Journal of Foot and Ankle Surgery (Asia Pacific)

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2022 | October-December | Volume 9 | Issue 4

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Tuberculosis of the Foot: What has Changed in the 21st Century?

[Year:2022] [Month:October-December] [Volume:9] [Number:4] [Pages:2] [Pages No:147 - 148]

   DOI: 10.5005/jp-journals-10040-1264  |  Open Access |  How to cite  | 


Original Article

Praveen K Pandey, Manuj Jain, Narayanan Subramanian, Nitish Khandelwal

Post-traumatic Tuberculous Osteomyelitis of Foot and Ankle: Case Series and Literature Review

[Year:2022] [Month:October-December] [Volume:9] [Number:4] [Pages:6] [Pages No:149 - 154]

Keywords: Atypical, Case series, Foot, Osteoarticular, Post-traumatic, Tuberculosis

   DOI: 10.5005/jp-journals-10040-1215  |  Open Access |  How to cite  | 


Osteoarticular tuberculosis involves 1–3 % of all tubercular cases with most common sites as spine, hip, and knee. Less than 10 % of osteoarticular tuberculosis involves foot. Its rare occurrence requires high degree of suspicion for early diagnosis and optimal management. Post-traumatic occurrence, atypical radiological picture, and variable presentation further worsen the prognosis and morbidity. Post-traumatic osteoarticular tuberculosis is a very rare entity with very few cases reported worldwide. We are reporting our case series of five patients with post-traumatic osteoarticular tuberculosis.


Original Article

Somya Saxena, Upinder P Singh, Sanjay Wadhwa, Shiv L Yadav, Gita Handa

Effect of Lateral Wedge Orthosis in Footwear on Foot Pressure Parameters in Patients of Osteoarthritis Knee

[Year:2022] [Month:October-December] [Volume:9] [Number:4] [Pages:7] [Pages No:155 - 161]

Keywords: Lateral wedge, KOA, Orthotic management, Plantar pressure

   DOI: 10.5005/jp-journals-10040-1243  |  Open Access |  How to cite  | 


Aim: Footwear modification with lateral elevation in the sole is considered an easy to administer and low-cost orthotic intervention for knee osteoarthritis, yet it is not routinely prescribed because of limited available data to prove its effectiveness. This study aimed to assess the effect of lateral wedging in footwear, quantitatively. Materials and methods: We used Zebris Foot pressure platforms integrated into Gait Analysis Laboratory for foot pressure assessment. A Prospective Pre-Post Interventional Study was conducted with 40 patients in the age-group 35–75 years who attended Physical Medicine and Rehabilitation (PMR) OPD with grade II and three osteoarthritis on Kellgren and Lawrence System affecting the medial compartment of the knee. Baseline evaluation was done without orthotic modification in footwear and then repeated after ¼ inches lateral wedge orthosis was given in footwear. Results and implications: Peak plantar pressures showed a trend of a shift toward the lateral zone of the foot after wearing lateral-wedged insoles in shoes, signifying the redistribution of pressure and change in the ground reaction forces in the patients with osteoarthritis knee after shoe modification. All patients reported relief in pain scores. Hence lateral wedging provides symptomatic benefits. Conclusion: In low-income nations, orthotic intervention has a lot of potential as a simple and economical treatment for knee osteoarthritis (KOA). Furthermore, our findings point toward the relevance of conservative management and its ability to slow disease progression, which could be extremely helpful for people with KOA who are not candidates for surgery.


