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1
Ting, Arthur J., Richard R. Tarr, Augusto Sarmiento, Ken Wagner, and Charles Resnick. "The Role of Subtalar Motion and Ankle Contact Pressure Changes from Angular Deformities of the Tibia." Foot & Ankle 7, no. 5 (1987): 290–99. http://dx.doi.org/10.1177/107110078700700505.
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It is a well known entity that fractures of the tibia heal with some component of angular deformity. Ankle and subtalar joints may compensate for small degrees of angular deformities, but the exact amount of malunion that can be accepted without development of late sequalae has yet to be determined. Two recent studies from this institution have concluded that (1) contact changes at the tibiotalar joint tend to be greater with distal third tibial fracture deformities compared to proximal and middle with the ankle in neutral, 5° dorsiflexion, and 20° of plantar flexion. (2) Anterior and posterior bow deformities produced a greater change in contact area of the tibiotalar joint than with valgus or varus deformities. This phenomena may be possibly explained by the subtalar motion in the horizontal plane which averages 23°. Thus, it was the primary purpose of this paper to determine the exact role, if any, in subtalar motion on tibiotalar contact in angular deformities of the tibia. To achieve this objective the subtalar joint was transfixed thereby eliminating its perceived compensatory movement. Six cadaveric lower extremities were disarticulated at the knee joint and stripped of soft tissue preserving capsular and ligamentous structures. A custom universal joint was used to create various angulatory deformities at proximal, middle, and distal third levels of the tibia. Contact pressure across the tibiotalar joint was recorded using pressure-sensitive film and analyzed quantitatively in terms of contact area as well as pattern. The same combinations of angular deformities were then run with the subtalar joint transfixed in neutral. The results indicated that as in the two previous studies distal third deformities resulted in the greatest amount of change in ankle contact pressure area. The data also demonstrated that when subtalar motion was restricted ankle contact area decreased significantly in all planes of angulatory deformity. (1) The data collected agree with the results of two previous studies which showed that there was a decreased in total ankle contact area consistently at the distal third level with posterior angulatory deformities of the tibia. (2) By defining the resultant fracture angle and the foot axis angle a geometric explanation can be given to demonstrate a distal level fracture of the tibia has a greater effect on the ankle articulation than one more proximal. (3) The ankle joint has been shown by others to be less congruent as it moves away from its neutral position. This was found to affect and therefore cause a decrease in ankle contact area with tibial angulatory deformities. (4) The ankle joint is more adapted for weightbearing in neutral and in dorsiflexion. The anterior portion of the talar dome is probably more adapted to weightbearing than the posterior portion. This accounted for greater changes in ankle contact area during plantarflexion than in dorsiflexion. (5) The subtalar joint was found to play a very significant role in maintaining the talus in its normal relationship to the tibia. Restriction of the subtalar joint affected all deformities of the tibia as the resultant fracture angle increased. (6) The data supports Inman's concept of the subtalar joint acting as a torque transmitter and compensates for tibial varus and valgus deformities. (7) Subtalar joint restriction affected varus deformities more than valgus deformities probably due to shifting of the talar dome therefore significantly altering its normal biomechanics.
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Krähenbühl, Nicola, Lukas Zwicky, Manja Deforth, Beat Hintermann, and Markus Knupp. "Subtalar Joint Alignment in Ankle Osteoarthritis." Foot & Ankle Orthopaedics 2, no. 3 (2017): 2473011417S0002. http://dx.doi.org/10.1177/2473011417s000249.
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Category: Ankle Arthritis, Hindfoot Introduction/Purpose: The influence of the subtalar joint on the evolution of ankle joint osteoarthritis is still a matter of debate. Although subtalar joint compensation of deformities above the ankle joint was proposed until mid-stage of ankle osteoarthritis, the evidence of this assumption is weak. In this study, we investigated the subtalar joint alignment in different stages of ankle joint osteoarthritis using weightbearing CT scans. The influence of the tibio-talar tilt and presence of subtalar joint osteoarthritis was additionally assessed. We hypothesized, that the subtalar joint compensates for deformities above the ankle joint in early- to mid-stage of ankle osteoarthritis. We also hypothesized, that subtalar joint compensation increases with a pronounced tibio-talar tilt and decreases with the presence of subtalar joint osteoarthritis. Methods: We included patients with ankle joint osteoarthritis treated in our institution from January 2013 to April 2016. A control group of 28 patients was additionally assessed. Varus and valgus ankles were subdivided according to the modified Takakura classification, the tilt of the talus in the ankle mortise and stage of subtalar joint osteoarthritis. The type of ankle osteoarthritis was diagnosed on a plain weightbearing anterior to posterior radiograph of the ankle. The medial distal tibial angle (TAS) and the angle between the tibial shaft and the surface of the talar dome (TTS) were measured. The subtalar joint alignment was assessed using weightbearing CT scans. Two angles were assessed: The subtalar inclination angle (SIA) was measured to investigate the subtalar compensation. For assessment of the morphology of the talus, the inftal-subtal angle (ISA) was determined. Results: This analysis showed significant differences of the subtalar inclination between varus feet and the controls (SIA, P=.001). Regarding the talar morphology, significant differences were found between varus/ valgus feet and the controls (ISA, P=.001 and .036, respectively). No significant differences of the subtalar joint inclination and talar morphology could be identified comparing different stages of ankle joint osteoarthritis inside the varus or valgus group. No relationship between the tilt of the talus in the ankle joint mortise and the subtalar joint inclination or talar morphology was identified. Neither presence nor absence of subtalar joint osteoarthritis influenced the subtalar joint inclination and talar morphology. Conclusion: Varus ankles compensate in the subtalar joint for deformities above the ankle joint. Compensation had no influence on the stage of ankle osteoarthritis, extent of the tibio-talar tilt and stage of subtalar joint osteoarthritis. Consequently, the progression of ankle joint osteoarthritis is more depended on the supramalleolar alignment and integrity of the periarticular structures (i.e. ligaments and tendons) than on the osseous alignment of the subtalar joint.
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Knupp, Markus, Sjoerd A. S. Stufkens, Lilianna Bolliger, Alexej Barg, and Beat Hintermann. "Classification and Treatment of Supramalleolar Deformities." Foot & Ankle International 32, no. 11 (2011): 1023–31. http://dx.doi.org/10.3113/fai.2011.1023.
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Background: Supramalleolar osteotomies are increasingly popular for addressing asymmetric arthritis of the ankle joint. Still, recommendations for the indication and the use of additional procedures remain arbitrary. We preoperatively grouped different types of asymmetric arthritis into several classes and assessed the usefulness of an algorithm based on these classifications for determining the choice of supramalleolar operative procedure and the risk factors for treatment failure. Methods: Ninety-two patients (94 ankles) were followed prospectively and assessed clinically and radiographically 43 months after a supramalleolar osteotomy for asymmetric arthritis of the ankle joint. Results: Significant improvement of the clinical scores was found. Postoperative reduction of radiological signs of arthritis was observed in mid-stage arthritis. Age and gender did not affect the outcome. Ten ankles failed to respond to the treatment and were converted to total ankle replacements or fused. Conclusions: Supramalleolar osteotomies can be effective for the treatment of early and midstage asymmetric arthritis of the ankle joint. However, certain subgroups have a tendency towards a worse outcome and may require additional surgery. Therefore preoperative distinction of different subgroups is helpful for determination of additional procedures. Level of Evidence: II, Prospective Comparative Study
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Hyer, Christopher F., Antonio M. Malloy McCoy, John M. Thompson, Mitchell Thompson, and Devon Consul. "Coronal Plane Deformity and Total Ankle Replacement: When to Stage with Cement Spacer Ankle Arthroplasty for Deformity Correction." Foot & Ankle Orthopaedics 7, no. 1 (2022): 2473011421S0025. http://dx.doi.org/10.1177/2473011421s00256.
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Category: Ankle Arthritis Introduction/Purpose: Degenerative ankle joint disease is a debilitating condition that causes significant pain, adversely affects function and quality of life. Though primary arthritis of the ankle can occur without deformity, frequently soft tissue imbalances or joint deformities complicate the clinical picture. Often, additional procedures are required to balance the foot and ankle during the index total ankle replacement procedure. When large deformities exist a staged approach to first, align the ankle joint to neutral as stage one and then implantation of the TAR as stage two can be deployed. This paper will further popularize the cement spacer staged TAR technique in correction of coronal deformities, share a clinical algorithm on approach, and depict a case series demonstrating its application. Methods: A case series was performed of 7 patients and 8 ankles, who underwent staged primary TAR utilizing a cement spacer to assist with deformity correction, between the years 2016-2019. Results: Patients' mean age 58.5 yrs., preoperative varus coronal plane deformity mean 19.1 degrees, preoperative valgus coronal plane mean 10.25 degrees. Mean time from stage 1 till 2 was 163.5, +-140.2 days. Stage 1 soft tissue procedures: Chrisman-Snook procedure with synthetic ligament graft, Brostrum-Gould with synthetic graft, Brostrum-Gould without graft, FDL transfer, and isolated medial release/peel. Osteotomies performed during stage one: Dwyer, MDCO, Cotton, and MDCO with medial malleolus osteotomy. Fusions performed during stage one consisted: Subtalar joint, talonavicular joint (TNJ), and STJ with 1st Metatarsophalangeal joint (MTPJ). Seven ankles were replaced with Cadence Total Ankle System (Integra), and one with INBONE II (Wright Medical Technology). Average follow-up time for included patients was 290.75 days (9.7 months). One revision was performed following index TAR procedure. Conclusion: This paper describes a cement wedge spacer staged total ankle arthroplasty technique for correction and stabilization of deforming forces at the ankle joint. While not all ankle deformities necessitate a staged approach, the complexity of the malalignment and the extent of tissue disruption needed to achieve a neutral ankle should be considered when correcting a given deformity with a staged or non-staged approach.
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Caravelli, Silvio, Giulia Puccetti, Emanuele Vocale, et al. "Reconstructive Surgery and Joint-Sparing Surgery in Valgus and Varus Ankle Deformities: A Comprehensive Review." Journal of Clinical Medicine 11, no. 18 (2022): 5288. http://dx.doi.org/10.3390/jcm11185288.
