Journal of Foot and Ankle Surgery (Asia Pacific)

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2022 | August | Volume 9 | Issue S1

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Kumar S Anand, Malhar Dave, Mahendra Kudchadkar

Status of Foot and Ankle Surgery in India: Where Do We Stand in 2022

[Year:2022] [Month:August] [Volume:9] [Number:S1] [Pages:2] [Pages No:S147 - S148]

   DOI: 10.5005/jp-journals-10040-1259  |  Open Access | 



Vishnu Senthil

Ram Janam Sulakshana Gold medal award (2021) Outcome Analysis of Posterior Plating and Lateral Plating for Lateral Malleolus Fracture

[Year:2022] [Month:August] [Volume:9] [Number:S1] [Pages:4] [Pages No:S149 - S152]

Keywords: American Orthopedic Foot and Ankle Society Ankle–Hindfoot Score, Bimalleolar fracture, Danis–Weber classification, Fibula fracture, Internal fixation

   DOI: 10.5005/jp-journals-10040-1258  |  Open Access | 


Aim: To highlight the outcome of posterolateral and lateral approach to ankle with posterior/lateral plating of distal fibula fractures. Methodology: Twenty ankle fractures were divided into two groups. Patients were randomly allocated into two groups. In one group fibula was plated with lateral approach and another group with posterior plating. In indicated cases involving additional posterior malleolus fixation, posterior plating of fibula was done. Posterolateral/lateral approach to ankle and posterior/lateral plating of lateral malleolus was the main method used for fracture fixation. Average timing of surgery was 6 days from presentation. Minimum follow-up period was 24 months. Factors analyzed were pain, maximum walking distance, walking surfaces, wound healing, union time, and American Orthopedic Foot and Ankle Society (AOFAS) score. Results: Posterior plating showed no wound complications. Lateral plating demonstrated superficial infection in three patients and wound gaping in two patients. Posterior plating (six patients) and lateral plating (three patients) showed union within 3 months. Posterior plating (four patients) and lateral plating (six patients) demonstrated union within 3–6 months. P-value (0.062) was statistically significant but there was no significant difference clinically. Posterior plating (seven patients) and lateral plating (five patients) showed excellent functional outcome (AOFAS score > 85). Posterior plating (three patients) and lateral plating (three patients) showed good outcome (AOFAS score 70–85). In lateral group, two patients (AOFAS 55–70) showed fair outcome. p-value is statistically significant. Complications included one case of malunion in each group, three patients showed superficial infections, and two patients demonstrated wound gaping. Conclusion: Posterior approach to lateral malleolus and posterior/posterolateral plating technique allows better implant placement, lesser hardware irritation, good wound healing, practically nil wound dehiscence, and an excellent functional outcome compared to lateral approach.



Akhil Sharma, Urvi J Patel, Rishin J Kadakia, Aman Chopra, Selene Parekh

Talus Avascular Necrosis: Demographics, Epidemiology, and Activity Level

[Year:2022] [Month:August] [Volume:9] [Number:S1] [Pages:4] [Pages No:S153 - S156]

Keywords: Outcome studies, Sports, Trauma

   DOI: 10.5005/jp-journals-10040-1232  |  Open Access | 


Background: The talus is predisposed to avascular necrosis (AVN) due to its intraosseous blood supply and extraosseous arterial sources. Currently, limited information exists on the patients’ functional level with regard to daily activity and their subjective sense of functioning. This work aimed to better appreciate the functional level of patients after surgery for talar AVN. Materials and Methods: Patients were identified through a publicly available online support group for talar AVN. A 36-question survey was distributed to determine baseline demographics, epidemiology of talar AVN, and functional status. A total of 96 patients completed the anonymous survey, and only fully completed surveys were included. Results: The majority of patients who responded were female (87/96 = 91%) and were diagnosed with talar AVN as adults. The most common etiology was trauma (35/96 = 37%). Most patients started with nonoperative treatment—however, the majority of patients ultimately underwent operative intervention (63/96 = 66%). Patients reported a functional activity level of 52% in regard to activities of daily living (ADLs). The functional activity level pertaining to sports-related activities was half that of ADLs (27%). Conclusion: Patients with talar AVN present with significant pain and limitation that negatively impacts their daily functioning. Our results demonstrate that patients report at least 50% loss in ability to function with regard to ADLs and almost a 75% loss in sporting-related activities. These substantial losses in the subjective sense of functioning illustrate how difficult this problem really is for patients. Providers must be cognizant of functional limitations associated with talar AVN when counseling patients. Level of evidence: III



Bryan Loh, Akshay Padki, Szeying Thong, Nicholas EM Yeo

An Evaluation of Peripheral Sciatic Nerve Block in Patients Undergoing Hallux Valgus Surgery

