共查询到20条相似文献，搜索用时 15 毫秒
1.
Narelle Wyndow Natalie J. Collins Bill Vicenzino Kylie Tucker Kay M. Crossley 《Journal of foot and ankle research》2018,11(1):65
Study design
Controlled laboratory study; cross-sectional design.Background
Foot and ankle characteristics and dynamic knee valgus differ in people with and without patellofemoral (PF) pain. However, it is unknown if these characteristics are evident in people with PF osteoarthritis (OA), compared to pain-free older adults.Objectives
To compare foot and ankle mobility, foot posture and dynamic knee valgus, measured as the frontal plane projection angle (FPPA) during single-leg squatting, between individuals with and without PFOA.Methods
Fifty-one participants with PFOA (66% women, mean?±?SD age 57?±?10?years, body mass index (BMI) 27?±?6?kg/m2), and 23 controls (56% women, age 56?±?9?years, BMI 24?±?4?kg/m2) had ankle dorsiflexion measured using the knee-to-wall test, foot mobility calculated as the difference in midfoot height or width between non-weightbearing and weightbearing, and static foot posture characterized utilizing the Foot Posture Index. Peak FPPA was determined from video recordings while participants performed 5 single-leg squats. Linear regressions examined between-groups relationships for foot and ankle characteristics and the FPPA.Results
The PFOA group had less ankle dorsiflexion (odds ratio 6.7, 95% confidence interval 2.46–18.2), greater midfoot height mobility (5.2, 1.78–15.14) and width mobility (4.3, 1.33–14.39), and greater foot mobility magnitude (8.4, 2.32–30.69) than controls. There was no difference in FPPA (knee valgus angle) between groups (15, 0.63–377.99).Conclusion
Foot and ankle characteristics were different in individuals with PFOA compared to control participants, however there was no difference in dynamic knee valgus during single leg squat. Clinical interventions to address greater foot mobility may be relevant for PFOA.2.
Queen RM Carter JE Adams SB Easley ME DeOrio JK Nunley JA 《Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society》2011,19(11):1338-1342
Objective
Unilateral ankle osteoarthritis (OA) is a debilitating condition which may lead to limb deformity, severe pain, and functional disability due to tibiotalar malalignment and gait dysfunction. The purpose of this study was to determine if coronal plane alignment (varus, valgus, or neutral) of the ankle resulted in different spatial-temporal gait mechanics, clinically-assessed function, and self-reported function in patients with end-stage ankle OA.Methods
Following informed consent, 96 patients with end-stage unilateral ankle OA were radiographically categorized as having varus, valgus, or neutral tibiotalar alignment. Each subject completed the foot and ankle disability index (FADI) questionnaire to assess self-reported function. The spatial-temporal parameters of interest (stance time, step length, stride length, stride width, single-support time, double support time, and walking speed) were assessed while the subject walked at a self-selected speed.Results
The varus group performed the timed up and go test significantly faster than the other groups (P = 0.05). All other variables were similar between the three alignment groups.Conclusion
There was little difference in gait mechanics and function between patients with end-stage OA based on coronal plane ankle alignment suggesting that factors other than coronal plane alignment contribute to diminished function. 相似文献3.
4.
Background
: Hallux valgus is a common chronic condition affecting up to a third of the population.Progressive disruption to the complex anatomy of the first ray involving metatarsal, sesamoids and hallux impose both structural and functional alteration to the foot which underpin the secondary pathologies associated with this condition. It is common for patients to seek correction of the deformity in order to alleviate pain and improve footwear tolerance. Surgical intervention remains the only viable means to restore osseous alignments. To date there remains no universally accepted standards for procedure selection.Methods
: A total of 179 consecutive participants were recruited into the study. Ethical approval was obtained and all participants consented to participate in the study, in accordance with the Helsinki Declaration. All patients attending the Department of Podiatric Surgery, between July 2004 and October 2007 for the surgical management of hallux valgus were invited to complete a Foot Health Status Questionnaire.Pre-operative data collection on all participants was undertaken on the day of admission, using the validated Foot Health Status Questionnaire measurement tool as with previous studies.Results
: A total of 179 complete data sets were recorded in this longitudinal study with an average participant age of 49.4 years (SD 14.5). The group comprised 164 females and 15 males. The mean days for administration of the Foot Health Status Questionnaire post operative follow up was 1045 days (149 weeks or 2.9 years).The results demonstrated that within all four foot specific domains, the minimal important differences were achieved by the majority of the group. Meanwhile, in domains relating to general health, physical activity, vigour and social capacity, the majority of participants failed to attain the calculated minimal important difference (94 [53%], 96 [54%], 93 [52%], 93 [52%], respectively).Conclusions
: The authors have presented for the first time minimal important difference for all eight domains for the Foot Health Status Questionnaire quality of life tool in respect to hallux valgus surgery. Results demonstrate that surgical correction of hallux valgus undertaken under local anaesthetic as a Day Case procedure is an effective intervention directly benefiting patients by reducing perceived foot pain, improving foot function and general foot health for the majority of patients. 相似文献5.