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Osteoarthritis (OA) of the ankle affects about 1% of the world’s adult population, causing an important impact on patient lives and health systems. Most patients with ankle OA can show an asymmetrical wear pattern with a predominant degeneration of the medial or the lateral portion of the joint. To avoid more invasive ankle joint sacrificing procedures, joint realignment surgery has been developed to restore the anatomy of the joints with asymmetric early OA and to improve the joint biomechanics and symptoms of the patients. This narrative, comprehensive, all-embracing review of the literature has the aim to describe the current concepts of joint preserving and reconstructive surgery in the treatment of the valgus and varus ankle early OA, through an original iconography and clear indications and technical notes.
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Hintermann, Beat, and Roxa Ruiz. "Joint Preservation Strategies for Managing Varus Ankle Deformities." Foot and Ankle Clinics 27, no. 1 (2022): 37–56. http://dx.doi.org/10.1016/j.fcl.2021.11.002.
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Shih, Han-Ting, Shun-Ping Wang, Cheng-Hung Lee, Kao-Chang Tu, Shih-Chieh Tang, and Kun-Hui Chen. "Factors influencing ankle alignment changes following medial unicompartmental knee arthroplasty: Preoperative knee and ankle deformities and extent of knee alignment correction." PLOS ONE 20, no. 3 (2025): e0318677. https://doi.org/10.1371/journal.pone.0318677.
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Introduction The impact of medial unicompartmental knee arthroplasty (MUKA) on ankle alignment is not well-studied. This study aims to investigate the changes in ankle alignment following MUKA and identify the influencing factors. Materials and Methods A retrospective analysis included 175 patients undergoing MUKA between 2018 and 2020. Patients were categorized into varus (n = 113) or valgus (n = 62) ankle groups based on preoperative ankle deformities. Preoperative and postoperative full-length standing radiographs were used for radiographic measurements. Results Following MUKA, significant differences in the change in tibial plafond-talus angle (PTA) were observed between the groups, with the varus ankle group showing a change of -0.71 ± 0.82° and the valgus ankle group showing a change of 0.08 ± 0.94° (p < 0.001). In the varus ankle group, the tibial plafond-ground angle (PGA) increased from -3.65 ± 4.22° preoperatively to -0.51 ± 4.52° postoperatively (p < 0.001), talus-ground angle (TGA) increased from -5.28 ± 4.32° to -1.32 ± 4.74° (p < 0.001), and PTA decreased from 1.52 ± 1.04° to 0.81 ± 1.12° (p < 0.001). In the valgus ankle group, PGA increased from -5.44 ± 4.39° to -1.43 ± 4.63° (p < 0.001) and TGA increased from -4.55 ± 4.24° to -0.59 ± 4.47° (p < 0.001), but PTA did not show a significant change. Ankle alignment change significantly correlated with preoperative joint line convergence angle (JLCA), preoperative medial proximal tibial angle (MPTA), preoperative PGA, preoperative TGA, preoperative PTA, hip-knee-ankle angle (HKA) changes, and bearing thickness. Conclusions MUKA significantly corrects the majority of ankle alignment towards a more neutral position. The extent of ankle alignment correction is influenced by preoperative knee and ankle joint deformities, as well as the degree of knee alignment correction.
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Banerjee, Sudip, Atanu Adak, Debadyuti Dutta, et al. "Angular assessment of joints in juvenile idiopathic arthritis." Rheumatology and Immunology Research 6, no. 1 (2025): 1–6. https://doi.org/10.1515/rir-2025-0001.
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Abstract Background Joint deformities in juvenile idiopathic arthritis (JIA) are most common in children, are not defined in term of angular measurements. The study was aimed to evaluate the joint deformities in angular deviation of the afected joints in JIA patients. Methods This cross-sectional study was conducted at Pediatric Rheumatology Clinic, North Bengal Medical College, West Bengal. The children aged 2–16 years diagnosed with JIA according to the International League of Associations for Rheumatology (ILAR) criteria were included in the study. Patients with co-morbid disease, hemodynamic instability, and other acute conditions were excluded. Angular measurements were performed using goniometer. Results The mean age of children was (8.05 ± 3.20) years of which 57.5% was male and the disease duration associated with the deformities in JIA. The prevalent subtypes of JIA were Oligoarticular JIA (oligoJIA)(40%), followed by polyarticular JIA (pJIA) (35%) and systemic-onset JIA (sJIA) (12.5%). The commonly involved joint were knee (40%), followed by small joint of hand (32.5%), ankle (30%), wrist and foot (17.5% each), elbow (12.5%) and cervical joint (7.5%). In pJIA, duration of disease significantly (P = 0.017) associated with the number of affected joints. Mostly, wrist, knee and ankle deformities were observed in oligoJIA, pJIA and sJIA. The angular deviation (mean ± SD) of right and left knee were (2° ± 4.16°) and (1.87° ± 5.12°) in oligoJIA, (13.36° ± 17.03°) and (12.5° ± 15.08°) in pJIA and (3° ± 6.71°) and (2.4° ± 5.37°) in sJIA. Right ankle angular deviation were (2.62° ± 5.06), (5.43° ± 8.21°) and 4° ± 8.94° respectively in oligoJIA, pJIA and sJIA. The angular deviation of right and left wrist were (1.25° ± 3.41°) and (0.94° ± 3.75°) in oligoJIA, (4.07° ± 8.93°) and (4.14° ± 9.36°) in pJIA and (2.45° ± 5.37°) and (2° ± 4.47°) in sJIA. Conclusion This study is the first study from India to quantify the angular deviation of deformed joints in JIA. Angular deviation could serve as a valuable parameter for monitoring disease progression across various JIA subtypes.
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Kim, Jaeyoung, Jensen K. Henry, Ji-Beom Kim, and Woo-Chun Lee. "Dome Supramalleolar Osteotomies for the Treatment of Ankle Pain with Opposing Coronal Plane Deformities Between Ankle and the Lower Limb." Foot & Ankle International 43, no. 4 (2021): 474–85. http://dx.doi.org/10.1177/10711007211050639.
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Background: The dome-type osteotomy is a powerful technique for deformity correction of the limb. However, there is limited information about the utility of dome supramalleolar osteotomy (SMO) in ankle joint preservation surgery. This study aimed to describe the technique and indications for dome SMO in distal tibial malalignment. Methods: Twenty-three patients (23 ankles) who underwent dome SMO with a 2-year follow-up were reviewed. Dome SMO was indicated when there were opposing deformities in the ankle and lower limb mechanical axis (ie, varus ankle deformity with valgus lower limb alignment and vice versa) where inherent translation following conventional wedge-type osteotomies could worsen the deformity of the entire lower limb. Patients were divided into 2 groups based on preoperative ankle alignment: the varus ankle group (n = 11) and the valgus ankle group (n = 12). The radiographic correction was assessed using 6 parameters from weightbearing ankle and hindfoot alignment views. In addition, the lower limb mechanical axis was assessed with ankle center deviation (ACD) from the hip-knee (HK) line on the whole limb radiograph, and the weightbearing line (WBL) point was measured to identify changes in the weightbearing load within the ankle joint. Results: Preoperatively, the varus ankle group had varus ankle deformity (tibiotalar angle [TTA], 76.5 ± 5.8 degrees) with valgus lower limb mechanical axis, whereas the valgus ankle group had valgus ankle deformity (TTA, 99.1 ± 4.5 degrees) with varus lower limb mechanical axis alignment. Postoperatively, a significant improvement in the ankle alignment and the lower limb mechanical axis was observed in both groups. The ACD significantly changed toward the HK line, suggesting an improved lower limb mechanical axis, and the WBL point showed a significant shift of the weightbearing axis toward the uninvolved area within the ankle joint. Conclusion: Dome SMO demonstrated a successful correction of local deformity while simultaneously realigning the hip-knee-ankle axis toward neutral. Additionally, an effective load shifting toward an uninvolved area within the ankle joint was observed. Level of Evidence: Level IV, case series.
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Shih, Han-Ting, Wei-Jen Liao, Kao-Chang Tu, Cheng-Hung Lee, Shih-Chieh Tang, and Shun-Ping Wang. "Poor Correction Capacity of Preexisting Ankle Valgus Deformity after Total Knee Arthroplasty." Journal of Clinical Medicine 10, no. 16 (2021): 3624. http://dx.doi.org/10.3390/jcm10163624.
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This study investigated the differences in ankle alignment changes after TKA in patients with varying preexisting ankle deformities. We retrospectively examined 90 knees with osteoarthritis and varus deformity in 78 patients who underwent TKA. Preoperative and postoperative radiographic parameters were analyzed. According to their preexisting ankle deformity, patients were assigned to the valgus or varus group. Overall, 14 (15.6%) cases were of preoperative valgus ankle deformity; the remainder were of preoperative varus ankle deformity. Hip–knee–ankle angle (HKA), tibial plafond–ground angle (PGA), and talus–ground angle (TGA) all exhibited significant correction in both groups; however, tibial plafond–talus angle (PTA) and superior space of ankle joint (SS) only changed in the varus group. The median PTA and SS significantly decreased from 1.2° to 0.3° (p < 0.001) and increased from 2.5 to 2.6 mm (p = 0.013), respectively. Notably, ∆PTA positively correlated with ∆HKA in the varus group (r = 0.247, p = 0.032) but not in the valgus group. Between-group differences in postoperative PTA (p < 0.001) and ∆PTA (p < 0.001) were significant. The degree of ankle alignment correction after TKA differed between patients with preexisting varus and valgus ankle deformities. TKA could not effectively correct the preexisting ankle valgus malalignment.
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Nazha, Hasan Mhd, Muhsen Adrah, Thaer Osman, et al. "Investigating Material Performance in Artificial Ankle Joints: A Biomechanical Study." Prosthesis 6, no. 3 (2024): 509–26. http://dx.doi.org/10.3390/prosthesis6030036.
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This study delves into an in-depth examination of the biomechanical characteristics of various materials commonly utilized in the fabrication of artificial ankle joints. Specifically, this research focuses on the design of an ankle joint resembling the salto-talaris type, aiming to comprehensively understand its performance under different loading conditions. Employing advanced finite element analysis techniques, this investigation rigorously evaluates the stresses and displacements experienced by the designed ankle joint when subjected to varying loads. Furthermore, this study endeavors to identify the vibrating frequencies associated with these displacements, offering valuable insights into the dynamic behavior of the ankle joint. Notably, the analysis extends to studying random frequencies across three axes of motion, enabling a comprehensive assessment of directional deformities that may arise during joint function. To validate the effectiveness of the proposed design, a comparative analysis is conducted against the star ankle design, a widely recognized benchmark in ankle joint prosthetics. This comparative approach serves dual purposes: confirming the accuracy of the findings derived from the salto-talaris design and elucidating the relative efficacy of the proposed design in practical application scenarios.
