Journal of Foot and Ankle Surgery (Asia Pacific)

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2018 | June | Volume 5 | Issue 1

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Sharad Prabhakar, Sameer Aggarwal, Devendra K Chouhan

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

[Year:2018] [Month:June] [Volume:5] [Number:1] [Pages:4] [Pages No:1 - 4]

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

   DOI: 10.5005/jp-journals-10040-1080  |  Open Access |  How to cite  | 


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.



Balaji Sambandam, Sundararajan Silvampatti Ramasamy, Ramakanth Rajagopalakrishnan

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

[Year:2018] [Month:June] [Volume:5] [Number:1] [Pages:8] [Pages No:5 - 12]

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

   DOI: 10.5005/jp-journals-10040-1081  |  Open Access |  How to cite  | 


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.



Dhananjaya Sharma, Pawan Agarwal

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

[Year:2018] [Month:June] [Volume:5] [Number:1] [Pages:3] [Pages No:13 - 15]

Keywords: Egyptian, Foot shape, Greek, Ingrown toenail

   DOI: 10.5005/jp-journals-10040-1082  |  Open Access |  How to cite  | 


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.



SK Mathur, 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:June] [Volume:5] [Number:1] [Pages:5] [Pages No:16 - 20]

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

   DOI: 10.5005/jp-journals-10040-1083  |  Open Access |  How to cite  | 


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.



Kapil Goyal, Kusum Sharma, Nitya Batra

Diagnosis of Foot and Ankle Tuberculosis

[Year:2018] [Month:June] [Volume:5] [Number:1] [Pages:6] [Pages No:21 - 26]

Keywords: Diagnosis, Foot and ankle tuberculosis, Osteoarticular tuberculosis

   DOI: 10.5005/jp-journals-10040-1084  |  Open Access |  How to cite  | 


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.



Amin Kheiran, Jitendra Mangwani

Addressing Controversies in the Management of Ankle Fractures

[Year:2018] [Month:June] [Volume:5] [Number:1] [Pages:8] [Pages No:27 - 34]

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

   DOI: 10.5005/jp-journals-10040-1085  |  Open Access |  How to cite  | 


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.



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:June] [Volume:5] [Number:1] [Pages:4] [Pages No:35 - 38]

Keywords: Clubfoot, Ponseti, Prognosis, Talonavicular, Ultrasonography

   DOI: 10.5005/jp-journals-10040-1086  |  Open Access |  How to cite  | 


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.



Arup K Daolagupu, Vikash Agarwala, Gaurav Khanted

Osteoid Osteoma of the Talus Neck

[Year:2018] [Month:June] [Volume:5] [Number:1] [Pages:4] [Pages No:39 - 42]

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

   DOI: 10.5005/jp-journals-10040-1087  |  Open Access |  How to cite  | 


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.



Tribhuwan NS Gaur, Harish Rao

Mirror Foot: A Case Report with Review of Literature

[Year:2018] [Month:June] [Volume:5] [Number:1] [Pages:4] [Pages No:43 - 46]

Keywords: Excision, Mirror foot, Preaxial polydactyly

   DOI: 10.5005/jp-journals-10040-1088  |  Open Access |  How to cite  | 


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.


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