Original Article

Lalli M Singh, Shobhalakshmi S Holla

Comparison of Trunk Muscular Endurance in Individuals with Pronated Feet and Age-Gender-matched Individuals with Neutral Arch Feet

[Year:2022] [Month:October-December] [Volume:9] [Number:4] [Pages:6] [Pages No:162 - 167]

Keywords: Biering-Sorensen test, Low back pain, Physical Activity Readiness-Questionnaire

   DOI: 10.5005/jp-journals-10040-1242  |  Open Access |  How to cite  | 


Background: Structural alteration in the feet can cause the trunk muscles to overwork thereby producing more pressure and stress on the muscles, leading to low back pain. To prevent recurrence of back pain, trunk muscular endurance becomes important. The need of the study arises in understanding the role of trunk muscle endurance in individuals with pronated feet. Aim: This study aimed at determining the trunk muscle endurance of individuals with pronated feet and individuals with neutral feet. Methodology: A cross-sectional study was undertaken. Participants were selected on the basis of inclusion criteria. Both groups were assessed for trunk muscular endurance using four trunk muscular endurance tests. The tests include Biering-Sorensen trunk extensor test, 60° trunk flexor endurance test, and right and left side planks. Data analysis: Independent t-test was used to compare the trunk muscular endurance between individuals with pronated feet and individuals with neutral arch feet. Results: The results of this study suggest that there is a deficit in trunk muscular endurance in individuals with pronated feet when compared with individuals with neutral arch feet (p < 0.05). Conclusion: With the present study, it can be concluded that there is significant deficit in the trunk muscular endurance between individuals with pronated feet and individuals with neutral arch feet.



Venkatesh Babu Subbiah

Safe Foot and Ankle Surgery: The Anatomic Principles and Techniques in Preventing Complications

[Year:2022] [Month:October-December] [Volume:9] [Number:4] [Pages:4] [Pages No:168 - 171]

Keywords: Ankle, Complications, Foot, Injury, Safe, Surgery, Trauma

   DOI: 10.5005/jp-journals-10040-1197  |  Open Access |  How to cite  | 


Today, the surgery is much tolerable for nearly all foot and ankle fractures. Surgical management of ankle fractures is one of the most frequently done orthopedic surgeries. They are all being fixed either maximally or minimally invasive approaches. At the same time, the complications during the foot and ankle surgery are also challenging. This article reviews and emphasizes the importance of anatomical acquaintance with precise operative expertise needed for the surgeon who is operating on the foot and ankle.



Tanarat Hempongphan, Chamnanni Rungprai, Yantarat Sripanich

Management in Stage IV Adult-acquired Flatfoot Deformity

[Year:2022] [Month:October-December] [Volume:9] [Number:4] [Pages:6] [Pages No:172 - 177]

Keywords: Acquired adult flatfoot, Flatfoot, Flatfoot deformity

   DOI: 10.5005/jp-journals-10040-1186  |  Open Access |  How to cite  | 


Adult-acquired flatfoot deformity (AAFD) is one of the most common degenerative tendinosis problems of the foot and ankle in the aging population. Tendon dysfunction, which typically occurs in the tibialis posterior tendon, leads to secondary damage of surrounding ligaments. Degeneration of the posterior tibial tendon (PTT) induces a change in this complex, resulting in further deformity of the talonavicular joint. In addition to this deformity, the interosseous ligament of the subtalar joint is also affected, resulting in subtalar subluxation. The advanced stage of the posterior tibialis tendon and deltoid ligament insufficiency with a concurrent valgus deformity results in an abnormal deforming force to the ankle, disruption of the foot, and ankle biomechanics, and the increase in the peak pressure loads. If left untreated, this abnormal condition ultimately leads to arthritic changes of the midfoot, hindfoot, and ankle joints. Adult-acquired flatfoot deformity stage IV is the foot deformity that involved lateral talar tilt deformity of the ankle, which can be subclassified into flexible type (IVA) and fixed type (IVB). This chapter will provide a state-of-the-art understanding of how to deal with patients suffering from the Stage IV AAFD and the outcomes of each treatment method.