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Shin, Sophie, Robin Evrard, Olivier Cornu, Karim Tribak, and Dan Putineanu. "Post-Traumatic Tibio-Fibular Malunion with Hindfoot Valgus: Treatment with Calcaneal Medializing and Fibular Lengthening Osteotomies – A Case Report." Journal of Orthopaedic Case Reports 15, no. 7 (2025): 195–200. https://doi.org/10.13107/jocr.2025.v15.i07.5822.
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Introduction: Post-traumatic fibular shortening results in malrotation and lateral talar tilt, disrupting joint congruence and increasing stress. These malunited ankle fractures lead to complications such as chronic pain, reduced mobility, and post-traumatic osteoarthritis. The impact of these malunions highlights the importance of anatomical reconstruction to restore biomechanical balance and prevent complications. This case study provides a detailed insight into the management of complex post-traumatic ankle deformities, highlighting the success of joint-preserving osteotomies and their potential to delay more invasive interventions. Case Report: This case report illustrates the restoration of joint congruence in a patient presenting with chronic lateral-dorsal pain, limited mobility, and impingement symptoms of the ankle. The valgus deformity of the hindfoot and post-traumatic misaligned tibio-talar osteoarthritis were addressed through fibular Z-lengthening osteotomy with corticocancellous grafting and medializing calcaneal osteotomy. Conclusion: This case underscores the importance of an early recognition and targeted surgical approach to correct complex post-traumatic deformities. Joint reconstruction, restoring the ankle mortise’s balance, has clinical benefits by reducing pain, improving ankle function, and preventing the development or progression of mechanical joint degeneration. Keywords: Hindfoot valgus, valgus ankle osteoarthritis, supramalleolar fibular lengthening osteotomy, medializing calcaneal osteotomy, realignment surgery.
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Daniels, Timothy R., Anthony R. Cadden, and Kay-Kiat Lim. "Correction of Varus Talar Deformities in Ankle Joint Replacement." Operative Techniques in Orthopaedics 18, no. 4 (2008): 282–86. http://dx.doi.org/10.1053/j.oto.2009.01.001.
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Calori, Sara, Chiara Comisi, Antonio Mascio, et al. "Overview of Ankle Arthropathy in Hereditary Hemochromatosis." Medical Sciences 11, no. 3 (2023): 51. http://dx.doi.org/10.3390/medsci11030051.
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Hereditary hemochromatosis (HH) is an autosomal recessive bleeding disorder characterized by tissue overload of iron. Clinical systemic manifestations in HH include liver disease, cardiomyopathy, skin pigmentation, diabetes mellitus, erectile dysfunction, hypothyroidism, and arthropathy. Arthropathy with joint pain is frequently reported at diagnosis and mainly involves the metacarpophalangeal and ankle joints, and more rarely, the hip and knee. Symptoms in ankle joints are in most cases non-specific, and they can range from pain and swelling of the ankle to deformities and joint destruction. Furthermore, the main radiological signs do not differ from those of primary osteoarthritis (OA). Limited data are available in the literature regarding treatment; surgery seems to be the gold standard for ankle arthropathy in HH. Pharmacological treatments used to maintain iron homeostasis can also be undertaken to prevent the arthropathy, but conclusive data are not yet available. This review aimed to assess the ankle arthropathy in the context of HH, including all its aspects: epidemiology, physiopathology, clinical and imaging presentation, and all the treatments available to the current state of knowledge.
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Alajlan, Ahmad, Simone Santini, Faisal Alsayel, et al. "Joint-Preserving Surgery in Varus Ankle Osteoarthritis." Journal of Clinical Medicine 11, no. 8 (2022): 2194. http://dx.doi.org/10.3390/jcm11082194.
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Ankle deformity is a disabling condition especially if concomitant with osteoarthritis (OA). Varus ankle OA is one of the most common ankle OA deformities. This deformity usually leads to unequal load distribution in the ankle joint and decreases joint contact surface area, leading to a progressive degenerative arthritic situation. Varus ankle OA might have multiple causative factors, which might present as a single isolated factor or encompassed together in a single patient. The etiologies can be classified as post-traumatic (e.g., after fractures and lateral ligament instability), degenerative, systemic, neuromuscular, congenital, and others. Treatment options are determined by the degree of the deformity and analyzing the pathology, which range from the conservative treatments up to surgical interventions. Surgical treatment of the varus ankle OA can be classified into two categories, joint-preserving surgery (JPS) and joint-sacrificing surgery (JSS) as total ankle arthroplasty and ankle arthrodesis. JPS is a valuable treatment option in varus ankle OA, which should not be neglected since it has showed a promising result, optimizing biomechanics and improving the survivorship of the ankle joint.
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Dodd, Charlene, Alis Trivelli, David Stephensen, Gillian Evans, and Miranda Foord. "Outcome of a combined physiotherapy and podiatry haemophilia clinic: patient perceptions and the effect on ankle bleeds and joint health." Journal of Haemophilia Practice 7, no. 1 (2020): 37–44. http://dx.doi.org/10.17225/jhp00153.
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AbstractBackgroundThe ankle joint is the most common site of bleeding for people with haemophilia (PWH) in the developed world. Recent surveys suggest that PWH do not always have access to non-surgical musculoskeletal interventions and that when provided; there is considerable heterogeneity in clinical practice.AimsTo determine patient perceptions and the potential benefits of a new combined multidisciplinary physiotherapy-podiatry haemophilia clinic, and to observe the effect on frequency of bleeds and ankle joint Haemophilia Joint Health Scores (HJHS).Materials and methodsPWH with a history of ankle bleeds, pain, foot and/or ankle deformities from a single UK haemophilia centre were referred to the clinic from December 2017 to December 2018. Pre- and post-intervention ankle joint HJHS data and ankle annualised joint bleed rate (AJBR) were collected together with a satisfaction questionnaire asking patients their views on the clinic's value, usefulness and their satisfaction after the initial appointment.ResultsTwenty-seven PWH (16 children and 11 adults) attended the clinic. All patients agreed or strongly agreed that they were satisfied with the new clinic. The combined multidisciplinary nature of the clinic meant that patients only needed to attend one appointment with the expertise of two professionals, rather than attending two separate appointments. All patients reported it “more useful to see the physiotherapist and podiatrist together”. There were no statistically significant differences in ankle AJBR or HJHS scores post-intervention compared to pre-intervention.ConclusionEstablishing a multidisciplinary physiotherapy-podiatry clinic for PWH with a history of ankle bleeds, pain, foot and/or ankle deformities appears to increase patient satisfaction. We did not observe a significant change in ankle AJBR or ankle HJHS scores, suggesting they might not be sufficient to evaluate potential benefits to patients. A larger study incorporating validated tools, focusing on patient-reported foot function, pain, activity and quality of life is needed to confirm if there is any effect of a combined physiotherapy-podiatry intervention on ankle joint AJBR and function.
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Varma, Ajit Kumar. "Reconstructive foot and ankle surgeries in diabetic patients." Indian Journal of Plastic Surgery 44, no. 03 (2011): 390–95. http://dx.doi.org/10.1055/s-0039-1699516.
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ABSTRACTDiabetic foot and ankle deformities are secondary to long-standing diabetes and neglected foot care. The concept of surgical correction for these deformities is quite recent. The primary objective of reconstructive foot and ankle surgery is the reduction of increased plantar pressures, reduction of pain and the restoration of function, stability and proper appearance. Foot and ankle deformities can result in significant disability, loss of life style, employment and even the loss of the lower limb. Therefore, restoration of normal, problem free foot function and activities will have a significant impact on peoples’ lives. Reconstructive surgical procedures are complex and during reconstruction, internal and external fixation devices, including pins, compression screws, staples, and wires, may be used for repair and stabilization. The surgeries performed depend on the type and severity of the condition. Surgery can involve any part of the foot and ankle, and may involve tendon, bone, joint, tissue or skin repair. Corrective surgeries can at times be performed on an outpatient basis with minimally invasive techniques. Recovery time depends on the type of condition being treated.
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Kim, Jahyung, Jaeyoung Kim, Saintpee Kim, and Young Yi. "Weight-Bearing CT for Diseases around the Ankle Joint." Diagnostics 14, no. 15 (2024): 1641. http://dx.doi.org/10.3390/diagnostics14151641.
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Weight-bearing computed tomography (WBCT) enables acquisition of three-dimensional bony structure images in a physiological weight-bearing position, which is fundamental in understanding the pathologic lesions and deformities of the ankle joint. Over the past decade, researchers have focused on validating and developing WBCT measurements, which has significantly enhanced our knowledge of common foot and ankle diseases. Consequently, understanding the application of WBCT in clinical practice is becoming more important to produce improved outcomes in the treatment of disease around the ankle joint. This review will describe an overview of what is currently being evaluated in foot and ankle surgery using WBCT and where the course of research will be heading in the future.
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Nozaka, Koji, Naohisa Miyakoshi, Yusuke Yuasa, Motoki Mita, and Yoichi Shimada. "Simultaneous Total Knee Arthroplasty and Ankle Arthrodesis for Charcot Neuroarthropathy." Case Reports in Orthopedics 2019 (December 7, 2019): 1–8. http://dx.doi.org/10.1155/2019/6136409.
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Introduction. Charcot neuroarthropathy is a progressive, deforming pathology of the bone and joints, especially affecting the knees and ankles. Although it is rare, it leads to considerable morbidity. The treatment of Charcot arthropathy of the knee and ankle remains controversial. Many authors suggest that knee involvement is an absolute contraindication to total knee arthroplasty. In recent years, however, several studies have shown satisfactory results for total knee arthroplasty. In the ankle, external fixators have recently been advocated by many authors. Their main advantages are that they permit monitoring of soft tissue healing and avoidance of more invasive surgery. Simultaneous Charcot knee and ankle joint surgery involving total knee arthroplasty (TKA) and ankle arthrodesis is rare and challenging and can lead to major complications if not addressed appropriately. Case Presentation. The case of a 71-year-old woman who underwent simultaneous total knee arthroplasty and ankle arthrodesis for severe neurosyphilitic Charcot arthropathy (Eichenholtz classification stage III) and was evaluated three years after surgery is reported. Deformities of the left knee joint and ankle developed. The left leg was shorter by 20 mm, with a functional leg length discrepancy. The patient was limping, and marked varus instability of the left ankle was observed during the stance phase of walking. Postoperatively, the patient was able to walk without assistance, confirming improvement of mobility. Conclusion. To the best of our knowledge, this is the first report of combined, simultaneous neurosyphilitic Charcot knee and ankle joint surgery involving TKA and ankle arthrodesis. It was an effective surgical method that maintained leg length and achieved satisfactory alignment without an autologous iliac bone graft.
