Journal of Foot and Ankle Surgery (Asia Pacific)

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2022 | April-June | Volume 9 | Issue 2

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Richard Buckley

Wandering through the Wilderness: Treatment of the Displaced Intra-articular Calcaneal Fracture over the Last 80 Years

[Year:2022] [Month:April-June] [Volume:9] [Number:2] [Pages:2] [Pages No:51 - 52]

   DOI: 10.5005/jp-journals-10040-1224  |  Open Access |  How to cite  | 


Review Paper

Richard Buckley

Best Evidence and Indications for Surgery with Different types of Displaced Os Calcis Fractures

[Year:2022] [Month:April-June] [Volume:9] [Number:2] [Pages:3] [Pages No:53 - 55]

Keywords: Best evidence, Nonoperative, Os calcis, Surgery

   DOI: 10.5005/jp-journals-10040-1210  |  Open Access |  How to cite  | 


Who deserves surgery and is nonoperative care still reasonable in this decade? And what type of surgery? Full open approach through an extended lateral incision or limited incision surgery with a lower complication rate? Can we get the reduction of the posterior facet through small incision surgery, or must we use the larger more invasive extended lateral approach to ensure that the joint is truly reduced? And what about the Sanders 4 patient–when is primary fusion the best option for such a fracture? These questions are much closer to being fully answered now with good randomized controlled trials and careful attention to some specific problems like wound issues and foot shape—that are only present in this very special fracture.


Review Paper

Jong M Lee, Richard Buckley, Andrew Clark, Colin Drury, Christopher Del Balso, Amir Khoshbin, Timothy Daniels, Mansur Halai

Surgical Options for Calcaneal Bony Defects: Current Clinical Evidence

[Year:2022] [Month:April-June] [Volume:9] [Number:2] [Pages:5] [Pages No:56 - 60]

Keywords: Best evidence, Bone substitute, Calcaneal fracture

   DOI: 10.5005/jp-journals-10040-1213  |  Open Access |  How to cite  | 


Autografts, allografts, bone graft substitutes, and bone replacement materials have been utilized in isolation or in combination to fill bony defects and enhance fracture healing or arthrodesis in all subspecialties of Orthopaedics. Although there is a robust literature on the effect of bone grafts on managing large bone defects in long bones and arthrodesis, little has been published on the management of calcaneal bony defects. In this review, we aim to discuss the various options for calcaneal bony defects and the current clinical evidence behind each graft option.


Review Paper

Maegan Shields, Richard Buckley, Christopher D Balso, Amir Khoshbin, Aaron Nauth, Timothy Daniels, Mansur Halai

The Emergent Management of Tongue-type Calcaneal Fractures: Technique Tips

[Year:2022] [Month:April-June] [Volume:9] [Number:2] [Pages:6] [Pages No:61 - 66]

Keywords: Calcaneus, Emergency, Open reduction

   DOI: 10.5005/jp-journals-10040-1214  |  Open Access |  How to cite  | 


The aim of this report is to aid the trauma surgeon with some technique tips to aid with maintaining and obtaining reduction of these complex tongue-type calcaneal fractures. This will be conveyed via two case examples (high and low energy fracture patterns), each requiring different principles of fixation.


Review Paper

Michael Swords, John Shank

Late Treatment of Displaced Intra-articular Calcaneus Fractures: When is Late too Late?

[Year:2022] [Month:April-June] [Volume:9] [Number:2] [Pages:5] [Pages No:67 - 71]

Keywords: Calcaneus, Calcaneus fracture, Osteotomies, Subtalar joint, Subtalar arthrodesis, Surgical timing

   DOI: 10.5005/jp-journals-10040-1226  |  Open Access |  How to cite  | 


Multiple studies support open reduction and internal fixation of displaced intra-articular calcaneus fractures (DIACFs). Clinical evidence does not currently support a clear, well-defined treatment recommendation for DIACFs that present in a late fashion. The treatment options for this challenging clinical presentation are reviewed as well as current literature on this most difficult clinical scenario. Specific treatment should be catered to the individual patient with consideration of the technical ability of the surgeon.