Purpose
The purpose of this study was to compare the results of hallux valgus surgery between feet fixed with Kirschner wires and those fixed with a plate and screws.Methods
Between December 2008 and November 2009, 53 patients (62 feet) were treated with proximal chevron osteotomy and distal soft tissue procedure for symptomatic moderate to severe hallux valgus deformity. Thirty-four patients (41 feet) were stabilised with Kirschner wires (K-wire group) and 19 patients (21 feet) were stabilised with a locking plate (plate group). Clinical results were assessed using American Orthopaedic Foot and Ankle Society (AOFAS) score. Radiographic parameters were compared between these groups. Recurrence rate at the last follow-up was compared between the K-wire and plate groups.Results
Mean AOFAS score was lower in the plate group, however, the difference between the groups was not statistically significant in AOFAS score at the last follow-up. Hallux valgus angle and intermetatarsal angle were significantly larger in the plate group at the last follow-up. Mean 1–2 metatarsal (MT) distance on immediately postoperative radiographs was significant larger in the plate group. Four (9.8 %) of the 41 feet in the K-wire group and 7 (33.3 %) of the 21 feet in the plate group showed hallux valgus recurrence at the last follow-up. The plate group had a significantly higher risk of recurrence than the K-wire group.Conclusions
Fixation of proximal chevron osteotomy using a plate and screws has a greater risk of hallux valgus recurrence than fixation using Kirschner wires. 相似文献6.
Dr. H. Waizy C. Stukenborg-Colsman M. Abbara-Czardybon J. Emmerich H. Windhagen D. Frank 《Operative Orthopadie und Traumatologie》2011,23(1):46-51
Objective
Maintaining the corrected position of the first metatasophalangeal axis. Reducing postoperative stiffness by forgoing a medial capsular shift.Indications
Hallux valgus deformities or recurrent hallux valgus deformities.Contraindications
Existing osteoarthritis, joint stiffness, large bone defects, osteonecrosis. General medical contraindications to surgical interventions and anesthesiological procedures.Surgical technique
Operation under regional anesthesia (foot block) or general anesthesia. Tourniquet. Longitudinal skin incision medial over the pseudexostosis of the first metatarsal bone. Preparing the tendon of the Musculus abductor hallucis. Detaching the tendon from the capsule. Incision of the joint capsule with protection of the extensor hallucis longus tendon and the dorsal neurovascular bundle in an L-wise manner. Osteotomy of the first metatarsal bone. Lax sutures of the capsule in correct position and reattachment of the Musculus abductor hallucis tendon shifted toward distal and dorsal, regarding the rotation of the hallux.Postoperative management
Postoperative elevation of the operated foot. Analgesia with nonsteroidal antiinflammatory drugs. Postoperative weight-bearing according to the osteotomy. Passive mobilization of the metatarsophalangeal joint. Dressing for 4?weeks postoperatively in the corrected position. Radiologic control after 6?weeks. Hallux valgus orthosis at night and a toe spreader for a further 6?weeks.Results
A total of 30 isolated hallux valgus deformities with a mean preoperative intermetatarsal (IMA) angle of 12.9°?(range 11?C15°) were operated with a chevron osteotomy. The mean follow-up was 14.4 (range 8?C17)?months. The mean dorsiflexion at the last follow-up was 44° (range 20?C60°). Only 2?patients had a dorsiflexion <40°. The mean reduction of the IM angle was 5.6° (range 3?C7°). One patient required wound revision. There was no infection or avascular necrosis of the metatarsal head observed in the patients. At follow-up, 20?(67%) patients were completely satisfied, 9?(30%) satisfied, and 1?(3%) was not satisfied. 相似文献7.