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Coughlin, Michael J., Brett R. Grebing, and Carroll P. Jones. "Arthrodesis of the First Metatarsophalangeal Joint for Idiopathic Hallux Valgus: Intermediate Results." Foot & Ankle International 26, no. 10 (2005): 783–92. http://dx.doi.org/10.1177/107110070502601001.
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Background: Followup studies documenting the outcome of primary metatarsophalangeal (MTP) joint arthrodesis for treatment of hallux valgus deformities are rare. The purpose of this report was to evaluate the results of first MTP joint arthrodesis as treatment for moderate and severe hallux valgus deformities over a 22-year period in a single surgeon's practice. Methods: All living patients treated between 1979 and 2001, for moderate and severe idiopathic hallux valgus deformities with first MTP joint arthrodesis were contacted and asked to return for a followup examination. Outcomes were assessed by comparing preoperative and postoperative pain, function, and radiographic appearance. First ray mobility and ligamentous laxity also were assessed postoperatively. Results: Eighteen of 21 of the first MTP joints had successfully fused with the primary procedure at an average followup of 8.2 years (range 24 to 271 months). The time to union averaged 10 (range 7 to 15) weeks. Two of the three nonunions, both in the same patient, were asymptomatic and were not revised. One required a revision to achieve fusion. The average corrections in the hallux valgus angle and 1–2 intermetatarsal (IM) angle were 21 degrees and 6 degrees, respectively, and the average postoperative dorsiflexion angle was 22 degrees. Subjective satisfaction was rated as excellent in seventeen of 21 cases (80%) and good in the remaining four (20%). There was significant reduction in postoperative pain ( p < 0.001), complete resolution of lateral metatarsalgia, and the postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores averaged 84 (range 72 to 90) at final followup. Major activity restrictions after surgery were uncommon, and all patients were able to wear conventional or comfort shoes. Interphalangeal (IP) joint arthritis progressed in seven of 21 feet (33%), but all of these changes were mild. Conclusions: In the present study, arthrodesis of the first MTP joint for idiopathic hallux valgus resulted in a high percentage of successful results at an average followup of over 8 years.
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DiDomenico, Lawrence A., and Danielle N. Butto. "Subtalar Joint Arthrodesis for Elective and Posttraumatic Foot and Ankle Deformities." Clinics in Podiatric Medicine and Surgery 34, no. 3 (2017): 327–38. http://dx.doi.org/10.1016/j.cpm.2017.02.004.
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Șerban, Oana, Maria Bădărînză, and Daniela Fodor. "The relevance of ultrasound examination of the foot and ankle in patients with rheumatoid arthritis – a review of the literature." Medical Ultrasonography 21, no. 2 (2019): 175. http://dx.doi.org/10.11152/mu-1967.
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Rheumatoid arthritis (RA) is an inflammatory disease characterized by symmetrical involvement of the joints and tendons, especially of the hands and wrists, but also of the feet and ankles from the very beginning of the disease. For the patient, the foot and ankle involvement is equally important as the other joints, since it affects the functionality of the feet and the quality of life of the patients. It is already known that subclinical involvement of the ankles and feet occurs even in patients that are considered in clinical remission, thus they do not need for changes of therapy, but still might benefit from it. In spite of this, theclinicians do not give enough care to the ankle and foot in RA patients, especially if asymptomatic, resulting future deformities, joint damage and feet disability. In order to show the importance of the feet and ankles in RA patients and to demonstrate the indispensable role of ultrasonography (US) for that purpose, at the same time displaying the US abnormalities that should draw our attention, we performed this review of the literature.
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Hong, Yong-Cheol, Ki-Jin Jung, Hee-Jun Chang, et al. "Staged Joint Arthrodesis in the Treatment of Severe Septic Ankle Arthritis Sequelae: A Case Report." International Journal of Environmental Research and Public Health 18, no. 23 (2021): 12473. http://dx.doi.org/10.3390/ijerph182312473.
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Septic ankle arthritis is a devastating clinical entity with high risks of morbidity and mortality. Prompt treatment is necessary because delayed or inadequate treatment can lead to irreversible damage that may occur on the articular surface, resulting in cartilage erosion, infective synovitis, osteomyelitis, joint deformity, and pain and joint dysfunction. An aggressive surgical approach is required when a joint infection causes severe limb-threatening arthritis. A 58-year-old woman visited our clinic with increasing pain in the right ankle, which had been present for the previous 2 months. She complained of discomfort in daily life due to deformity of the ankle; limping; and severe pain in the ankle even after walking a little. The patient reported a history of right-ankle injury while exiting a bus in her early 20s. Plain radiographs of the right ankle joint revealed that the medial malleolus was nearly absent in the right ankle joint on the anteroposterior view, and severe varus deformity was observed with osteoarthritic changes because of joint space destruction. Magnetic resonance imaging revealed diffuse synovial thickening of the destroyed tibiotalar joint with joint effusion. Hybrid 99mTc white blood cell single-photon emission computed tomography/computed tomography showed increased uptake along the soft tissue around the ankle joint; uptake was generally low in the talocrural and subtalar joints. A two-stage operation was performed to remove the infected lesions and correct the deformity, thus enabling limb salvage. The patient was nearly asymptomatic at the 6-month follow-up, with no discomfort in her daily life and nearly normal ability to carry out full functional activities. She had no complications or recurrent symptoms at the 1-year follow-up. We have described a rare case of a staged limb salvage procedure in a patient with chronic septic arthritis sequelae. For patients with severe joint deformity because of septic ankle sequelae, staged arthrodesis is a reliable method to remove infected lesions, solve soft tissue problems, correct deformities, and maintain leg length.
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Li, Shuyuan, Mark S. Myerson, and Cesar de Cesar Netto. "Peritalar Subluxation: A Key Finding for Both Cavovarus and Flatfoot Deformities." Foot & Ankle Orthopaedics 7, no. 1 (2022): 2473011421S0031. http://dx.doi.org/10.1177/2473011421s00316.
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Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: Peritalar subluxation in both the talonavicular and subtalar joints has been described as characteristic markers for adult acquired flatfoot deformity (AAFD). However, no study has reported these changes in in cavovarus deformity, and we postulated that peritalar subluxation would apply to both the AAFD as well as the cavovarus foot deformity but in different directions using the same markers. Furthermore, the use of calcaneocuboid (CC) joint subluxation as an additional marker for peritalar subluxation has never been investigated in either flatfoot or cavovarus deformities. This study used three dimensional images of weightbearing cone beam computed tomography (WBCT) to evaluate the alignment of the peritalar joints in feet with normal, varus and valgus hindfoot alignment. Methods: WBCT scan images and medical charts of 400 patients were retrospectively reviewed. Thirty cavovarus and 15 flexible AAFD feet were chosen as the study groups. Fifteen feet without deformities and arthritis, a history of trauma or surgery in both the hindfoot and ankle were chosen as controls. Hindfoot moment arm (HMA), Foot and ankle offset (FAO) were used to assess hindfoot alignment. Middle facet subluxation (MFS), talonavicular joint coverage angle (TNCA), and calcaneocuboid joint subluxation (CCS) were used as markers of peritalar subluxation. The talocalcaneal (Kite's) angle in the axial plane was used to demonstrate the relative position between the talus and the calcaneus. The arch height index in the sagittal plane was used to assess medial arch height. Positive was used to reflect lateral subluxations while negative for medial ones. Correlations between HMA, FAO and each of the above three peritalar subluxation parameters were assessed by bivariate linear regression. Results: Patients in both the cavovarus and the AAFD groups showed totally different hindfoot alignment, peritalar subluxation and the height of the medial arch compared to the control group. In the order of Cavovarus, AAFD, and Control, the mean HMA- CR values were -20.43mm, 14.02mm, and 0.03mm, respectively; HMA-WBCT values were -6.34mm, 15.75 mm, and 3.19 mm; FAO values were -11.17%, 7.42%, and 2.63%; TNCA were -16.8 degrees, 22.11, and 6.45; The MFS values were -17%, 42%, and 22%; CCS values were -21% (IQR=-35%,-0.17%), -7% (IQR=-11%, 0) and 0 (IQR=-4%, 5%); The Kite's angles were 22.19 degrees, 34.27 degrees, and 28.06 degrees; The arch height index values were 0.25, 0.71, and 0.44. There was a statistically significant difference among the three groups in all the above parameters. There was a strong positive linear correlation between each parameter of the peritalar subluxation marks with both hindfoot moment arm and FAO. Conclusion: This is the first study to bring the concept of peritalar subluxation to cavovarus deformity assessment, proving that peritalar subluxation is a key characteristic in both flatfoot and cavovarus foot deformities. The two deformities are pathologically completely different, and as expected, markers of peritalar subluxation were in opposite directions. The use of calcaneocuboid joint subluxation as additional marker of perisubtalar subluxation is novel to assess both deformities. The findings of this study will provide useful guidelines for future clinical evaluation and decision making in treating patients with either varus or valgus hindfoot deformities.
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Lázaro-Martínez, José Luis, Francisco Javier Aragón-Sánchez, Juan Vicente Beneit-Montesinos, Maximo A. González-Jurado, Esther García Morales, and David Martínez Hernández. "Foot Biomechanics in Patients with Diabetes Mellitus." Journal of the American Podiatric Medical Association 101, no. 3 (2011): 208–14. http://dx.doi.org/10.7547/1010208.