[Year:2022] [Month:August] [Volume:9] [Number:S1] [Pages:5] [Pages No:S157 - S161]

Keywords: Bunion, Functional outcome, Hallux valgus surgery, Peripheral nerve block, Regional anesthesia

   DOI: 10.5005/jp-journals-10040-1185  |  Open Access | 


Background: This study aims to evaluate the use of popliteal sciatic nerve block (PSNB) on pain and functional outcome following hallux valgus (HV) surgery. Materials and methods: This retrospective review of 100 patients who underwent surgery by a single surgeon for symptomatic HV was categorized into two groups: 50 who received general anesthesia (GA) while the other 50 received an ultrasound-guided PSNB. The following outcome measures were then collected: visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS), and RAND 36-Item Health Survey scores. Results: The 24-hour postoperative VAS score for the PSNB group was significantly lower than the GA group (0.66 vs 1.04, p = 0.035). Similarly, the average hourly VAS score in the immediate 6 hours after surgery for the PSNB group was significantly lower than the GA group (0.28 vs 0.49, p = 0.001). The VAS score for the PSNB group was significantly lower than the GA group at 6 months postoperatively (1.78 vs 0.50, p < 0.001). Conclusion: The use of popliteal sciatic nerve block in hallux valgus surgery significantly reduces postoperative pain up to 6 months postsurgery when compared to general anesthesia alone. Clinical significance: Popliteal sciatic nerve block can improve patients’ postoperative pain and function while reducing the need for oral or intravenous analgesics.


Original Article

Gideon JW Cheok, Akshay Padki, Kinjal V Mehta

Outcomes of Surgical Fixation of Lisfranc Injuries: A 2-year Review

[Year:2022] [Month:August] [Volume:9] [Number:S1] [Pages:6] [Pages No:S162 - S167]

Keywords: Foot and ankle, Lisfranc injury, Lisfranc surgical outcomes

   DOI: 10.5005/jp-journals-10040-1192  |  Open Access | 


Aims/Background: Current literature recommends that unstable Lisfranc joint fracture-dislocations be treated with open reduction and internal fixation. There are limited regional data regarding the outcomes of surgical management of these injuries. The primary aim of our study is to explore patient-reported outcomes of surgically managed unstable Lisfranc injuries as limited locoregional data are detailing such outcomes. Secondarily, we aim to compare differences in outcomes between patients who had implants removed and those who retained their implants. Materials and methods: We performed a single-center, single-surgeon, retrospective review of 17 cases diagnosed with Lisfranc injuries treated surgically at our center from 2016 to 2017. Seventeen patients were followed up for an average of 24 months (range 21–34 months). Thirteen patients had their implants removed at an average of 5.9 months. Patients were assessed using Patient-reported Outcome Measures (SF-36), American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot score, and Foot Function Index (FFI). Results: In our review, we found that the commonest type of repair was with transarticular screws. Of the 17 patients assessed, we derived a mean FFI score of 13.7% (scale of 0–100%, with a higher percentage indicating worse function and increased disability). Most patients showed decreased function with more strenuous activities. The average AOFAS midfoot score was 81.5, with most patients losing points for mild pain and limitations with recreational activities. The average SF-36 physical functioning score (PFS) was 80.9 (scale of 0–100, higher scores indicating better physical function), and the average SF-36 mental health score (MHS) was 95.8. Conclusion: In relation to available literature, the vast majority of our patients showed comparably good outcomes as measured using functional outcome and quality of life assessment scores.


Original Article

Ari R Berg, Nicholas F Cuppari, Mohamed Rupani, Sheldon Lin

Salvage Technique for Failed ORIF in Diabetic Ankle Fractures: A Case Series

[Year:2022] [Month:August] [Volume:9] [Number:S1] [Pages:5] [Pages No:S168 - S172]

Keywords: Ankle external fixator, Diabetic ankle, Diabetic ankle fracture, Failed ankle ORIF, Salvage ankle ORIF, Tibiotalocalcaneal fusion

   DOI: 10.5005/jp-journals-10040-1212  |  Open Access | 


Aim: This study describes a treatment algorithm for addressing failed ankle open reduction and internal fixation (ORIF) in diabetic patients using two successful patient cases. Background: The complication rate following ankle fracture ORIF in diabetic patients is significantly higher compared to that in nondiabetic patients and salvage techniques are limited. Complications include soft tissue problems and increased infection rate, impaired bone healing and the possibility of a lost reduction, and Charcot arthropathy. Case description: We analyze two cases of failed ORIF following traumatic ankle fracture in diabetic patients. Both patients underwent salvage procedures utilizing skinny wire external fixators with tibiotalocalcaneal stabilization via one or two Steinmann pins and were initiated on an 8-week course of IV antibiotics. Conclusion: Use of external fixation with tibiotalocalcaneal Steinmann pin fixation and IV antibiotics is an effective treatment after failed ankle ORIF in diabetic patients. Clinical significance: An algorithm to salvage failed ankle ORIF can help avoid the worst outcomes in diabetic patients.



