(2):71-73.

Source of support: Nil

Conflict of interest: None


 
Editorial
Mandeep S Dhillon, Siddhartha Sharma

Percutaneous Repair of Acute Achilles Tendon ruptures: A Step in the Right Direction

[Year:2015] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:49] [Pages No:v-vi][No of Hits : 348]


ABSTRACT

Percutaneous Repair of Acute Achilles Tendon Ruptures:


A Step in the Right Direction

Acute ruptures of the Achilles tendon are common and generally involve males in their 3rd or 4th decades who play sports intermittently. The mechanism of trauma is thought to be sudden and forced plantar-flexion of the foot, sudden dorsiflexion of the foot or sudden dorsiflexion of the plantar-flexed foot.



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