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Background: We sought to identify the biomechanical characteristics of the feet of patients with diabetes mellitus and the interrelationship with diabetic neuropathy by determining the range of joint mobility and the presence and locations of calluses and foot deformities. Methods: This observational comparative study involved 281 patients with diabetes mellitus who underwent neurologic and vascular examinations. Joint mobility studies were performed, and deformities and hyperkeratosis locations were assessed. Results: No substantial differences were found between patients with and without neuropathy in joint mobility range. Neuropathy was seen as a risk factor only in the passive range of motion of the first metatarsophalangeal joint (mean ± SD: 57.2° ± 19.5° versus 50.3° ± 22.5°, P = .008). Mean ± SD ankle joint mobility values were similar in both groups (83.0° ± 5.2° versus 82.8° ± 9.3°, P = .826). Patients without neuropathy had a higher rate of foot deformities such as hallux abductus valgus and hammer toes. There was also a higher presence of calluses in patients without neuropathy (82.8% versus 72.6%; P = .039). Conclusions: Diabetic neuropathy was not related to limited joint mobility and the presence of calluses. Patients with neuropathy did not show a higher risk of any of the deformities examined. These findings suggest that the etiology of biomechanical alterations in diabetic people is complex and may involve several anatomically and pathologically predisposing factors. (J Am Podiatr Med Assoc 101(3): 208–214, 2011)
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Kolodziej, Lukas, Boguslaw Sadlik, Sebastian Sokolowski, and Andrzej Bohatyrewicz. "Results of Arthroscopic Ankle Arthrodesis with Fixation Using Two Parallel Headless Compression Screws in a Heterogenic Group of Patients." Open Orthopaedics Journal 11, no. 1 (2017): 37–44. http://dx.doi.org/10.2174/1874325001711010037.
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Background: As orthopedic surgeons become skilled in ankle arthroscopy technique and evidence -based data is supporting its use, arthroscopic ankle arthrodesis (AAA) will likely continue to increase, but stabilization methods have not been described clearly. We present a technique for two parallel 7.3-mm headless compression screws fixation (HCSs) for AAA in cases of ankle arthritis with different etiology, both traumatic and non-traumatic, including neuromuscular and inflammatory patients. Materials and Methods: We retrospectively verified 24 consecutive patients (25 ankles) who underwent AAA between 2011 and 2015. The average follow-up was 26 months (range 18 to 52 months). Arthrodesis was performed in 16 patients due to posttraumatic arthritis (in 5 as a sequela of pilon, 6 ankles, 3 tibia fractures, and 2 had arthritis due to chronic instability after lateral ligament injury), in 4 patients due to neuromuscular ankle joint deformities, and in 4 patients due to rheumatoid arthritis. Results: Fusion occurred in 23 joints (92%) over an average of 12 weeks (range 6 to 18 weeks). Ankle arthrodesis was not achieved in 2 joints (8%), both in post-pilon fracture patients. The correct foot alignment was not achieved in 4 feet (16%). None of the treated patients required hardware removal. Conclusion: The presented technique was effective in achieving a high fusion rate in a variety of diseases, decreasing intra- and post-operative hardware complications while maintaining adequate bone stability.
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Kondo, Naoki, Tetsuya Igarashi, Tomoya Inukai, and Hiroyuki Kawashima. "Case Report: Postsurgical hallux varus in which metatarsophalangeal joint arthrodesis was useful." F1000Research 12 (July 9, 2024): 344. http://dx.doi.org/10.12688/f1000research.131495.2.
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A 74-year-old Japanese woman who underwent Mann’s procedure with fibular sesamoidectomy for left hallux valgus 21 years ago complained of left hallucis pain. She was diagnosed with iatrogenic hallux varus and hammer toe deformities. Metatarsophalangeal joint arthrodesis and shortening oblique osteotomy were performed. After surgery, the hallux valgus angle improved from -28° to 0°, and the intermetatarsal angle between the first and the second metatarsus improved from 0° to 6°. The Japanese Society for Surgery of the Foot RA foot and ankle scale improved from 73 to 81 points. She could walk without pain and sustained no deformity at 4 years after the surgery.
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Yadav, Sandeep K., Rajesh K. Rajnish, Dhirendra Kumar, Sudeep Khera, Abhay Elhence, and Aakash Choudhary. "Primary Synovial Chondromatosis of the Ankle in a Child: A Rare Case Presentation and Review of Literature." Journal of Orthopaedic Case Reports 13, no. 4 (2023): 5–10. http://dx.doi.org/10.13107/jocr.2023.v13.i04.3594.
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Introduction: Synovial chondromatosis is not a common condition and involvement of the ankle joint is quite rare. We found only one case of synovial chondromatosis of the ankle joint among the pediatric population. We present a case of a 9-year-old boy with synovial chondromatosis of the left ankle. Case Report: A 9-year-old boy had synovial osteochondromatosis in the left ankle joint, which caused pain, swelling, and restriction of movement of the left ankle. Radiological examinations showed variable size calcific foci adjacent to the medial malleolus and medial ankle joint space with mild soft-tissue swelling. The ankle mortise space was well-maintained. The magnetic resonance imaging of the ankle joint revealed a benign synovial neoplastic process and a few focal marrows containing loose bodies. The synovium was thick, and there was no articular erosion. The patient was planned and underwent an en bloc resection. A lobulated pearly white mass arising from the ankle joint was observed intraoperatively. Histological examination also showed attenuated synovium with osteocartilaginous nodule with binucleated and multinucleated forms of chondrocyte typical of osteochondroma were appreciated. Endochondral ossification, mature bony trabeculae with intervening fibro adipose tissue, was noted. The patient had remarkable relief of clinical complaints and was almost asymptomatic at the time of the first follow-up. Conclusion: Synovial chondromatosis may present with diverse clinical manifestations according to the different stages of the disease as described by Milgram; like joint pain, limitation of movements, swelling due to the close proximity of important structures including joints, tendons, and neurovascular bundles. A simple radiograph with a characteristic appearance is usually sufficient in confirming the diagnosis. In pediatric patients, overlooking these conditions may result in growth abnormality, skeletal deformities, and several mechanical problems. We suggest that when dealing with the case of swelling in or around the ankle, the differential diagnosis should include synovial chondromatosis. Keywords: Synovial chondromatosis, osteocartilaginous nodule, case report, pediatric population, endochondral ossification, en bloc resection.
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Kuznetsov, Vasilii V., Sergei M. Gudi, Liliya K. Skuratova, and Igor A. Pakhomov. "Total Talar Replacement with Ceramic Implant in Combination with Tibial Component of Ankle Endoprosthesis: A Case Report." Traumatology and Orthopedics of Russia 27, no. 4 (2021): 111–19. http://dx.doi.org/10.21823/2311-2905-1638.
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Background. Surgical treatment of patients with talus posttraumatic aseptic necrosis and its consequences usually includes tibiotalocalcaneal arthrodesis with various foot joints according to additional indications. This type of surgical treatment has number of significant disadvantages: traumatic surgical technique, permanent loss of movement in functionally significant joints, high risk of non-union, high frequency of residual deformities, the need for long periods of limb immobilization. The question arises: how to overcome the existing disadvantages and improve the results of talus posttraumatic aseptic necrosis treatment? A potential solution to this problem is the total talus endoprosthetics. Clinical case. A 64-year-old patient came to the clinic complaining of pain and deformity of the right foot and ankle area. After the examination, talus posttraumatic aseptic necrosis was diagnosed. The patient underwent ankle joint arthroplasty using total talus ceramic endoprosthesis in combination with the tibial component of the ankle joint endoprosthesis, a course of rehabilitation treatment was performed. Results. The VAS and AOFAS scales indicators showed a significant improvement both in the pain decrease (from 75 mm before surgery to 10 mm after), and in the functional state according to AOFAS by 2.2 times (from 36 to 80 points 20 months after surgery). By the last follow-up the patient could take more than 8000 steps a day. Conclusion. Considering the good clinical result achieved, the ankle joint arthroplasty using total talus ceramic endoprosthesis in combination with the tibial component of the ankle joint endoprosthesis can be considered a promising method of treatment of this severe pathology.
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Garg, Bipul Kumar, and Harshit Dave. "Pantalar arthrodesis in a case of chronic subluxated tibiotalar and subtalar joint with secondary arthritis: a case report." International Journal of Research in Orthopaedics 5, no. 5 (2019): 974. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20193846.
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<p class="abstract">Post-traumatic arthritis is the most common cause of ankle arthritis. Pantalar arthrodesis (PA) is a salvage operation that can be used to create a stable and functional plantigrade foot for those who have a painful ankle joint with significant bony destruction and/or malalignment of ankle and hindfoot producing deformities and instabilities not amenable to bracing, orthotic devices or shoes. It is commonly performed as a double staged procedure. We present a case of 50 years old male with chronic subluxated tibiotalar and subtalar joint with secondary arthritis who was operated with a single staged pantalar arthrodesis with a follow up of 6 months. A single staged Pantalar arthrodesis combining both transfibular approach for ankle and olliers approach for triple arthrodesis is an effective surgical treatment option in a case of chronic subluxated tibiotalar and subtalar joint with secondary arthritis.</p>
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Manzi, Luigi, Cristian Indino, Christopher Gross, Riccardo D’Ambrosi, and Federico Giuseppe Usuelli. "Hindfoot alignment in total ankle replacement at 2 year follow-uo." Foot & Ankle Orthopaedics 3, no. 3 (2018): 2473011418S0033. http://dx.doi.org/10.1177/2473011418s00333.
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Category: Ankle Arthritis Introduction/Purpose: End-stage ankle osteoarthritis frequently involves multiplanar malalignment both tibio-talar and subtalar joint. Restoration of the correct position of the tibial and the talar component and of the hindfoot is mandatory for the long-term survival of total ankle replacement. Since patients with ankle osteoarthritis often present concomitant hindfoot deformity, radiographic references are needed to describe deformities. However, the possible compensatory mechanisms of these linked joints are not well known.The aim of this study is to show if there is any difference regarding hindfoot position at 6 months, 1 year and 2 years follow-up. Methods: The study included 68 ankles who underwent Total Ankle Replacment through a later transfibuklar approach between May 2013 and December 2015. The main indications for TAR were: post-traumatic (55 patients, 80.9%) and reumathoid arthritis (5 patients, 7.4%). In these patients the hindfoot view angle was measured 6, 12 and 24 months postoperatively. Furthermore, clinical outcomes were recorded. Patients who underwent hindfoot/midfoot fusions were excluded. Results: The mean hindfoot alignment angle (HAV) was 0.4±0.0 pre-operatively and 0.1±6.2, 0.7±6.2, 1.2±7.0 at 6, 12 and 24 months postoperatively. There was no statistically significant difference in the HAV between follow-up. A statistically significant improvement in clinical scores (AOFAS, VAS and SF.12) was found at each follow-up. The main complications were: 6 hardware removal for intollerance (8,8%), 3 delayed wound healing (4,4%), 1 medial impingement (1,5%). Conclusion: Regarding the hindfoot alignment angle, TAA through a lateral approach showed a good reliability. Furthermore, hindfoot alignment remains stable over time.
