Journal of Foot and Ankle Surgery (Asia Pacific)

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2019 | January-June | Volume 6 | Issue 1

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The AOFAS Clinical Rating Systems—Time to Bid Adieu?

[Year:2019] [Month:January-June] [Volume:6] [Number:1] [Pages:1] [Pages No:1 - 1]

   DOI: 10.5005/jp-journals-10040-1103  |  Open Access |  How to cite  | 


Original Article

Manjeet Singh, Ashwani Ummat, Chetan Sharma, Praveen S Thivari, Sonia Kochhar

Efficacy of Platelet-rich Plasma vs Corticosteroid Injection in Chronic Plantar Fasciitis: A Comparative Study

[Year:2019] [Month:January-June] [Volume:6] [Number:1] [Pages:5] [Pages No:2 - 6]

Keywords: Chronic plantar fasciitis, Corticosteroid, Platelet-rich plasma

   DOI: 10.5005/jp-journals-10040-1097  |  Open Access |  How to cite  | 


Introduction: Chronic plantar fasciitis (PF) is the most common cause of foot complaints making up to 11–15% of the foot symptoms requiring professional care among adults. Also, it is a common problem that affects sport participants as well as inactive middle-aged individuals. The purpose of this study was to compare the effect of steroid and platelet-rich plasma (PRP) in chronic PF. The results were assessed by comparing American orthopedic foot and ankle scale (AOFAS) and visual analogue scale (VAS) before injection, 1, 2, and 6 months after injection in both groups comprising 25 patients in each group. Results: In our study of 50 patients, in steroid group-A, there is significant change in mean VAS from 6.28 ± 0.86 before follow-up injection to 2.8 ± 0.76 in first follow-up visit (1 month after injection) and to 2.92 ± 0.75 in second follow-up visit (2 months after 1st injection) and remained constant at 2.92 + 0.75 at third follow-up (6 months post 1st injection) and significant change in mean AOFAS from 67 ± 10 before injection to 85.76 ± 5.44 in first follow-up visit (1 month after injection) and to 84.16 + 5.94 in second follow-up visit (2 months after first injection) and deteriorated further to 83.92 + 5.84 at third follow-up (6 months after first injection). In 25 patients in group B, there is significant change in mean VAS from 5.8 ± 80.78 before follow-up injection to 1.96 ± 0.45 in first follow-up visit (1 month after injection) and to 1.96 ± 0.45 in second follow-up visit (2 months after first injection) and remained constant at 1.96 ± 0.45 at third follow-up (6 months post first injection) and significant change in AOFAS from 68.44 ± 17.78 before injection to 89.56 ± 0.91 in first follow-up visit (1 month after injection) and to 89.84 ± 0.55 in second follow-up visit (2 months after first injection) and improved further to 89.92 ± 0.40 at third follow-up (6 months after first injection). Conclusion: PRP injection is more effective than corticosteroid injection in the treatment of chronic PF in the long run.


Original Article

Vimal Kumar KH, Anil Agarwal, Obanglemla Imsong

Attendee Profile of a Clubfoot Patient: Experiences from an Indian Ponseti Clubfoot Clinic

[Year:2019] [Month:January-June] [Volume:6] [Number:1] [Pages:3] [Pages No:7 - 9]

Keywords: Attendee, Clubfoot, CTEV

   DOI: 10.5005/jp-journals-10040-1098  |  Open Access |  How to cite  | 


Introduction: The attendee (relatives) profile of clubfoot child for initiating treatment is probably a gross measure of family responsibility and social awareness regarding the disease in Indian circumstances. We conducted a prospective pilot study with primary research question “Who brings the clubfeet patient to the clubfeet clinic?” Further, the patients were followed up to 7 visits to see any gross changes in the attendee trend. The involvement of second-degree relatives was also closely monitored. Materials and methods: The CURE counselors recorded the relatives accompanying the newly enrolled clubfoot patients (July–December 2017). Patients already in follow-up, with irregular follow-up, lost to follow-up, and not willing to participate in the study were excluded. For the purpose of statistical analysis, the total opportunities to accompany patient (100 patients × 7 visits = 700 occasions) were taken as the base measurement. Results: Out of 100 studied patients, only 39 children sought treatment within 6 weeks. Mother accompanied the child most (88.5%) followed by father (71.7%) (p < 0.000001). Both parents accompanied the child on 62.4% occasions. The second-degree relatives accompanied the child on 32.7% occasions (p < 0.000001). The most persistent attendee over 7 weeks was child's mother, followed by father and next by parents together. The second-degrees relatives were least persistent of all. Conclusion: Our study showed a high percentage of parental participation and its persistence during the casting phase of Ponseti method in Indian clubfoot children. There seems to be a lot of scope for further community education and awareness in view of the relatively older child being brought for treatment and lesser involvement of second-degree relatives.


