Journal of Foot and Ankle Surgery (Asia Pacific)

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2021 | April-June | Volume 8 | Issue 2

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Leslie Grujic, Andrew Rajkumar Stephens

Evolution of Australian Orthopedic Foot and Ankle Surgery

[Year:2021] [Month:April-June] [Volume:8] [Number:2] [Pages:2] [Pages No:39 - 40]

   DOI: 10.5005/jp-journals-10040-1155  |  Open Access |  How to cite  | 


Foot and ankle surgery has advanced greatly in Australia since Dr Cecil Cass commenced his term as President in 1988. As a society, we have progressed to lead the discussion in many areas of advanced foot and ankle surgical practice. Fellowships and AO trauma involvement have advanced the practice, training, and research into the management of complex foot and ankle conditions.



Sharad Prabhakar

Guest Editorial: Mini-symposium: Understanding the Flatfoot Deformity

[Year:2021] [Month:April-June] [Volume:8] [Number:2] [Pages:1] [Pages No:41 - 41]

   DOI: 10.5005/jp-journals-10040-1158  |  Open Access |  How to cite  | 



Nikku Mathew Geevarughese, Shivam R Shah

Tarsal Coalitions in Adults: A Case Series

[Year:2021] [Month:April-June] [Volume:8] [Number:2] [Pages:6] [Pages No:42 - 47]

   DOI: 10.5005/jp-journals-10040-1138  |  Open Access |  How to cite  | 


Tarsal coalition is an uncommon finding in children and adolescent age groups. Its occurrence in adulthood is even rarer. Though the majority of the coalitions are asymptomatic, pain, and fatigue in 25% of coalitions become indicators for aggressive treatment. Surgical procedures are undertaken only at the failure of conservative management. Triple arthrodesis has been advocated earlier but causes substantial stresses at the ankle joint. Hence, a limited arthrodesis aiming at the involved joint spares loading of the ankle and calcaneocuboid joints. More so, hindfoot valgus is a common component noted in tarsal coalitions and needs to be addressed along with isolated arthrodesis to achieve overall favorable outcomes. We present a series of tarsal coalitions in adults who presented with different symptoms, managed with corrective arthrodesis, and simultaneous treatment of associated pes planus deformity.



Chamnanni Rungprai, Parinya Maneeprasopchoke

A Clinical Approach to Diagnose Flatfoot Deformity

[Year:2021] [Month:April-June] [Volume:8] [Number:2] [Pages:7] [Pages No:48 - 54]

   DOI: 10.5005/jp-journals-10040-1149  |  Open Access |  How to cite  | 


Flatfoot is a complex disorder combining multiple static and dynamic deformities, associated with a collapsing medial longitudinal arch. The etiology of flatfoot is multifactorial and can be divided into two main groups; congenital and acquired groups. History, physical examination, and radiographs of the foot are used to establish and confirm the diagnosis. The staging system for flatfoot demonstrates the deformity and guides the appropriate treatment. This article will focus on etiologies, pathophysiology, and clinical approach to diagnose flatfoot deformity.



Pisit Boonma, Chamnanni Rungprai

Controversies in the Management of Stage II Flatfoot

[Year:2021] [Month:April-June] [Volume:8] [Number:2] [Pages:5] [Pages No:55 - 59]

   DOI: 10.5005/jp-journals-10040-1153  |  Open Access |  How to cite  | 


Stage II flatfoot patients will complain about pain on the medial side of midfoot and hindfoot due to tendinitis and tendinosis of medial foot structure, such as, posterior tibialis tendon (PTT) and spring ligament and some will complaint the lateral midfoot and hindfoot pain due to impingement of lateral structure; the peroneus, fibula, and lateral process of the talus. There are many etiologies to explain flatfoot deformity pathology. Previously, posterior tibialis tendon dysfunction (PTTD) was known as the primary problem. Nowadays, many works of literature explain the cause of flat feet that not only the dysfunctional PTT. The reports of isolated spring ligament torn and the shortening of the calcaneus also thought to be the causes. Due to many subtypes and disease pathologies, the management in stage II flat feet are diverse. This topic will discuss the main approach of type II flatfoot and the controversies topics, such as, the amount of medial calcaneal sliding osteotomy, how to correct forefoot abduction, forefoot varus, arthroereisis, or arthrodesis.



