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Foot and Ankle Clinics

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https://www.readbyqxmd.com/read/28779815/the-flatfoot-even-after-decades-of-work-we-still-need-help-understanding-it
#1
EDITORIAL
J Kent Ellington
No abstract text is available yet for this article.
September 2017: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/28779814/pediatric-flatfoot-pearls-and-pitfalls
#2
REVIEW
Samuel E Ford, Brian P Scannell
Pediatric flatfeet are common, are usually asymptomatic, and typically improve over time as young children age. It is critical to differentiate flexible from rigid flatfeet and to assess for associated Achilles contracture with a careful history, physical examination, and initial radiographs. Although there are limited data, nonsurgical management of symptomatic flatfeet, both flexible and rigid, should be exhausted before considering surgical intervention. If patients fail conservative treatment, surgical management with joint-preserving, deformity-corrective techniques is typically used for pediatric flexible flatfeet in conjunction with deformity-specific soft tissue procedures...
September 2017: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/28779813/severe-stage-2-fuse-or-reconstruct
#3
REVIEW
Scott B Shawen, Theodora C Dworak
Stage II posterior tibial tendon dysfunction encompasses a wide range of patients with varying degrees of deformity and function. The spectrum of patients can be difficult to treat with a single surgical approach, as evidenced by the wide range of techniques present in the literature. Severity of the deformity, patient functional level, age, and comorbidities must be considered to determine the best course of treatment. This article examines when fusion versus reconstruction is the appropriate treatment of patients with severe stage II posterior tibial tendon dysfunction and its subclassifications...
September 2017: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/28779812/management-of-the-malunited-triple-arthrodesis
#4
REVIEW
Jeffrey D Seybold
Malunion remains a common complication after triple arthrodesis, with rates as high as 6% in the reported literature. Careful patient evaluation is critical to determine the location and degree of bony deformity. A stepwise systematic approach to correct hindfoot and midfoot deformity is presented in this article. Few studies have been published to guide foot and ankle surgeons with this difficult clinical scenario, but reports have demonstrated high success rates and low rates of complications after revision triple arthrodesis...
September 2017: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/28779811/the-undercorrected-flatfoot-reconstruction
#5
REVIEW
Kenneth J Hunt, Ryan P Farmer
In symptomatic patients, undercorrection of a flatfoot deformity can lead to the need for revision surgery to restore functional mechanics and prevent progression of deformity. The underlying cause of undercorrection is failure to fully recognize or understand the extent of the deformity. This article discusses the typical deformities in adult flatfoot and indications for surgical intervention. Also presented are the surgical procedures for the correction of the typical deformity patterns with available outcome statistics and a stepwise algorithm for patient evaluation to assist in treatment and mitigate the risk of undercorrection of deformity...
September 2017: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/28779810/overcorrected-flatfoot-reconstruction
#6
REVIEW
Todd A Irwin
The overcorrected flatfoot reconstruction is a less common but often difficult sequelae of surgical treatment of the adult acquired flatfoot deformity. Understanding the patient's symptoms and how they correlate to the procedures performed during the index surgery are paramount to determining the appropriate course of treatment. Patients' symptoms may resemble those seen in the cavovarus foot condition, often secondary to overlengthening of the lateral column or excessive displacement of the calcaneal tuberosity...
September 2017: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/28779809/is-this-my-ankle-or-my-foot
#7
REVIEW
William Hodges Davis
Understanding of the complexities of the adult acquired pathologic flatfoot has undergone serious evolution in the past 30 years to an understanding of the subtleties of what causes the different presentations and drives successful treatment. As the treatment of ankle arthritis evolves from fusion to ankle replacement, the need for answers for the difficult patient with valgus degenerative ankle disease begs a look at what causes this form of flatfoot. This article poses the question, is there a subset of patients with "flatfoot" that has little to do with the foot and is all about the ankle?...
September 2017: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/28779808/evans-osteotomy-complications
#8
REVIEW
Marcelo E Jara
In 1975, Evans published an article describing the surgical management of the "calcaneo-valgus deformity," pointing out that the deformity was due to relative shortening of the lateral column of the foot. Correction involved "equalizing" both columns by performing an osteotomy in the neck of the calcaneus 1.5 cm from the calcaneocuboid joint, where a trapezoidal wedge of tricortical bone was placed. Although it was considered a success, there were complications, including sural nerve injury, surgical wound dehiscence, undercorrection, and graft subsidence...
September 2017: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/28779807/calcaneal-osteotomies-pearls-and-pitfalls
#9
REVIEW
Stephen Greenfield, Bruce Cohen
Adult acquired flatfoot deformity is a debilitating condition typically affecting middle-aged patients. The multiple components include hindfoot valgus, first ray elevation, medial soft tissue compromise, and forefoot abduction. As the foot becomes unbalanced, the deformity progresses with repetitive loading and time. Untreated patients often need significant reconstructions or extensive arthrodesis after arthritis and joint contractures present. Medializing calcaneal osteotomy is the workhorse operation for correction of hindfoot valgus, reliably correcting deformity with a relatively low complication risk...
September 2017: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/28779806/did-failure-occur-because-of-medial-column-instability-that-was-not-recognized-or-did-it-develop-after-surgery
#10
REVIEW
Anish R Kadakia, Armen S Kelikian, Mauricio Barbosa, Milap S Patel
Medial column instability is a primary deforming force in the setting of pes planovalgus deformity. Consideration for medial column stabilization only after correction of the hindfoot deformity may result in creating a rigid hindfoot, compromising clinical outcomes. Careful analysis of the lateral radiograph to determine whether the deformity is secondary to the medial column or true peritalar subluxation may allow superior outcomes. Iatrogenic creation of an excessively rigid medial column may lead to significant instability of the remaining joints in the short term and arthrosis in the long term...