Original Article

Srikant Venkatakrishnan, Kurian Zachariah, Paulraj Chinnappan, Nidhi Rawat

A Description of a Modified Bohler Iron Walking Cast in the Management of Plantar Ulcers

[Year:2019] [Month:January-June] [Volume:6] [Number:1] [Pages:3] [Pages No:10 - 12]

Keywords: Articulated Bohler, Bohler iron, Hindfoot ulcer, Off-loading, Plantar ulcer

   DOI: 10.5005/jp-journals-10040-1101  |  Open Access |  How to cite  | 


Aim: The aim of this study is to describe the method of Bohler iron plaster casting and a modification of the technique—the articulated Bohler iron walking cast. Background: Trophic ulcers are a common problem for clinicians managing foot disorders, especially with the increasing prevalence of diabetic foot disease. Management of trophic ulcers requires offloading. The gold standard of off-loading, total contact casting (TCC), has disadvantages which include incomplete offloading, variable expertise in the application, and lack of access for wound care. Bohler iron plaster casting is less commonly used and is efficacious in plantar ulcer management. A modified method of Bohler iron casting can be used to manage midfoot and hindfoot ulcers. Technique: Bohler iron plaster casting is done by attaching iron uprights with an elevated platform to a below-knee cast. A layer of casting material is applied over the uprights to secure the apparatus. A cut out is made at the site of the plantar wound to allow access for dressing. The disadvantage of the conventional method is that midfoot and hindfoot ulcers are less accessible for wound care. To facilitate hindfoot wound care, a joint with a drop lock mechanism is incorporated in the uprights. The hinge joint allows pivot of the uprights and drop lock allows for the stability of the apparatus during weight-bearing. Conclusion: Midfoot and hindfoot ulcers can be well managed with an articulated Bohler iron plaster cast. The method allows for off-loading of the ulcer, facilitating wound care and ambulation. Further studies are required to describe ulcer-healing efficacy and compare this technique with conventional offloading methods. Clinical significance: The described techniques can be useful tools in the management of plantar ulcers especially those involving the mid- and the hindfoot.


Original Article

Murat Gulcek, Nural Aydin, Ali Oznur

Surgical Treatment of Tarsal Tunnel Syndrome

[Year:2019] [Month:January-June] [Volume:6] [Number:1] [Pages:5] [Pages No:13 - 17]

Keywords: Patient outcome assessment, Surgery, Tarsal tunnel syndrome, Tibial nerve

   DOI: 10.5005/jp-journals-10040-1096  |  Open Access |  How to cite  | 


Background and aim: To assess the long-term functional outcomes of operative treatment for tarsal tunnel syndrome (TTS) and determine the factors that are associated with favorable and unfavorable clinical results. Patients and methods: Sixty six patients (71 feet) who had undergone tarsal tunnel release (TTR) operation between 2000 and 2009 were recalled for a follow-up evaluation by a physiatrist to determine the outcome. The subjective complaints of the patients were re-evaluated using two different questionnaires: the foot function index (FFI) and a structured questionnaire. Results: The mean age of the patients was 51.67 ± 13.07 (range 21–84) years. The mean follow-up time was 54.36 ± 15.72 (range 12–96) months. Outcomes in terms of patient satisfaction were 45.1%—very satisfied (VS), 16.9%—moderately satisfied (MS), 19.7%—somewhat satisfied (SS), and 18.3%—not satisfied. Prognostic indicators of poor results in univariate analysis were older age, obesity, longer disease duration, coexisting lower back pain (LBP), plantar fasciitis, diabetes mellitus (DM), and/or carpal tunnel syndrome (all p 0.05). Conclusion: LBP and DM were the most significant factors associated with unfavorable clinical results. The majority of the patients’ symptoms improved following TTR operation.