Arthithat Kirinpanu

Role of Arthrodesis in Adult-acquired Flatfoot Deformity

[Year:2021] [Month:April-June] [Volume:8] [Number:2] [Pages:6] [Pages No:60 - 65]

   DOI: 10.5005/jp-journals-10040-1140  |  Open Access |  How to cite  | 


Adult-acquired flatfoot deformity (AAFD) is composed of multi-structure problems. Failure of tendons, capsular, and other ligamentous structures lead to significant deformity and disability. Several therapeutic approaches are used to treat this disease. Arthrodesis reconstruction type procedure was raised as a satisfactory operation with high patient satisfaction. Ability to reduce most severe and fix deformities made it a procedure of choice in dealing with advance stage AAFD. Malunion, nonunion, lateral wound breakdown, and adjacent joint osteoarthritis are leading problems associated with this operation. However, there are some situations that patient will be best undergone these operations. Realigned triple arthrodesis along with its modifications are currently wide-accepted treatment for rigid arthritic flatfoot. Severe flexible AAFD and failed flatfoot reconstruction while choosing patients properly are also possible indications to treat with the fusion techniques. Lastly, some specific patient factors (age, morbid obesity, preexisting degenerative joint disease, and neuropathic patients) could be important factors to influence type of operations.



Thanut Valleenukul, Pongpol Petchkum

Failed Flatfoot Reconstruction: Reasons and Management

[Year:2021] [Month:April-June] [Volume:8] [Number:2] [Pages:6] [Pages No:66 - 71]

   DOI: 10.5005/jp-journals-10040-1150  |  Open Access |  How to cite  | 


This article will focus on the common failures and the treatment plans for complications after flatfoot deformity correction procedures including how to prevent the failures. The comprehensive history and the physical examination, including a thorough assessment of which procedure was used throughout the prior surgery, are essential to realize this complex problem. The appropriate surgical procedure should be adjusted to the symptoms as it may be related to the cause of the failures from the previous operation.


Original Article

Pankaj K Mishra, Sharad Pathak, Abha Tenguria

Bohler's Angle and Critical Angle of Gissane: Morphometry in Adult Indian Population

[Year:2021] [Month:April-June] [Volume:8] [Number:2] [Pages:4] [Pages No:72 - 75]

   DOI: 10.5005/jp-journals-10040-1147  |  Open Access |  How to cite  | 


Introduction: For the quantification of intra-articular fracture of the calcaneus, different types of angles have been mentioned in the literature. Of these, the Bohler's angle (BA) and the critical angle of Gissane (CAG) are used in common practice. However, there is a great paucity of literature conducted on the Indian populace to find out the normal range of BA and CAG. In this article, our objective is to homologate and confirm the normal range of BA and the CAG in the Indian population and compare their values to the published international reference values. Materials and methods: It is an observational cross-sectional study done between 2017 and 2019. X-rays were anonymized by hiding the identification data. The BA and CAG were measured together and by two authors simultaneously. Each angle was measured two times. Two-sample T-test was chosen to compare the means of the values and the p value <0.05 was considered significant. Results: Three hundred and eighty-four (n = 384) X-rays were studied. The average age of the patients was 41.73 years. The mean (°) of BA was 33.53 ± (SD) 6.78 (max = 46.35, min = 16.23) and the mean (°) of CAG was 115.90 ± (SD) 11.00 (max = 142.88, min = 90.22). Conclusion: The distinct apprehension of the normal dispersion of Bohler's angle and the CAG is utmost needed for the clinical practice in a population (racial) group. So, it is praiseworthy to conduct a multicenter study over a large Indian population (considering racial variation) with inter and intra-rater reliability.


