Journal of Foot and Ankle Surgery (Asia Pacific)

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2024 | January-March | Volume 11 | Issue 1

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Mandeep S Dhillon

Embracing Evolution: A New Era in Foot and Ankle Surgery

[Year:2024] [Month:January-March] [Volume:11] [Number:1] [Pages:1] [Pages No:1 - 1]

   DOI: 10.5005/jp-journals-10040-1334  |  Open Access |  How to cite  | 



Zhi Hao Tang, Keen W Chong, Chi S Chong

Early Radiographic Outcomes of Minimally Invasive Distal Metatarsal Osteotomies with the Spear Plate in Asian Patients for Hallux Valgus Correction

[Year:2024] [Month:January-March] [Volume:11] [Number:1] [Pages:6] [Pages No:2 - 7]

Keywords: Bosch osteotomy, Hallux valgus, Intramedullary plate, Minimally invasive, Radiological outcomes

   DOI: 10.5005/jp-journals-10040-1326  |  Open Access |  How to cite  | 


Introduction: Minimally invasive hallux valgus corrective osteotomies have gained popularity in recent years, with several implant options used to stabilize osteotomies. We aim to report the early radiological outcomes of the Spear plate intramedullary system used in minimally invasive hallux valgus correction in Asian patients. Materials and methods: A total of 17 patients (22 foot) who underwent minimally invasive distal metatarsal osteotomy for hallux valgus correction with the Spear plate intramedullary system between June 2020 and February 2022 were included in this study. All patients were followed up for a minimum of 3 months when the radiological bony union of the osteotomy site was evident. Preoperative and postoperative hallux valgus angle (HVA), first–second intermetatarsal angle (IMA), and tibial sesamoid position (based on the Hardy and Clapton system) on weight-bearing dorsoplantar foot radiographs were measured. Results: The mean radiological follow-up period was 4.4 months (range, 3.0–10.0 months). Radiographic analysis showed the HVA, IMA, and tibial sesamoid position all improved significantly postoperatively after a minimally invasive hallux valgus correction with the Spear plate. All cases showed union of the osteotomy sites by postoperative 3 months. Conclusion: The Spear plate system is a reasonable option for stabilization of a minimally invasive Bosch osteotomy in the correction of hallux valgus.



Ajoy S Manik, Rahul Panduranga, Prasoon Kumar, Ronak N Kotian, Ramesh Debur, Sushruth Jagadish, Vishal Patil

Harvesting Peroneus Longus Tendon for ACL Reconstruction: Impact on Ankle Functions and Biomechanics?

[Year:2024] [Month:January-March] [Volume:11] [Number:1] [Pages:5] [Pages No:8 - 12]

Keywords: Anterior cruciate ligament reconstruction, Ankle function, Biomechanics, Peroneus longus tendon

   DOI: 10.5005/jp-journals-10040-1320  |  Open Access |  How to cite  | 


Aim and background: The purpose of this review was to evaluate the available evidence on the effect of harvesting the peroneus longus tendon (PLT) for anterior cruciate ligament (ACL) reconstruction on ankle functions and biomechanics. Materials and methods: A total of 17 studies of interest were included in this narrative review. There were two systematic reviews, and the remaining 15 were either case series or comparative studies. Results: Current literature does not strongly recommend the usage of PLT as a primary graft choice, which is evident from the many conflicting conclusions noted among them. Conclusion: There is a need to build the evidence with long-term studies that evaluate the objective assessment of ankle function, such as gait analysis, isokinetic muscle strength testing, and foot pressure studies after PLT harvest for ACL reconstruction. Alternatively, a multicentric study is required to recruit a large number of subjects to come to a true conclusion. Clinical significance: The effect of harvesting PLT on the foot biomechanics has to be evaluated before it becomes a norm to utilize it as an autograft for ACL reconstruction. This review provides information regarding the current trend and discusses evidence behind the same.



Chandan Narang, Girish Motwani, Rehan Ahmed

A Two-step Protocol for Managing the Severe Consequences of Septic Arthritis in the Ankle

[Year:2024] [Month:January-March] [Volume:11] [Number:1] [Pages:12] [Pages No:13 - 24]

Keywords: Case report, Osteotomy, Pantalar arthrodesis, Radical debridement, Septic ankle arthritis, Tibiotalocalcaneal nail