September 2017: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/28779805/naviculocuneiform-sag-in-the-acquired-flatfoot-what-to-do
#11
REVIEW
Joshua A Metzl
Sag at the naviculocuneiform (NC) joint represents an important aspect of the flatfoot deformity. Failure to address medial column instability could lead to continued deformity and poor patient outcomes. No single procedure is enough to address the complexity of the adult acquired flatfoot deformity. Whether in combination with other procedures or in isolation, NC fusion and Cotton osteotomy are important pieces of the armamentarium to address all aspects of the flatfoot deformity.
September 2017: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/28779804/what-to-do-with-the-spring-ligament
#12
REVIEW
Brian Steginsky, Anand Vora
The spring ligament complex is an important static restraint of the medial longitudinal arch of the foot and its failure has been associated with progressive flatfoot deformity. Reconstruction of the spring ligament complex is most appropriate in stage II posterior tibial tendon dysfunction, before severe peritalar subluxation and rigid deformity develops. Although an understanding of the spring ligament complex and its contribution to medial arch stability has grown, there is no unanimously accepted surgical technique that has consistently demonstrated satisfactory outcomes...
September 2017: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/28779803/deltoid-ligament-repair-in-flatfoot-deformity
#13
REVIEW
Ezekiel Oburu, Mark S Myerson
Deltoid ligament reconstruction allows for joint preservation of the ankle in the setting of patients a triple arthrodesis due to a flat foot deformity. Although the increased forces that may occur in the ankle joint after a triple arthrodesis cannot be eliminated, reconstruction of the ligament will delay and may prevent the onset arthritis, allowing the patient to maintain mobility of the ankle joint. The anatomy, surgery, and risks and benefits are discussed.
September 2017: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/28502360/preface
#14
EDITORIAL
J Chris Coetzee
No abstract text is available yet for this article.
June 2017: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/28502359/pearls-and-pitfalls-for-a-surgeon-new-to-ankle-replacements
#15
REVIEW
Federico Giuseppe Usuelli, Camilla Maccario
The role of the surgeon learning curve in total ankle replacement (TAR) has produced contradictory results. It is important for a new surgeon to know what clinical and radiological parameters are considered reliable and ideal. It is clear that exposure to a high-volume center will increase the reliability of a new surgeon approaching TAR. Implant choice may be influenced by surgeon training, and the debate of mobile versus fix-bearing prosthesis is still open. Anterior versus lateral approach is still an open debate, with any hypothetical advantages given by the direct vision on the center of rotation to be proven...
June 2017: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/28502358/is-there-anything-to-learn-from-a-national-joint-registry
#16
REVIEW
Dawson Muir
National joint registries (NJRs) have been established in Northern Europe for over 20 years. Since then, many other countries have begun collecting and reporting national data for total ankle arthroplasty (TAA). With relatively small numbers implanted, a large variety of available designs, and with any long-term reports dominated by designer groups, TAA is ideally placed to benefit from large national or even pooled national registries. This article reviews the existing registry-based literature with respect to what is already known...
June 2017: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/28502357/experience-with-navigation-in-total-ankle-arthroplasty-is-it-worth-the-cost
#17
REVIEW
Christopher W Reb, Gregory C Berlet
Optimal placement of correctly sized total ankle replacement (TAR) implants is elemental to prolonging the working life. The negative mechanical effects of implant malalignment are well characterized. There is one FDA-approved navigated TAR system with limited but encouraging outcomes data. Therefore, its value can be estimated only based on benefits other than a proven clinical outcomes improvement over conventional systems. These include unique preoperative planning through 3-dimensional templating and virtual surgery and the patient-specific cut guides, which also reduce overall instrumentation needed for the case...
June 2017: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/28502356/dealing-with-the-stiff-ankle-preoperative-and-late-occurrence
#18
REVIEW
Beat Hintermann, Roxa Ruiz, Alexej Barg
In patients with a stiff ankle replacement, appropriate resection of scarred capsular structures, hypertrophic bone debridement, and careful release of tendons should be performed to achieve good outcomes. Appropriately sized and correctly implanted components are required to restore ankle function to as normal as possible. Although not proven, the better a total ankle replacement is balanced, the less likely scar and heterotopic bone formation will occur. In patients with a stiff and painful ankle replacement, a preoperative diagnostic workup is mandatory to understand the underlying pathologic process and plan appropriate treatment...
June 2017: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/28502355/how-to-diagnose-and-treat-infection-in-total-ankle-arthroplasty
#19
REVIEW
Yousef Alrashidi, Ahmed E Galhoum, Martin Wiewiorski, Mario Herrera-Pérez, Raymond Y Hsu, Alexej Barg, Victor Valderrabano
Periprosthetic infection after total ankle arthroplasty (TAA) is a serious complication, often requiring revision surgery, including revision arthroplasty, conversion to ankle arthrodesis, or even amputation. Risk factors for periprosthetic ankle infection include prior surgery at the site of infection, low functional preoperative score, diabetes, and wound healing problems. The clinical presentation of patients with periprosthetic ankle joint infection can be variable and dependent on infection manifestation: acute versus chronic...
June 2017: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/28502354/soft-tissue-reconstruction-after-total-ankle-arthroplasty
#20
REVIEW
Yash J Avashia, Ronnie L Shammas, Suhail K Mithani, Selene G Parekh
Wound complications following total ankle replacement are common. A team approach, including plastic surgeons, should be utilized to manage these wound issues. The handling of the wound, from the index procedure, to a variety of flaps, can be utilized to provide a successful outcome following an ankle replacement.
June 2017: Foot and Ankle Clinics
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