Original Article

WeiJing Tan

Prevalence of Foot Deformity among Urban Young Working Women

[Year:2021] [Month:April-June] [Volume:8] [Number:2] [Pages:4] [Pages No:76 - 79]

   DOI: 10.5005/jp-journals-10040-1154  |  Open Access |  How to cite  | 


Background: Pathological foot deformities in the adult population are more prevalent in women and many are closely related to ill-fitting footwear. To date, most literature related to footwear and foot health is based on Western society or developed nations. We conduct this study to establish the prevalence of foot deformity in young women working in an urban area. Materials and methods: This is a cross-sectional study on young working women age between 21 years and 40 years through the convenience sampling method. Data on the foot problems were collected through a surveyor-directed questionnaire and clinical examination of the feet. Results and discussion: A total of 400 working women with a mean age of 29.4 years were recruited into the study. More than half (65.0%) of the women had normal body mass index (BMI). About half (52.8%) of the women had foot deformity of different severity, but only 54 (25.6%) of them were aware of these deformities. One hundred and six women (26.5%) had skin hyper-callosity, 47 (11.8%) had hallux valgus, and 46 (11.5%) had lesser toe deformity. Our result showed that the prevalence of foot deformity was much higher in women wearing high-heel shoes to work which was statistically significant (p < 0.001). However, there was no statistically significant relationship between foot deformity with age, race, and BMI. Conclusion: In young working women, deformity of the foot is associated with wearing high-heel footwear to work. Public awareness of the potential adverse effect of high heel shoes may help to reduce the prevalence of non-traumatic foot deformity in these women.


Original Article

Khalis Boksh, Linzy Houchen-Wolloff, Aqua Asif, Neelam Mangwani, Jitendra Mangwani

Stress Fractures: A Growing Concern during the COVID-19 Pandemic

[Year:2021] [Month:April-June] [Volume:8] [Number:2] [Pages:6] [Pages No:80 - 85]

   DOI: 10.5005/jp-journals-10040-1157  |  Open Access |  How to cite  | 


During coronavirus disease-2019 (COVID-19) pandemic, public health measures to encourage social distancing have been implemented, including a temporary shutdown of gyms, organized sports, and social activities. Although such policies have helped contain the virus, they have had a secondary effect on the increasing incidence of patients presenting with stress fractures in the lower limb. This is mainly due to the environmental restrictions from the COVID-19 crisis, leading to suboptimal conditions in exercise performance. We present an overview on this topic for healthcare professionals in primary and secondary care and our recommendations for its management during the COVID-19 pandemic and beyond.



Uttam C Saini, Sanjay S Rawat

Syme's Amputation: Do We Need It in 2020?

[Year:2021] [Month:April-June] [Volume:8] [Number:2] [Pages:5] [Pages No:86 - 90]

   DOI: 10.5005/jp-journals-10040-1156  |  Open Access |  How to cite  | 


Syme's amputation was initially described during the pre-antisepsis and pre-antibiotic era and was found useful in many situations. Over time, this amputation technique lost favor due to associated complications and a cosmetically unacceptable prosthesis. The original technique was modified over the years, with reduced complications and improved outcomes and gait. We discuss here the evolution of Syme's amputation, its modifications, the importance of preoperative evaluation, and critical intraoperative steps for the success of the procedure.



Amol Saxena, Nicola Maffulli

RE: Darwish et al. “Ethibond Suture Granuloma Formation Following Repair of Acute Achilles Tendon Ruptures”

[Year:2021] [Month:April-June] [Volume:8] [Number:2] [Pages:1] [Pages No:91 - 91]

   DOI: 10.5005/jp-journals-10040-1151  |  Open Access |  How to cite  | 



Amr Darwish, Osama Gamal, Mohamed Kamal Mesregah

Reply to the Letter to the Editor of Saxena A and Maffulli N Concerning “Ethibond Suture Granuloma Formation Following Repair of Acute Achilles Tendon Ruptures” by Darwish A, Gamal O, Mesregah MK [J Foot Ankle Surg (Asia Pacific) 2021;8(1):12–15.]

[Year:2021] [Month:April-June] [Volume:8] [Number:2] [Pages:1] [Pages No:92 - 92]

   DOI: 10.5005/jp-journals-10040-1152  |  Open Access |  How to cite  | 


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