Praveen K Pandey

Infection Induced by Foreign Body Mimicking Tuberculosis: A Diagnostic Challenge and Management

[Year:2022] [Month:October-December] [Volume:9] [Number:4] [Pages:5] [Pages No:178 - 182]

Keywords: Lytic, Metatarsal, Osteoarticular, Pseudomonas, Tuberculosis

   DOI: 10.5005/jp-journals-10040-1161  |  Open Access |  How to cite  | 


Osteoarticular tuberculosis (TB) mimics and mimicked as well by other diseases very closely, i.e., tumors, chronic infections, fungal infections, parasitic infections, etc., which poses a great difficulty in early diagnosis and initiation of treatment. In our case report, the patient complains of dull aching pain and discharging sinus over the dorsum of the left foot with a lytic lesion in the base of the third metatarsal left foot on plain radiographs. We have started the patient on anti-tubercular therapy (ATT) based on high suspicion. Due to the non-resolution of the discharging sinus on multidrug ATT, an open biopsy was planned for the patient. Intraoperatively, a wooden foreign body was detected lying in the soft tissue around the lytic lesion of the third metatarsal base which was found to be a thorn retrospectively on further evaluation. Histopathological examination (HPE) of soft tissue suggestive of chronic osteomyelitis and culture showed growth of Pseudomonas spp. sensitive to ciprofloxacin. The patient improved clinical–radiological over the period of 3 weeks on a sensitive antibiotic (ciprofloxacin). All the cases with a suspected diagnosis of tuberculous osteomyelitis and associated lytic lesion in the foot bones should undergo open biopsy and culture evaluation.



Neetin P Mahajan, Pranay Kondewar, GS Prasanna Kumar, Shubham Atal, Amey Sadar

Multifocal Tubercular Osteomyelitis of Metatarsal and Ulna: A Case Report

[Year:2022] [Month:October-December] [Volume:9] [Number:4] [Pages:5] [Pages No:183 - 187]

Keywords: Antitubercular treatment, Curettage, Metatarsal and ulna, Tubercular osteomyelitis

   DOI: 10.5005/jp-journals-10040-1193  |  Open Access |  How to cite  | 


Introduction: Skeletal tuberculosis is relatively uncommon compared with the pulmonary form of tuberculosis. Bones and joints are affected in 1–3% of all cases, the spine and hip are most commonly involved. Localization in the foot is very rare. Management of tubercular osteomyelitis of metatarsals includes medical/surgical or both depends on the severity and location of the disease. Case description: A 25-year-old female patient presented with complaints of pain, swelling over the medial aspect of the right foot for 6 months. She had a history of left proximal ulna tubercular osteomyelitis 6 years ago, for which curettage was done and she took AKT for 6 months. X-ray foot showed a cavitary lytic lesion in the proximal part of the first metatarsal bone. It was managed with debridement, curettage, and saucerization of the metatarsal bone and CAT2 AKT. At present 1-year follow-up, the patient is comfortable with no pain, difficulty in weight-bearing, and no recurrence. X-ray foot revealed complete filling of the defect in the metatarsal with remineralization with no recurrence and fracture. Conclusion: Although metatarsal and olecranon tubercular osteomyelitis involvement is rare, early diagnosis and management help in getting a better outcome. Early surgical intervention and antitubercular treatment help in preventing further progression to adjacent joint/bone/soft tissue. Along with long-term AKT, high protein and nutritious diet help in maintaining good immunity and helps in preventing recurrence.



Venkataram Vellaipandi, Kamal Dureja

Two-stage Management of Forefoot Osteomyelitis in an Immunocompetent Young Adult: A Case Report

[Year:2022] [Month:October-December] [Volume:9] [Number:4] [Pages:4] [Pages No:188 - 191]

Keywords: Forefoot, Fusion, Immunological competence, Metatarsophalangeal joint, Osteomyelitis, Precontoured locking plates