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Choi, Ji Hye, Yoon Hyo Choi, Dae Hyun Kim, Dong Yeon Lee, Seungbum Koo, and Kyoung Min Lee. "Effect of flatfoot correction on the ankle joint following lateral column lengthening: A radiographic evaluation." PLOS ONE 18, no. 11 (2023): e0286013. http://dx.doi.org/10.1371/journal.pone.0286013.
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Objectives The effects of foot deformities and corrections on the ankle joint without osteoarthritis has received little attention. This study aimed to investigate the effect of flatfoot correction on the ankle joint of patients without osteoarthritis. Methods Thirty-five patients (24 men and 11 women; mean age 17.5 years) who underwent lateral column lengthening for flatfoot deformities were included. The mean postoperative follow-up period was 20.5 months (standard deviation [SD]: 15.7 months). Radiographic indices were measured pre- and postoperatively, including anteroposterior (AP) and lateral talo-first metatarsal angles, naviculocuboid overlap, position of the articulating talar surface, and lateral talar center migration. Postoperative changes in the radiographic indices were statistically analyzed. Results There was significant postoperative improvement in flatfoot deformity in terms of AP and lateral talo-first metatarsal angles (p<0.001 and p<0.001, respectively) and naviculocuboid overlap (p<0.001). On lateral radiographs, the talar articulating surface dorsiflexed by 7.3% (p<0.001), and the center of the talar body shifted anteriorly by 0.85 mm (p<0.001) postoperatively. Conclusions Flatfoot correction using lateral column and Achilles tendon lengthening caused dorsiflexion and an anterior shift of the articular talar body in patients without osteoarthritis. Correction of flatfoot deformity might affect the articular contact area at the ankle joint. The biomechanical effects of this change need to be investigated further.
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de Cesar Netto, Cesar, Gao Zhengyu, Pooyan Abbasi, et al. "The Influence of Calcaneal and First Ray Osteotomies on the Contact Pressures of the Ankle Joint." Foot & Ankle Orthopaedics 4, no. 4 (2019): 2473011419S0015. http://dx.doi.org/10.1177/2473011419s00159.
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Category: Ankle, Hindfoot Introduction/Purpose: Medial displacement calcaneal osteotomies (MDCO) and first ray plantarflexion osteotomies, such as a Cotton osteotomy, are frequently used realignment procedures for hindfoot and ankle joint valgus malalignment. Multiple studies demonstrated the effects of calcaneal osteotomies on the contact pressures of the ankle joint (CPAJ), with slight medial displacement of the center of pressure and lateral unloading of the ankle joint. However, the influence of a first ray plantarflexion osteotomy on the CPAJ is yet to be determined. In this cadaveric study we compared the effects of calcaneal and first ray osteotomies in the CPAJ. Methods: Fifteen bellow-knee cadaveric specimens were dissected to expose the ankle joint and isolate the flexor and peroneal tendons. Tekscan 5033 sensors were placed in the ankle joint and held in place with cyanoacrylate. Specimens were loaded in a servohydraulic load frame. The following loads were applied to the tendons: Achilles (200 N), PTT (40 N), peroneals combined (44 N), FHL/FDL combined (35 N). Ankles were tested in an intact position, after isolated MDCO (6, 8, 10 and 12 mm), isolated Cotton osteotomies (4, 8 and 12 mm) as well as combined osteotomies (10 mm and 12 mm, respectively). Specimens were then cyclically load from 100N-700 N at a rate of 0.5 Hz for 30 cycles while CPAJ data was collected at a rate of 20 Hz. Average and maximum pressure data were extracted as well as the center of pressure (CoP) movement in the AP and ML directions. Results: There was a significant (p<0.05) and progressive decrease in respective maximum and average contact pressures of the ankle joint when comparing intact ankle (1608 and 1312kPa), calcaneal osteotomy (1291 and 1034 kPa), Cotton osteotomy (1165 and 962 kPa) and combined osteotomies (1134 and 903 kPa). Cotton osteotomy and combined osteotomies showed similar contact pressures. Regarding CoP measurements of the ankle joint, native ankle and MDCO demonstrated similar positionings in the sagittal and coronal planes. Cotton and combined osteotomies caused a significant shift of the CoP anteriorly and laterally when compared respectively to the intact/MDCO and MDCO ankles. Conclusion: The results of this study demonstrate that the Cotton osteotomy has a greater effect on the contact pressures of the ankle when compared to the MDCO. There is an overall decrease in the maximum and average pressures as well as a deviation of the center of pressure toward the anterior and lateral aspect of the ankle joint. These findings should guide surgeons when deciding between first ray and calcaneal osteotomies as realignment procedures for hindfoot and ankle valgus deformities.
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Oganesyan, O. V., and A. V. Korshunov. "The use of a modified hinge-distraction apparatus for chronic injuries of the ankle and foot." N.N. Priorov Journal of Traumatology and Orthopedics 9, no. 3 (2022): 83–87. http://dx.doi.org/10.17816/vto99974.
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The experience (126 patients) in the use of the suggested by O.V. Oganesyan modified hingedistraction device for the treatment of old foot dislocations and fractures of the ankle joint articular ends is presented. Perfection of the construction enabled to simplify the application of the device as well as makes it possible to put together the articular ends and their fragments either in one step or gradually, to maintain the width of the articular slit along the articular surface, to perform active and passive motions in the unloaded joint. When the apparatus is used the volume of open surgical interventions is reduced to the required minimum. Due to the device construction it is also possible to eliminate all types of ankle joint and foot deformities (varus, valgus, equinus, adduction, excavation). In 109 patients the follow up period ranged from 1 to 17 years: the overwhelming majority of cases (82%) showed the restoration of the ankle joint function.
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Khabibyanov, R., A. Skvortsov, and M. Maleev. "SURGICAL ELIMINATION OF DEFORMATIONS OF THE BONES OF THE DISTAL SHIN." Znanstvena misel journal, no. 81 (August 21, 2023): 47–52. https://doi.org/10.5281/zenodo.8266152.
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In the surgical treatment of post-traumatic and post-osteomyelitic deformities of the ankle joint area, using the generally accepted layout of the Ilizarov apparatus, during the distraction mode, the parallelism of the rods is often disturbed, which leads to a skew of the threaded rods and disruption of the process of formation of the distraction regenerate. This leads to an increase in the formation of the distraction regenerate and the time of healing of patients. The authors have developed and put into practice remote modules for the Ilizarov apparatus, which make it possible to facilitate the implementation of the technology for eliminating bone deformities and to reduce the time of its implementation
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Wagener, Joe, Christine Schweizer, Lukas Zwicky, and Beat Hintermann. "Ligament Balancing During TAR in Varus Deformity by Open Wedge Osteotomy of the Medial Malleolus." Foot & Ankle Orthopaedics 2, no. 3 (2017): 2473011417S0000. http://dx.doi.org/10.1177/2473011417s000079.
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Category: Ankle Arthritis Introduction/Purpose: After reducing the tilted talus during total ankle replacement (TAR) in severe varus deformities, the surgeon is faced to a contract medial joint and an abducted medial malleolus leaving a wide gutter. A sliding osteotomy will release the deltoid ligament but the “horizontal” position of the medial malleolus remains and bony containment of the ankle joint is not restored. We propose an open wedge osteotomy, which will both lengthen and adduct the medial malleolus and restore ligament balancing. Fixation is done by either screw or plate fixation. We present our primary results with this new technique. Methods: From 2008-2015 Total Ankle Replacement combined with open wedge medial malleolar osteotomy was done in 50 ankles (48 patients). Inclusion criteria: Takakura stages 3 and 4 ankle arthritis. Minimum follow-up was defined as one year. Results: Neutral alignment was achieved in all ankles at last follow-up. AOFAS score increased from 36 preoperative to 82 at last follow-up. In 15 Ankles an additional bony procedure was done during the TAR surgery (Calcaneus Osteotomy: 5, Dorsiflexion Osteotomy of first ray: 6, Fibula Osteotomy: 4, peritalar fusion: 4) Complications included one non-union of the medial malleolus, which resolved after revision. One deep infection that was treated in a staged procedure with reimplantation of a TAR and no recurrence of infection. Two luxations of the polyethylene due to insufficient lateral ligaments and syndesmotic dehiscence, both were stable at final follow-up after revision (ligament reconstruction and tight-rope Fixation). Conclusion: Open wedge osteotomy of the medial malleolus restores the bony containment of the ankle joint and decreases the tension of the deltoid ligament. It is a valuable tool for ligament balancing during TAR.
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Badhal, Suman, and Annie Mathew. "Functional Rehabilitation of a Neglected Foot Deformity: An Interesting Case Report." Indian Journal of Physical Medicine and Rehabilitation 35, no. 1 (2025): 51–53. https://doi.org/10.4103/ijpmr.ijpmr_44_24.
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Abstract Equinocavovarus deformity is the most common foot and ankle deformity in patients suffering from Post Polio Residual Paralysis (PPRP). These deformities can lead to gait abnormalities, abnormal pressure areas, increased energy expenditure and joint arthritis which eventually hampers the quality of life. We reports case of a 30 year old female with PPRP, whose ambulation was severely affected by rigid ankle foot deformity. A patient tailored rehabilitation plan was provided which comprised of an accommodative Ankle Foot Orthosis (AFO), exercise training and patient education on energy conservation techniques. Patient reported significant improvement in her ambulation and quality of life following rehabilitation.
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Tajin, Kairat. "Supramalleolar tibial osteotomy for the prevention of asymmetric crus arthrosis." Traumatology and Orthopаedics of Kazakhstan 75, no. 4 (2024): 19–25. https://doi.org/10.52889/1684-9280-2024-4-75-19-25.