   DOI: 10.5005/jp-journals-10040-1299  |  Open Access |  How to cite  | 


Aim: The aim of this study was to report a novel two-step technique for managing the severe consequences of septic ankle arthritis. Background: Septic ankle arthritis is a challenging orthopedic disease with a high risk of morbidity and mortality. Early treatment is essential to avoid irreparable articular cartilage damage and erosion, osteomyelitis, and dysfunctional painful foot and ankle deformities. Therefore, an aggressive surgical approach is essential to prevent severe extremity-threatening arthritis. Case description: We report that three of the cases of challenging septic ankle and ankle arthritis were treated with a two-phase protocol. The first stage included radical debridement, microbiological evaluation, insertion of vancomycin-coated biogranules, and administration of empirical intravenous antibiotics. In the second stage, deformity correction was performed by osteotomy and fixation. All three were asymptomatic at 6 months follow-up, had no discomfort in daily life and were able to perform fully functional activities. Conclusion: Two-stage protocol is a reliable way to manage septic arthritis of the ankle, with significant bone loss in the talar region and related deformities. It provides a good functional outcome of the limb with rigidness. It gives rigid, stable fixation using tibiotalocalcaneal nails.



Siddharth Gupta, Ankit Khurana, Karan Jaggi, Dheeraj K Singh, Raskesh Malhotra, Karan Rajpal

Giant Schwannoma of Foot: A Report of Two Cases and Literature Review

[Year:2024] [Month:January-March] [Volume:11] [Number:1] [Pages:4] [Pages No:25 - 28]

Keywords: Ankle, Benign, Case report, Foot tumors, Tibial nerve

   DOI: 10.5005/jp-journals-10040-1306  |  Open Access |  How to cite  | 


Schwannomas are benign, isolated, and encapsulated tumors originating from schwann cells of the peripheral nerve sheath. Schwannomas usually affect the head and neck region and localization in the lower extremity is exceptionally rare with a reported prevalence rate of 1–10%. A <20 cases of schwannomas of feet have been reported in the literature, most commonly causing compression in the tarsal tunnel, it is however rare for them to be seen more distally. We herein report a rare presentation of giant schwannoma of the foot diagnosed on either a magnetic resonance imaging (MRI) scan or ultrasound scan of the foot which revealed a well-defined, lobulated soft tissue lesion likely of fibrous or neural origin. Both patients underwent an excisional biopsy under spinal anesthesia, with an uneventful recovery period. The postoperative (post-op) follow-up was reported to be normal with no radiological evidence of recurrence. This report of two cases and the included literature review aims to highlight the diagnostic challenges of this rarely encountered entity and the authors hope to raise awareness of lower limb schwannomas and their clinical presentation.



Pradeep Choudhari, Mohit Mahoviya, Rishabh Chouhan, Aayush K Soni

Fungal Osteomyelitis of Cuboid Bone Case Report with Literature Review

[Year:2024] [Month:January-March] [Volume:11] [Number:1] [Pages:4] [Pages No:29 - 32]

Keywords: Case control study, Cuboid bone, Fungal infection, Fungal osteomyelitis, Immunocompetent fungal infection

   DOI: 10.5005/jp-journals-10040-1281  |  Open Access |  How to cite  | 


Background: Chronic osteomyelitis with sinus formation of right cuboid bone has often been missed, which leads to the morbidity of the patient. Case description: Here, we present a case of a 29-year-old male with fungal involvement of the cuboid bone. Fungal osteomyelitis of cuboid bone is of an unusual occurrence. Delayed diagnosis is one of the prime concerns leading to the progression of the disease and further bone involvement. In our study, we did a prompt diagnosis which changed the progression and treatment of the disease. Conclusion: Early diagnosis and prompt treatment with surgical intervention, antifungal medications, and a multidirectional approach is the key in treating cases of fungal osteomyelitis for immunocompetent and immunocompromised fungal infection.



Vijay Kumar Digge, MLV Sai Krishna, Anmol Anand, Sumit Kumar

Recurrent Synovial Chondromatosis of the Fifth Metatarsophalangeal Joint of the Foot: A Case Report

[Year:2024] [Month:January-March] [Volume:11] [Number:1] [Pages:5] [Pages No:33 - 37]

Keywords: Foot, Metatarsophalangeal joint, Recurrence, Synovial chondromatosis

   DOI: 10.5005/jp-journals-10040-1279  |  Open Access |  How to cite  | 


Background: Primary synovial chondromatosis is a disease occurring in normal joints and is characterized by the formation of hyaline cartilage in the subintimal layer of the synovium and loose body formation eventually leading to degenerative arthritis. Though it mostly affects large joints, it can rarely involve small joints of the foot as well. The treatment is excision of the loose bodies along with complete synovectomy because partial synovectomy leads to recurrence. The disorder is rarely associated with malignant transformation as well and hence the excised tissue should always be sent for histopathological examination. Case description: A 15-year-old girl presented to us with a painful swelling over the fifth metatarsophalangeal joint of the foot. She had a past history of similar complaints two years ago for which she underwent surgical excision of the same. She presented to us again with recurrence, for which she again underwent surgical excision and the biopsy was sent for histopathological examination which was suggestive of metaplastic calcification with no evidence of malignant transformation. Conclusion: The treatment for synovial chondromatosis is synovectomy and loose body removal either as an arthroscopic or open procedure, and incomplete synovectomy has been attributed to higher recurrence rates. Malignant transformation though rare has also been described and should always be suspected in a recurrent disease that has rapid growth and bone destruction and requires histopathological examination.