Radiology Corner

Shahnawaz Khan

Techniques for Ideal Intraoperative Radiography of Calcaneum

[Year:2022] [Month:April-June] [Volume:9] [Number:2] [Pages:3] [Pages No:72 - 74]

Keywords: Ankle, Calcaneus, Foot, Radiography, Radiographs, Trauma

   DOI: 10.5005/jp-journals-10040-1225  |  Open Access |  How to cite  | 


Calcaneum is an important bone in the foot and ankle system. It is involved in the weight bearing axis and also forms the arches of the foot. Any fracture of calcaneus needs to be treated. Operating on a fractured calcaneus is technically demanding and requires thorough knowledge of foot and ankle radiography. This helps in accurate reduction of the fracture and improves patient outcomes. To analyze an image of calcaneus, one must have knowledge about the anatomy and the angular measurements of the calcaneus. These structures are then visualized on radiographic images. Lateral view of foot, Harris axial view, Broden's view, Saltzman's view and the Captain's view are some of the most frequently performed radiographs intraoperatively.


Original Article

Mahesh Soni, Diwakar Mishra

Sinus Tarsi Approach for Calcaneal Fracture Treatment: Our Experience with 36 Consecutive Cases

[Year:2022] [Month:April-June] [Volume:9] [Number:2] [Pages:6] [Pages No:75 - 80]

Keywords: Calcaneus fractures, Displaced intra-articular calcaneal fractures, Sinus tarsi approach

   DOI: 10.5005/jp-journals-10040-1228  |  Open Access |  How to cite  | 


A total of 35 patients with 36 Sanders type 2 and 3 calcaneal fractures were treated with open reduction and internal fixation using the sinus tarsi approach. Wires, screws, plates, and combinations of these were used for the fixation of fractures. The patients were followed for 10–44 months and evaluated for radiological and clinical outcomes. Bohler angle was corrected from a preoperative mean of 0.68 degrees (range: 34.7–23.4 degrees) to postoperative mean of 23.5 degrees (range: 16–40 degrees). Gissane angle was corrected from a preoperative mean of 94.7 degrees (range: 41.8–123.8 degrees) to 110 degrees postoperatively (range: 87.7–135.8 degrees). Clinical outcomes were evaluated using The American Orthopedic Foot and Ankle Society (AOFAS) scoring. The score, at last, follow-up was 62–90 with an average of 82. We conclude that the sinus tarsi approach can be used for earlier intervention and permits adequate access for satisfactory reduction of Sanders type 2 and 3 calcaneal fractures and optimum implant placement. The approach is associated with a low incidence of soft tissue complications.


Original Article

Gurunath S Wachche, Sunil Handralmath, Prashant Dhamoji

Management of Neglected Medial Peritalar Dislocations: A Preliminary Report with Clinical and Radiological Analysis of 10 Cases

[Year:2022] [Month:April-June] [Volume:9] [Number:2] [Pages:5] [Pages No:81 - 85]

Keywords: Neglected medial peritalar dislocations, Open reduction and transarticular fixation, Subtalar joint, Talonavicular joint

   DOI: 10.5005/jp-journals-10040-1181  |  Open Access |  How to cite  | 


Aim and objective: To study the functional outcome of neglected medial peritalar dislocations treated with open reduction and k-wire fixation and assess the clinical and radiological outcome of these neglected cases. Materials and methods: A prospective study was performed on 10 patients between June 2016 and July 2020. All the cases were treated with open reduction and internal fixation with k-wire fixation in the Department of Orthopaedics and private setup. We graded these injuries according to the AOFAS ankle hindfoot scale. Results: In our study, all the patients had closed injury and presented to us between 4 weeks to 8 weeks after injury without taking any primary treatment. The mean age group was 21–58 years of age with male predominance (60%). Road traffic accident (RTA) is the most common mode of injury (80%). Five (50%) of the patient had right side involvement and five (50%) left-sided. Four (40%) patients had excellent outcomes, four (40%) good, and two (20%) fair. Three patients had complications like superficial skin infection, broken k-wire, and persistent pain due to missed calcaneocuboid subluxation preoperatively. Conclusion: All chronic neglected peritalar dislocations need open reduction and K-wire fixation. Preoperative computed tomography (CT) scan, proper operative planning, if needed use of distractor for reduction is useful in some cases. Meticulous soft tissue handling is key factor for better outcome. Long-term follow-up is needed to know about the talus osteonecrosis and post-traumatic arthritis.