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Post-traumatic or congenital varus deformity of the distal third of the tibia leads to disruption of anatomical relationships in the ankle joint, resulting in deformative osteoarthritis (DOA) of the ankle, which is a serious complication. The lower extremities of the human body have specific characteristics that must be considered in any reconstructive surgery, such as external appearance, disruption of physiological limb anatomy, disruption of reference lines and angles. The blood supply to the ankle joint is peculiar due to the absence of a muscular mass around the ankle region; in case of injury, microcirculatory activity sharply decreases, leading to local tissue hypoxia, which is also a contributing factor in the development of DOA. This literature review analyzes sources on the correction of post-traumatic and congenital deformities of the distal part of the tibia in asymmetric ankle osteoarthritis, sourced from PubMed, Google Scholar, SCOPUS, and Web of Science databases. Currently, various surgical interventions are used to prevent the development of DOA, showing promising results. The most common method is corrective supramalleolar osteotomy of the tibia, as one of the radical treatment options. This procedure is performed to optimize the biomechanics of the ankle joint and preserve its functional capacity, thereby preventing ankle arthritis and potentially delaying ankle joint arthroplasty or arthrodesis. Keywords: Asymmetric ankle osteoarthritis, post-traumatic varus deformity of the distal tibia, congenital varus deformity of the distal tibia, supramalleolar osteotomy, opening wedge osteotomy, closing wedge osteotomy.
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Balasankar, Ganesan, and Luximon Ameersing. "Common Foot and Ankle Disorders in Adults and Children." Research Journal of Textile and Apparel 19, no. 2 (2015): 54–65. http://dx.doi.org/10.1108/rjta-19-02-2015-b008.
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The human foot is a complex structure, which includes bones, joints, muscles, ligaments, soft tissues, nerves and veins. It supports the weight of the whole body and helps one to walk, run, and jump. Ankle and foot biomechanical functions that are interrupted by various pathological deformities lead to pain or other deformities, and result in difficulties during mobility. Foot problems are very common in children and adults. In this article, attempts are made to explore the clinical aspects of the most common foot and ankle deformities and their management by children and adults. Foot deformities may be congenital or acquired, and may involve arthritis conditions, such as rheumatoid arthritis and osteoarthritis. In children, congenital clubfoot, cavus, and flat feet are the most common disorders and can be treated by non-operative means or surgical management. Hallux valgus and rigidus, lesser toe deformities, and arthritis are mostly present with or without pain in the adult population.
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Mochocki, Karol, Radosław Górski, Sławomir Żarek, Łukasz Szelerski, and Paweł Małdyk. "Ankle Arthrodesis with Simultaneous Lengthening of the Lower Limb Using the Ilizarov Fixator." Ortopedia Traumatologia Rehabilitacja 20, no. 6 (2018): 441–50. http://dx.doi.org/10.5604/01.3001.0012.8393.
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Background. Patients with advanced ankle arthrosis or joint deformities and co-existing lower limb shortening present a complex therapeutic problem. This paper presents the Ilizarov treatment as a comprehensive method of simultaneous ankle arthrodesis and equalisation of lower limb length in 18 patients. Material and methods. Eighteen patients with arthrosis, deformities or other conditions of the ankle joint and ipsilateral lower limb shortening were treated with the Ilizarov method. The patients were assessed with the Foot and Ankle Outcomes Questionnaire before the treatment and one year after Ilizarov Fixator removal. Results. The Ilizarov Fixator allows early weight-bearing of the operated limb, which is undoubtedly convenient for the patient. The mean treatment duration was 8.2 months (range 4-18 months). Lower limb lengthening was 4.1 cm on average (range 2.5-8.5 cm). Bone union was achieved in all cases. Radiological and clinical outcomes were satisfactory in all 18 cases. Prolonged regenerate calcification was recorded in 1 patient. Ten patients developed soft tissue pin-tract infections and in 1 patient the Kirschner wire broke. According to the Foot and Ankle Outcomes Questionnaire, patients achieved a notable improvement in daily functioning and quality of life. Conclusions. The outcomes of a comprehensive treatment consisting of ankle arthrodesis and lower-leg lengthening using the Ilizarov method confirm its effectiveness. The Ilizarov Fixator allows early weight-bearing of the operated limb and evaluation at all treatment stages, creating an optimal biological environment for bone healing. The patient recovers functionally to allow satisfactory and pain-free functioning as well as resumption of daily responsibilities. The low incidence of complications adds to the attractiveness of the method.
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Tazegul, Tutku, Donald D. Anderson, Nacime SB Mansur, et al. "Developing Objective Computational Methods for Quantifying Ankle Osteoarthritis using Low-Dose Weight Bearing CT." Foot & Ankle Orthopaedics 7, no. 4 (2022): 2473011421S0096. http://dx.doi.org/10.1177/2473011421s00969.
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Category: Ankle Arthritis; Ankle; Other Introduction/Purpose: Decision regarding ankle osteoarthritis (OA) management varies depending on the severity and distribution of the associated joint degeneration. Disease staging is typically based on subjective grading of appearance on conventional plain radiographs, with reported sub-par reproducibility and reliability. Weight-bearing computed tomography (WBCT) offers clinical advantages in the setting of OA, where thinning of the ankle cartilage, softening of the cartilage, and other deformities become more apparent under load. WBCT also provides a better geometric representation of the ankle and allows for more accurate measurements when compared to a conventional radiograph. The purpose of this study was to develop and describe computational methods to objectively quantify radiographic changes associated with ankle OA apparent on low-dose WBCT images. Methods: We analyzed two patients with ankle OA and one healthy control that had all undergone WBCT of the foot and ankle. The severity of OA in the ankle of each patient was scored using the Kellgren-Lawrence (KL) classification by plain weight-bearing radiographs. For each ankle, the subsequent analysis focused on a volume of interest (VOI) centered on the tibiotalar joint. Within the VOI, the initial computational analysis focused on measuring the 3D joint space width (JSW). Subsequent analyses utilized WBCT image intensity (Hounsfield Unit, or HU) profiles along lines perpendicular to the subchondral bone/cartilage interface of the distal tibia extending across the entire VOI. The HU intensity profiles were recorded, and graphical plots of the HU distributions were generated for each line. These plots were then used to calculate the HU contrast, a novel measure of the regional variation in bone density. Results: The average JSW was 3.89 mm for the healthy control ankle, 2.69 mm for the mildly arthritic ankle (KL 2), and 1.57 mm for the severely arthritic ankle (KL 4). The average HU contrast was 72.31 for the healthy control ankle, 62.69 for the mildly arthritic ankle, and 33.98 for the severely arthritic ankle. The use of four projections at different locations throughout the joint allowed us to visualize specifically which quadrants have reduced joint space width and contrast. One projection in the severely arthritic ankle had JSW and contrast values of 0 due to complete joint space loss along with projection 4, which corresponds in this case to the posterolateral part of the joint (Figure). Conclusion: We presented a novel computational assessment of ankle osteoarthritis using low-dose WBCT imaging. We were able to demonstrate differences between normal ankles and ankles with mild and severe OA using JSW and HU contrast measurements. This methodology represents an important step towards a more reliable OA assessment when compared to the current standard qualitative evaluations, potentially serving as a starting point for the development of a more robust osteoarthritis staging system. Additional studies are needed to assess the algorithm more rigorously over a variety of radiographic presentations.
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Ryzhikov, Dmitry V., and Sergei V. Vissarionov. "Prevention of ankle joint deformities in children on the side of fibular graft intake for microsurgical transposition." Pediatric Traumatology, Orthopaedics and Reconstructive Surgery 11, no. 4 (2023): 501–6. http://dx.doi.org/10.17816/ptors562772.
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BACKGROUND: Reconstructive operations of the musculoskeletal system in children may require the removal of a massive autograft for microsurgical bone grafting. The traditional donor site is the diaphyseal part of the fibula. In the late postoperative period, these patients may develop complications such as a valgus deformity of the ankle joint on the side of the donor fibular defect.
 AIM: To analyze the effectiveness of surgical methods for the prevention of hallux valgus of the ankle joint after free transplantation of a fragment of the fibula to replace limb-bone defects in children.
 MATERIALS AND METHODS: The treatment results of 11 patients aged 11–16 years (6 girls and 5 boys), in whom an autograft from the fibular diaphysis was used to replace defects in long tubular bones were analyzed. Two patients had a femoral defect as a result of previously transferred hematogenous osteomyelitis. A congenital false joint of the femur was found in 2 patients, bones of the lower leg in 6, and the ulna in 1. The distal fragment of the resected fibula was stabilized by an autograft from the iliac bone, in eight and three cases at the level of the diaphysis and metaphysis of the specified fragment, respectively. The size of the resected fragment in % of the total length of the fibula and the level of distal osteotomy were considered. The presence and magnitude of the proximal displacement of the fragment and the position of the ankle joint gap were evaluated at least 5 years after surgery.
 RESULTS: In this study, ≥5 years after the intervention, proximal displacement of the distal fragment of the fibula was absent in only one patient. In the remaining 10, the displacement value did not exceed 3.5 mm. Valgus deformity in the ankle joint of 5° from the initial position developed in two patients. Its progression was prevented by temporary hemiepiphysis of the distal epiphysis of the tibia using a 4.0-mm diameter spongiose screw, whereas in up to 16 months, the valgus deformity progression stopped and decreased to initial values.
 CONCLUSIONS: Fibular resection in the optimal variant should preserve the distal part of the bone as much as possible, and the stability of the ankle joint increases with synostosis of the shin bones in the distal diaphyseal section without bringing the bones closer together. When a clinically significant valgus deformity appears (5° from the initial position) with the preservation of the function of the distal growth zone of the tibia, the use of temporary transphyseal hemiepiphysiodesis of the tibia for correction is optimal.
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Šponer, Pavel, Tomáš Kučera, Jindra Brtková, and Jaromír Šrot. "THE MANAGEMENT OF CHARCOT MIDFOOT DEFORMITIES IN DIABETIC PATIENTS." Acta Medica (Hradec Kralove, Czech Republic) 56, no. 1 (2013): 3–8. http://dx.doi.org/10.14712/18059694.2014.30.
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Charcot foot neuropathic osteoarthropathy is a disorder affecting the soft tissues, joints, and bones of the foot and ankle. The disease is triggered in a susceptible individual through a process of uncontrolled inflammation leading to osteolysis, progressive fractures and articular malpositioning due to joint subluxations and dislocations. The progression of the chronic deformity with a collapsed plantar arch leads to plantar ulcerations because of increased pressure on the plantar osseous prominences and decreased plantar sensation. Subsequent deep soft tissue infection and osteomyelitis may result in amputation. The Charcot foot in diabetes represents an important diagnostic and therapeutic challenge in clinical practice. Conservative treatment remains the standard of the care for most patients with neuropathic disorder. Offloading the foot and immobilization based on individual merit are essential and are the most important recommendations in the active acute stage of the Charcot foot. Surgical realignment with stabilization is recommended in severe progressive neuropathic deformities consisting of a collapsed plantar arch with a rocker-bottom foot deformity.