Original Article

Malhar Dave, Heloni M Dave, Rakesh Rathava, Niravkumar P Moradiya

Surgical Treatment of Insertional Achilles Tendinosis and Haglunds Deformity by Using Central Tendon-splitting Approach: Retrospective Case Series of 15 Cases

[Year:2019] [Month:January-June] [Volume:6] [Number:1] [Pages:5] [Pages No:18 - 22]

Keywords: Achilles tendinosis, Chronic achilles tendinopathy, Haglund's deformity

   DOI: 10.5005/jp-journals-10040-1099  |  Open Access |  How to cite  | 


Purpose of the study: Haglund's deformity or pump bump is a degenerative process and is a common cause of posterior heel pain. Operative treatment is required when conservative treatment fails and the symptoms are not relieved. Different surgical procedures and approaches have been used for this deformity. But in the literature, the results have been inconsistent. In this study, we retrospectively evaluated the clinical and functional outcome of operative treatment with debridement of the retrocalcaneal bursa and the Achilles tendon using a central tendon-splitting approach. Materials and methods: A total of 15 patients that underwent a surgical procedure were included in this study. The study duration was from January 2006 to June 2011. The clinical and functional outcome was evaluated using the American Orthopedics Foot and Ankle Society (AOFAS) score. All patients were operated in the prone position by using a central tendon-splitting approach. Results: The mean follow-up period was 26 months. The mean AOFAS ankle–hind foot score had improved by 33 points from the preoperative mean score (37), with a mean score of 70 at the final follow-up. No complications (wound dehiscence and tendon avulsion) were noted. Out of 15 patients, all patients had good results except one due to persistent pain. Conclusion: We concluded that the central approach to surgical correction is an effective method with a good clinical and functional outcome in patients with refractory Haglund's deformity.



Mohammad Rimawi, Jose M Gonzalez

Bedside or Surgical Fasciotomy: Which would You Choose for Treatment of Compartment Syndrome?

[Year:2019] [Month:January-June] [Volume:6] [Number:1] [Pages:2] [Pages No:23 - 24]

Keywords: Bedside, Bedside fasciotomy, Compartment, Compartment syndrome, Podiatric emergency

   DOI: 10.5005/jp-journals-10040-1100  |  Open Access |  How to cite  | 


A compartment is an area of muscle groups and neurovascular structures enclosed by fascia. The leg consists of four compartments: anterior, lateral, superficial posterior, and deep posterior. The foot, although occupying less surface area than the leg, contains nine compartments. Common causes include but are not limited to trauma, hemorrhage, tight casting, or constrictive bandaging. When the physician has diagnosed an acute compartment syndrome, surgical decompressive fasciotomy should be performed urgently. Although a compartmental release in the operating room is the standard of care, in select cases, bedside fasciotomy can be performed to reduce the incidence of morbidity in a patient. In this brief review, we discuss the use of a bedside fasciotomy under local anesthetics in select cases to avoid delay in compartmental release.



Gautam Rava, Pranjal Mahanta

Entrapment of Extensor Hallucis Longus Tendon in Fracture Callus Leading to Dropped Hallux: A Case Report

[Year:2019] [Month:January-June] [Volume:6] [Number:1] [Pages:3] [Pages No:25 - 27]

Keywords: Distal tibia fracture, Fracture callus, Tendon entrapment

   DOI: 10.5005/jp-journals-10040-1102  |  Open Access |  How to cite  | 


Aim: The aim of this study is to describe a case of isolated extensor hallucis longus (EHL) dysfunction leading to dropped hallux, which to our belief is due to entrapment of EHL tendon in the fracture callus following open reduction and internal fixation (ORIF) and autologous bone grafting of nonunion of distal 1/3 tibia fracture. Background: Dropped hallux due to EHL dysfunction is a problematic condition because during the swing phase of the gait cycle, the hallux drags across the ground surface leading to altered gait pattern. Isolated dysfunctions of EHL due to various causes are rarely described in the literature. Case description: Dropped hallux in a 61-year-old lady with nonunion distal 1/3 tibia fracture, treated by ORIF with interlocking nail and autologous bone grafting, after the fracture was united, which got corrected after surgical release of the tendon from fracture callus and EHL anastomosis to extensor digitorium longus (EDL) tendon. Conclusion: Awareness of the possibility of entrapment of long tendons in fracture callus leading to their dysfunction, where a simple release and anastomosis of tendon could correct their function, provided the tendon is viable. Clinical significance: Tendon adherence to fracture callus leading to dropped hallux as a differential diagnosis in cases of isolated EHL dysfunction in distal 1/3 tibia fracture.


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