Adrian JC Tablante, Emiliano B Tablante

Scarf Osteotomy without Internal Fixation for Hallux Valgus: A Systematic Review

[Year:2022] [Month:April-June] [Volume:9] [Number:2] [Pages:6] [Pages No:86 - 91]

Keywords: Hallux valgus, Implantless, Scarf osteotomy, Screwless, Systematic review, Without internal fixation

   DOI: 10.5005/jp-journals-10040-1227  |  Open Access |  How to cite  | 


Background: Scarf osteotomy is traditionally performed with screw fixation and has been found to be useful for moderate to severe grade deformities. Our study aimed to evaluate the efficacy and safety of scarf osteotomy without internal fixation for hallux valgus deformity correction based on the available literature. Methods: A systematic search of PubMed and the Cochrane database of controlled trials was performed to include any available studies that examine the effectiveness of scarf osteotomy without internal fixation in terms of clinical or radiographic outcomes, as well as complications. The methodological quality of each study was assessed using the MINORS criteria. Results: Five studies were included in this systematic review (four cases series and one retrospective comparative study). We noted that all studies concluded acceptable outcomes using scarf osteotomy without internal fixation with the American Orthopaedic Foot and Ankle Society (AOFAS) score improving from an average of 46.5–91, the mean hallux valgus angle improving from 32.9°–9.7°, the mean intermetatarsal angle improving from 14.5°–6.1°, and lastly, the mean distal metatarsal articular angle from 15.5°–5.9°. Complication rates were low across all studies with a 5.5% in 305 patients, with displacement being the most common complication accounting for 2.2% across all studies. Conclusion: Scarf osteotomy without internal fixation has been shown to have potential in the treatment of hallux valgus deformities. Acceptable results and complication rates suggest that this technique can be a viable alternative for patients, especially those who are financially burdened and those who cannot afford increased hospital time. However, there is limited knowledge and small number of research studies on this surgical technique. The current systematic review hopes to invoked renewed interest in this technique. Clinical significance: Scarf osteotomy without internal fixation can provide a cheaper alternative to the standard protocol of hallux valgus correction as it does not need an implant for internal fixation and can theoretically provide comparable results which can lessen the financial burden for patients such as those living in third-world countries.



Dharampal Swami, Nitesh Gahlot, Abhay Elhence

Giant Cell Tumor of the Talus: A Case Report and Review of Literature

[Year:2022] [Month:April-June] [Volume:9] [Number:2] [Pages:4] [Pages No:92 - 95]

Keywords: Case reports, Giant cell tumor, Giant cell tumor talus, Management, Outcome, Review of literature

   DOI: 10.5005/jp-journals-10040-1162  |  Open Access |  How to cite  | 


Aim and objective: This study aims to describe a rare case of giant cell tumor (GCT) of the talus. Background: Giant cell tumors rarely present around bones of the foot and involvement of the talus is infrequent. In comparison to long bones, diagnosis and management of talus GCT is challenging and is sparsely reported in the literature. Case description: We report a case of GCT arising from the talus in a 19-year-old boy, presenting as non-specific foot pain for the past 2 months. The diagnosis was established by open biopsy and treated with curettage, bone grafting, and subtalar joint arthrodesis. At 6 months of follow-up, the patient had painless arthrodesis of subtalar joint with functional ankle joint and no sign of recurrence at last clinicoradiological examination. Conclusion: Diagnosis and management of GCT talus is challenging and can be treated with extended curettage with subtalar arthrodesis. Clinical significance: Presentation of GCT talus may be missed at early stages. A high index of suspicion can help in diagnosis and appropriate management.



Neetin P Mahajan, GS Prasanna Kumar, Kartik P Pande, Tushar C Patil

Non-union of the Navicular with Associated Talonavicular and Calcaneocuboid Joint Degenerative Arthritis and Its Management: A Case Report

[Year:2022] [Month:April-June] [Volume:9] [Number:2] [Pages:3] [Pages No:96 - 98]

Keywords: Degenerative arthritis, Navicular, Non-union

   DOI: 10.5005/jp-journals-10040-1176  |  Open Access |  How to cite  | 


Introduction: Tarsal navicular bone fractures are most commonly occurs as a result of either trauma or undue stress. The stress causes higher incidence in younger individuals and athletes. These fractures are at higher risk of going to non-union and osteonecrosis because of the bone's tenuous blood supply as well as the joint complexity. Case description: A 40-year-old male patient presented with complaints of right foot pain for 2 years with an old history of trauma. Radiological examination revealed non-union of the right navicular with adjacent joint degeneration. We managed with open reduction and internal fixation using a cannulated cancellous screw. At 1-year follow-up, the patient has got a good radiological and functional outcome. Conclusion: Navicular non-unions are well managed with open reduction and internal fixation using cannulated cancellous screws, which helps in getting compression at the non-union site and provides stability. Early surgical intervention helps to prevent adjacent joint degenerative arthritis. CT scan evaluation is very essential to diagnose the non-union navicular as the X-rays appear normal in most cases.


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