   DOI: 10.5005/jp-journals-10040-1220  |  Open Access |  How to cite  | 


Background: Chronic osteomyelitis of metatarsals is commonly seen in patients with diabetic foot disease or following open fractures of the foot. However, it is extremely rare for chronic osteomyelitis of the forefoot to occur in the absence of an immunocompromised state. There has been one case report describing osteomyelitis of the first metatarsal head in an immunocompetent female. Here we present a case report of a young female without any immunocompromise presenting with forefoot osteomyelitis managed successfully in a staged manner. Case description: A 34-year-old woman presented to our Outpatient department with pain involving her right forefoot for the past 14 weeks and discharging sinus on the sole for the past 6 weeks. Clinical examination revealed the instability of the first three metatarsophalangeal (MTP) joints. Radiological and hematological investigations confirmed forefoot osteomyelitis. Local and systemic immunocompromise was ruled out by a detailed evaluation. AOFAS Hallux score was recorded as 36. In the first stage, she underwent debridement and trans-articular K-wire fixation of the affected joints. Later she was taken up for a fusion of the first MTP joint using Synthes Hallux locking fusion plate. Clinical and radiological fusion was discernible by the end of 12 weeks. AOFAS Hallux score at the end of 6 months and 12 months was 84 and 92, respectively. There was no sign of recurrence of infection until the last follow-up. Conclusion: Chronic osteomyelitis of the forefoot in immunocompetent individuals is a rare clinical presentation. A satisfactory outcome in the form of a pain-free functional foot can be achieved by either joint fusion or salvage provided the infection is controlled. Clinical significance: Thorough evaluation is needed to rule out a local or systemic immune compromise in forefoot osteomyelitis in the absence of trauma. Regardless of the underlying etiology, the principles of management should be infection control and stabilization of the involved joints.



Rajyalakshmi N Reddy, Somasekhara R Nallamilli, Venkataramana R Neelam

Correction of Talipes Cavovarus with Simultaneous Foot Lengthening in a Spina Bifida Patient

[Year:2022] [Month:October-December] [Volume:9] [Number:4] [Pages:4] [Pages No:192 - 195]

Keywords: Avoiding toe contractures while correcting foot deformity and foot lengthening, Correction of cavovarus foot deformity in spina bifida with an external fixator, cosmetic foot lengthening, distraction osteogenesis foot lengthening by osteotomy of the bases of all metatarsal bones, extra-articular valgus osteotomy of calcaneum to correct heel varus, joint preservation during foot deformity correction and foot lengthening, medial column lengthening of cavovarus foot with an external fixator, ring fixator vs. uniplanar fixator for foot deformity correction

   DOI: 10.5005/jp-journals-10040-1221  |  Open Access |  How to cite  | 


Background: Spina bifida can leave a permanent foot deformity into adulthood with a difficulty in walking and with a risk of callosities and pressure sores. Arthrodesis surgeries lead to stiff joints with an associated high risk of skin breakdowns. Hence, it is important that any corrective surgery must spare the joints. Extra-articular bony osteotomies and tenotomies are preferred, especially in cases with sensory deficits. Both joint fusions and closed wedge osteotomies share the disadvantage of shortening the foot. This is more relevant in cases where the affected foot is already short; hence, saving the length of the foot is a priority. Case description: A 14-year-old girl presented with a cavovarus foot on the right side, which is short by about 3 cm compared to that on the left side. After soft tissue releases, basal osteotomies of all the metatarsal bones were done, and the medial column was lengthened by distraction osteogenesis. This procedure corrected the forefoot deformity and also helped in increasing the length of the foot by 8 mm. Heel varus needed an Extra-articular osteotomy of calcaneum in a separate procedure. In a follow-up, 6 years after the operation, the patient's foot remained plantigrade though with a mild residual deformity, but the patient is walking well wearing normal shoes. Conclusion: This technique to correct deformity with simultaneous lengthening of the foot is not described before and is suited well for this patient. Surgical treatment of mature deformed feet with special problems needs to be individualized, and in cases like this, we found that our technique is safe and can be considered in similar situations.


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