Vishnu Senthil

Primary End-end Tendo-Achilles Repair for Defect of 7 cm: A Case Report with Literature Review

[Year:2024] [Month:January-March] [Volume:11] [Number:1] [Pages:4] [Pages No:38 - 41]

Keywords: Creep phenomenon, End-end repair, Tendo-Achilles tear, Ultrabraid suture, V-Y plasty

   DOI: 10.5005/jp-journals-10040-1276  |  Open Access |  How to cite  | 


Achilles tendon evolved in humans as a consequence of bipedal gait. We report a case of neglected tendo-Achilles injury in a 32-year-old female. Magnetic resonance imaging (MRI) showed a defect of 3.5 cm, about 5.5 cm from the calcaneal attachment. On debridement, a defect of 7 cm was found intraoperatively. It was repaired end-to-end with ultra braid suture with Krackow 90° locking stitch with gift box configuration along with V-Y plasty. Paratenon suturing was done to reinforce the repair. Now the patient is at an 18-month follow-up, showing intact repair in MRI and full weight-bearing. In our case, we want to bring out the mechanical properties of tendo-Achilles. Mechanical properties of tendo-Achilles with emphasis on its viscoelastic nature and repair in a high amount of tension produced good strong repair and functional outcome at final follow-up.



Ashok N Johari, Rashid Anjum

Inadvertent Metatarsal Lengthening and Hallux Valgus Associated with JESS in a Case of AMC: A Rare and Unreported Complication

[Year:2024] [Month:January-March] [Volume:11] [Number:1] [Pages:4] [Pages No:42 - 45]

Keywords: Arthrogryposis multiplex congenita, Case report, Complication, Congenital talipes equinovarus, External fixation, Joshi's external stabilization system, Metatarsal lengthening

   DOI: 10.5005/jp-journals-10040-1323  |  Open Access |  How to cite  | 


Background: External fixators provide a flexible approach for addressing intricate foot deformities such as clubfoot, particularly in situations involving inflexible or recurrent deformities, neglected cases, or deformities associated with neuromuscular conditions. Case description: A 10-year-old patient of arthrogryposis multiplex congenita (AMC) with congenital talipes equinovarus (CTEV) undergoing treatment with Joshi's external stabilization system (JESS) presented with inadvertent metatarsal lengthening with hallux valgus. The complication was treated by a metatarsal shortening osteotomy. Conclusion: JESS is frequently used to treat relapsed, recurrent, and rigid clubfeet including cavovarus foot deformities seen in AMC. This method of differential distraction has shown promising results with fewer complications than soft tissue releases. The reported complications include pin tract infection, loosening of pins, wire cut through, flexion of toes, and recurrence; however, the present complication of inadvertent metatarsal lengthening has not yet been described.



MS Rudra Prasad, Chandan Kulkarni, Puneeth Pai, Amit K Jain

Idiopathic AVN of Calcaneus: A Case Report

[Year:2024] [Month:January-March] [Volume:11] [Number:1] [Pages:4] [Pages No:46 - 49]

Keywords: Avascular necrosis, Calcaneum, Case Report, Heel pain, Idiopathic

   DOI: 10.5005/jp-journals-10040-1289  |  Open Access |  How to cite  | 


Introduction: Calcaneus is an uncommon location for avascular necrosis (AVN) due to its robust vascular supply. Case description: We present a case of isolated idiopathic AVN diagnosed after excluding the common etiologies. The patient presented to us with heel pain and inability to bear weight, for which he was investigated; plain radiographs and magnetic resonance imaging (MRI) of the foot revealed a lytic lesion in the body of the calcaneum. Excision biopsy of the lesion was carried out by a lateral approach, and the lesion was thoroughly curetted out. Infective etiologies were suspected after intraoperative (intra-OP) assessment of the material obtained after the biopsy and were sent for culture sensitivity and histopathology. The cavity was left in situ as there was good surrounding bone, and the limb was stabilized with a below knee slab. Results: The culture revealed no growth and tested negative for tuberculosis, and histopathology revealed features of AVN of the calcaneus, which was confirmed by two experienced pathologists. The patient was kept non weight bearing for 6 weeks. At 6 weeks, he was pain free and started full weight bearing. There was radiological evidence of healing of the lesion at 3 months and he is being followed up regularly. Conclusion: Thus, AVN of the calcaneum can be a rare cause of heel pain and has to be kept in mind when evaluating a patient with heel pain without a history of trauma.


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