Sukhmin Singh, Bushu Harna, Gayatri Vishwakarma, Maninder S Singh

Functional Outcomes and Fusion Rates Following Arthroscopic Subtalar Arthrodesis: A Systematic Review and Meta-analysis

[Year:2022] [Month:August] [Volume:9] [Number:S1] [Pages:6] [Pages No:S173 - S178]

Keywords: AOFAS, Arthrodesis, Arthroscopic, Fusion rate, Subtalar

   DOI: 10.5005/jp-journals-10040-1218  |  Open Access | 


Background: Subtalar arthritis presents as severe pain, inability to walk on uneven ground, and instability which hampers the normal gait biomechanics in patients. Arthrodesis is considered the gold standard to alleviate these symptoms. Over time, arthroscopic subtalar arthrodesis has established itself as a viable method of treatment for isolated subtalar arthritis without significant deformity. This systematic review analyzes the functional outcomes and fusion rates following arthroscopic subtalar arthrodesis for subtalar arthritis. Materials and Methods: The systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines from peer-reviewed journals published in English between June 2000 and March 2021. Quality appraisal of all selected articles was done and data was subsequently extracted and analyzed. Results: After a thorough literature search, 13 studies were included for analysis. A total of 361 patients (376 feet) undergoing subtalar arthrodesis using arthroscopic technique have been described in literature. Pooled data showed improvement in AOFAS score from 44.2 to 79.6 (p < 0.001) and a fusion rate of 94.6%. Mean time to fusion was 9.9 weeks (±0.9 week) with no significant increase in complication rates with use of the arthroscopic technique. Conclusion: Based on available literature, arthroscopic subtalar arthrodesis appears to be a reliable and safe technique. This study showed promising results for isolated arthroscopic subtalar arthrodesis with good fusion rates and improved functional outcomes. The authors recommend further studies for exploring use of this approach for subtalar arthritis. Level of evidence: Level IV.



Juan Agustin D Coruna IV, Jose Maria R Coruna, Chloe Marie C Samarita, Bea Mercede A Calderon

Preoperative Planning in Ankle Trauma: Harmonizing 2D and 3D Technology

[Year:2022] [Month:August] [Volume:9] [Number:S1] [Pages:6] [Pages No:S179 - S184]

Keywords: Ankle fracture, Preoperative planning, Preoperative template, 3D printing

   DOI: 10.5005/jp-journals-10040-1247  |  Open Access | 


The most important exercise prior to doing actual surgery is the completion of the preoperative template. Its tangible structure reflects the amount of preparation trainees and their attending pour into for the success of the procedure. The discipline allotted for the task offsets incorrect fracture configuration, considers the best approach, and places value in hardware and implant preparation. The practice ultimately decreases varying degrees of surgical morbidities and time delay in the operating theater. In this area of practice, there is a window for innovation and the invitation to discover is wide open. A progressive timeline showing the evolution of preoperative templating in one institution will be shared, beginning with the classic exercise of templating on paper, to using an app, then with the considerable augmentation brought about by 3D printing.



Pradeep Moonot, Prashant P Pawar, Hatesh Kumar

Deltoid and Spring Ligament Reconstruction: The Quadrangular Construct

[Year:2022] [Month:August] [Volume:9] [Number:S1] [Pages:4] [Pages No:S185 - S188]

Keywords: Ankle joint, Deltoid ligament, Internal brace, Spring ligament

   DOI: 10.5005/jp-journals-10040-1234  |  Open Access | 


Background: The majority of the ankle injuries involves the lateral ankle ligaments, while deltoid ligament injuries are seen in 5%. Both deltoid and spring ligament are primary medial stabilizer of ankle and foot and can be injured simultaneously. Purpose: In this article, we explain a method for combined deltoid and spring ligament reconstruction using Internal Brace™ (Arthrex, Naples, USA) fibertape which mimics the anatomical ligament complex along with the lateral ligament reconstruction. Conclusion: It is a safe and simple technique with promising results at 1 year follow-up.



Proceedings of Indian Foot & Ankle Society Conference, IFASCON 2022

[Year:2022] [Month:August] [Volume:9] [Number:S1] [Pages:5] [Pages No:S189 - S193]

   DOI: 10.5005/jfasap-9-S1-S189  |  Open Access | 


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