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Kauts, О. А., Yu A. Barabash, S. I. Kireev, et al. "Surgical approach to the treatment of patients with sequelae of intra-articular fractures of the distal tibia (literature review)." Genij Ortopedii 28, no. 1 (2022): 133–40. http://dx.doi.org/10.18019/1028-4427-2022-28-1-133-140.
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Background Management of patients with sequelae of intra-articular fractures of the distal tibia continues to be a substantial clinical challenge in orthopaedic trauma due to the high incidence, poor outcomes and high disability rate. The objective was to review Russian and international experience in repair of intra-articular ankle fractures and explore contemporary trends in treatment strategies. Material and methods The literature search was produced using medical electronic databases of eLibrary, PubMed, Medline, SpringerLink between 2000 and 2020 and keywords: cruzarthrosis, arthrodesis, total ankle arthroplasty, arthroscopy, distal tibia, ankle joint, joint replacement, intra-articular fractures of distal tibial. Results The article presents an insight into the problem of malunited and nonunited ankle fractures, ankle contractures and deformities, post-traumatic ankle arthritis. Major surgical techniques used to address sequelae of ankle fractures include correcting osteotomy, arthroscopy, distraction arthroplasty, arthrodesis, total ankle arthroplasty with the advantages and disadvantages with each of the practices. Discussion The surgical option would depend on the time of injury, condition of soft and bone tissue, malalignment and severity of ankle arthritis. Joint saving procedures of correcting osteotomy, arthroscopy or distraction arthroplasty can be applied at early stages of the disease, and arthrodesis or total ankle arthroplasty are secured for terminal stages of ankle arthritis. Benefits of total ankle arthroplasty include preservation and improvement of ankle mobility, a short inpatient period. Ankle fusion is associated with less complication rate and low costs. Conclusion There is an obvious need for a uniform treatment algorithm with specific indications and contraindications to each surgical option.
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Krause, Fabian, Ivan Zderic, Boyko Gueorguiev, and Timo Schmid. "The Effect of Subtalar Motion on Calcaneal Osteotomies." Foot & Ankle Orthopaedics 4, no. 4 (2019): 2473011419S0025. http://dx.doi.org/10.1177/2473011419s00258.
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Category: Ankle Arthritis, Hindfoot Introduction/Purpose: Background There is evidence that the subtalar joint may compensate for supramalleolar deformities and thereby slower or halt progression of ankle arthritis. The mobile subtalar joint may also compensate for the effect of realigning osteotomies of the calcaneus and the tibia. The compensation is limited by the joint orientation and limited ROM (arthritic joint, tarsal coalitions, previous fusion). Objectives: The hypotheses are: - the curvature of posterior facet influences subtalar ROM - subtalar ROM influences subtalar compensatory capacity - there is compensation of realigning osteotomies through a mobile subtalar joint, resulting in a less effective correction of weightbearing axis - the osteotomy of the calcaneus (COT) is more affected by the compensation than the supramalleolar tibia osteotomy (SMOT) Methods: 11 fresh-frozen human lower leg cadaver were mounted into a carbon frame. High resolution ankle TekScan sensors were fixed in the ankle joint via anterior arthrotomy. 300 N load were applied according to half body weight and Achilles tendon pull was simulated. The center of force (COF) migration, max. pressure (Pmax), and the area loaded were measured in the ankle with 10 mm varus / valgus sliding calcaneus osteotomy and 10° varus / valgus SMOT. A CT evaluation of subtalar anatomy (curvature of posterior facet) was conducted and the correlation of posterior facet curvature and subtalar motion and the correlation of subtalar motion and SMOT/COT effect calculated. Results: The COF migration was significant for valgus COT and for both SMOT versus the initial position, while the varus SMOT versus the varus COT. Pmax and area loaded changed but not significantly. There was a significant correlation of posterior facet curvature and subtalar motion (r = 0.87), a moderate inverse correlation of subtalar motion and COT effect (r = -0.52), and a poor inverse correlation of subtalar motion and SMOT effect (r = -0.27). In contrast, in a previous study with a stiff cavovarus model significant COF migration and peak pressure changes were found in the ankle joint for all lateral closing SMOT and valgus COT. Conclusion: The compensatory capacity of mobile subtalar joint limits effect of COT more than SMOT, likely because the subtalar joint is closer to COT than to SMOT. Biomechanically, the COT is therefore less effective in influencing ankle joint pressure than SMOT. The effect of the COT is more reliable in stiff subtalar joints. The curvature of posterior facet correlates with subtalar ROM.
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Pratobevera, Andrea, Romain Seil, and Jacques Menetrey. "Joint line and knee osteotomy." EFORT Open Reviews 9, no. 5 (2024): 375–86. http://dx.doi.org/10.1530/eor-24-0037.
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This review explores the intricate relationship between knee osteotomy and frontal plane joint line orientation, emphasizing the dynamic nature of the joint line’s influence on knee forces and kinematics. Consideration of coronal alignments, knee phenotypes, and associated angles (medial proximal tibial angle (MTPA), lateral distal femoral angle (LDFA), joint line convergence angle (JLCA)) becomes crucial in surgical planning to avoid joint line deformities. The double-level osteotomy is to be considered a valid option, especially for severe deformities; however, the target patient cannot be selected solely based on high predicted postoperative joint line obliquity (JLO) and MPTA.
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Burssens, Arne, Kristian Buedts, Alexej Barg, et al. "The Association Between a Hindfoot Deformity Assessed by Weightbearing CT and the Full Leg Alignment." Foot & Ankle Orthopaedics 4, no. 4 (2019): 2473011419S0001. http://dx.doi.org/10.1177/2473011419s00014.
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Category: Hindfoot Introduction/Purpose: The exact relationship between different types of hindfoot deformities and the full leg alignment is currently unclear. Therefore, our aim is to assess hindfoot alignment on a weight-bearing CT (WBCT) and its association with the full leg radiographic alignment. Methods: A retrospective analysis was performed on a study population of 109 patients (mean age of 53 years ± 14.49) with a varus or valgus hindfoot deformity and the presence or absence of ankle osteoarthritis (OA) based on the Takakura classification. The mechanical hindfoot - (mHA) and subtalar vertical angle (SVA) were determined on WBCT, while the mechanical tiba – (mTA) and mechanical tibiofemoral angle (mTFA) were measured on full leg radiographs. Results: In patients with ankle OA, a hindfoot valgus deformity was associated with a significantly higher mean varus alignment of the knee (mTFA = -1.8°±2.1; mTAx= -4.3°±1.9) compared to a valgus alignment of the knee (mTFA = 0.3°±2.6; mTAx= -1.4°±2.2; P <0.001) in patients with a varus hindfoot (Fig1A, B). The opposite relation was found in patients without ankle OA (P <0.001). The SVA was significantly more orientated in valgus (mean=106.9°±8.0) for patients with a hindfoot valgus compared to a higher varus orientation (mean=89.3°±13.9) in patients with a hindfoot varus deformity (P <0.001). The same pattern was found in patients without ankle OA, but not significant (P >0.05). Conclusion: A valgus hindfoot deformity demonstrated a higher varus alignment of the knee when compared to patients with a hindfoot varus deformity, if ankle OA was present. The subtalar joint did not attain an overall compensatory correction towards the hindfoot deformity as opposed to a compensatory orientation of the tibia alignment. In clinical practice, these findings could improve the current understanding of both joint preserving as well as joint replacing procedures of the hindfoot and the knee.
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Ibragimova, Iroda Vakhidovna. "DIAGNOSTIC SIGNIFICANCE OF RADIOLOGICAL SIGNS OF TARSALIC COALITIONS." Multidisciplinary Journal of Science and Technology 5, no. 1 (2025): 71–74. https://doi.org/10.5281/zenodo.14640919.
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Tarsal coalition is an abnormal fusion of two or more tarsal bones, which can lead to foot deformities, pain syndrome, and damage to the ligaments of the ankle joint. Radiological diagnostics of tarsal coalitions is difficult, since most radiological signs only indirectly indicate its presence. The aim of the study is to determine the diagnostic significance of indirect radiological signs of tarsal coalitions in children.
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Bhaskar, Atul. "Lever Arm Disorders of the Feet in Cerebral Palsy." International Journal of Paediatric Orthopaedics 10, no. 1 (2024): 26–33. https://doi.org/10.13107/ijpo.2024.v10i01.175.
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The key for optimum management for progressive musculoskeletal deformities in cerebral palsy patients is understanding the causative mechanisms. The impact of muscle shortening and contracture on the long bones and joints leads to lever arm problems in the foot and ankle and the associated deformities. Management of each deformity is considered separately although many of these can occur concurrently and the severity my vary in an individual. Keywords: Lever, Cerebral palsy, Foot & Ankle
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Wu, Kitty Y., Paula A. Pino, Daniel B. Ryssman, and Peter C. Rhee. "Combined Surgical Technique of Hyperselective and Partial Motor Neurectomies for Spastic Equinus, Equinovarus, and Claw Toe Deformities." Plastic and Reconstructive Surgery - Global Open 12, no. 11 (2024): e6207. http://dx.doi.org/10.1097/gox.0000000000006207.
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Background: Patients with spastic equinus, equinovarus, and claw toe deformities can experience marked pain and functional limitations in the ability to weight-bear comfortably, ambulate efficiently, or mobilize independently. Seen in 80% of patients with cerebral palsy and 18% of patients with stroke (1, 2), the spastic foot and ankle deformities, and its secondary sequelae of static joint contractures, osseous changes, and chronic pain, are unfortunately common. Methods: Adult and pediatric patients undergoing combined hyperselective and selective partial motor neurectomies for varus or claw toe deformities were reviewed. Patient demographics and complications were recorded. Pre- and postoperative Modified Ashworth Scale scores were compared. Results: Twenty-three patients (16 adults and seven pediatric) met inclusion criteria and were included in analysis. At early 6-month follow-up, the mean preoperative Modified Ashworth Score of 2.8 in adult patients and 3.0 in pediatric patients decreased to 0.6 postoperatively. Complications in three adult patients included one patient with temporary dysesthesias to the plantar foot, one with a popliteal abscess requiring incision and drainage, and one superficial wound dehiscence that was managed conservatively. Conclusions: A combined technique of hyperselective and partial motor neurectomies are effective in decreasing tone in the correction of spastic foot and ankle deformities in both adult and pediatric patients in short-term 6-month follow-up.