Athanasios Badekas Dimitrios Georgiannos Vasilios Lampridis Ilias Bisbinas 《International orthopaedics》2013,37(9):1765-1770
Purpose
Hallux valgus is a complex deformity of the first metatarsophalangeal joint, with varus angulation of the first metatarsal, valgus deviation of the great toe and lateral displacement of the sesamoids and the extensor tendons. The aim of the surgery is to achieve correction of the varus deviation of the 1st metatarsal which is considered by some as the primary intrinsic predisposing factor to hallux valgus deformity.Methods
We retrospectively reviewed 85 patients (107 feet) who underwent an opening wedge osteotomy of the 1st metatarsal for correction of moderate to severe hallux valgus and metatarsus primus varus. A medially applied anatomic pre-contoured locking plate was used for fixation of the osteotomy.Results
The mean IMA was decreased from 15.8 (range 12–22) degrees to 7.8 (range 0–12) degrees. The mean pre-operative HVA was 39 (range 21–52) degrees and the mean postoperative HVA was 11.8 (6–19) degrees. The pre-operative AOFAS score was 52 (SD 3.1) and the postoperative score was 85 (SD 5.2).Conclusion
The proximal opening wedge metatarsal osteotomy is a safe, effective and reproducible technique for correction of moderate to severe hallux valgus deformity. The use of a locking plate provides enough control at the fragments, enhancing healing of osteotomy and maintenance of the correction even with a violated proximal lateral cortex. 相似文献8.
Kiriakos Daniilidis N. Martinelli G. Gosheger S. Hoell M. Henrichs B. Vogt J. Hardes V. Vieth 《Archives of orthopaedic and trauma surgery》2012,132(12):1707-1710
Introduction
Percutaneous radiofrequency ablation (RFA) has been considered, in recent years, the standard treatment for osteoid osteoma (OO) of the appendicular skeleton. The variable clinical presentations in the foot and ankle pose problems in diagnosis, localization and thus treatment. The aim of this study was to assess the efficacy of RFA for patients with osteoid osteoma of the foot and ankle.Materials and methods
A total of 29 patients (22 males, 7 females; mean age 16.7?years; range 8?C44?years) with OO of the foot and ankle (distal tibia, n?=?17; distal fibula, n?=?6; talus, n?=?3; calcaneus, n?=?3) were enrolled in the study. A CT-guided RFA was performed, using a cool-tip electrode without the cooling system, heating the lesion up to 90?°C for 4?C5?min. Clinical success, assessed at a minimum follow-up of 1?year, was defined as complete or partial pain relief after RFA. Pain and clinical outcomes were scored pre-operatively and at the follow-up with a visual analogue scale (VAS) and with the American Orthopaedic Foot and Ankle Society (AOFAS) score. Complications and local recurrences were also recorded.Results
Clinical success was achieved in 26 patients (89.6?%). After RFA, mean VAS and AOFAS score significantly improved from 8?±?1 to 2?±?1 (p?<?0.05) and from 60.7?±?12.7 to 89.6?±?7.1 (p?<?0.05), respectively. Two patients experienced partial relief of pain and underwent a second successful ablation. Local recurrences were found in three patients, always associated with pain. These underwent conventional excision through open surgery. No early or late complications were detected after RFA.Conclusion
CT-guided RFA of foot and ankle osteoid osteoma is a safe and effective procedure, showing similar results for the rest of the appendicular skeleton. 相似文献9.
10.
Dr. S. Lieske K. Schenk H.W. Neumann M. John 《Operative Orthopadie und Traumatologie》2014,26(4):401-413
Aim of surgery
Operative treatment of advanced primary and secondary arthritis of the ankle was carried out with the aim of achieving pain-free movement and retention of mobility.Indications
Surgery is indicated when conservative therapy is no longer sufficient for treatment of arthritis of the ankle with painful limited movement, sufficient bony joint conditions and correctable instability or axis malpositioning.Contraindications
Surgery is not recommended with general surgical or anesthesiological contraindications, rampant infections, severe disturbances of peripheral perfusion, bony defects in areas relevant for anchoring, unstable soft tissue conditions, talus necrosis >30?%, manifest osteoporosis and severe non-correctable instability or malpositioning.Operation technique
Tibial and talar bone resection was carried out via ventral access to the ankle through an incision and if present, soft tissue correction of instability after insertion of test components. Cement-free implantation of the original implants followed by subtle reconstruction of the extensor retinaculum and layer for layer closure of the wound.Additional interventions
Additional measures were necessary on the periarticular soft tissues, the hindfoot and lower leg due to movement restrictions, instability and axis malpositioning which could be carried out in a one or two stage procedure depending on the extent and morphology.Results
Between February 2009 and February 2010 a total of 115 patients (52?% with posttraumatic arthritis) received a cement-free implantation with a Salto 2 prosthesis. Additional corrective interventions were carried out in the presence of varus and valgus deformities. The degree of movement for dorsal extension and plantar flexion could be increased by an average of 8.3°. The interventions resulted in a significant reduction in pain from an average preoperative visual analogue pain scale (VAS) score of 7.8 (range 5–10) to an average postoperative score of 1.9 (range 0–6.1). 相似文献11.
Background and purpose
A questionnaire was introduced by the New Zealand Arthroplasty Registry for use when evaluating the outcome of total ankle replacement surgery. We evaluated the reliability, validity, and responsiveness of the modified Swedish version of the questionnaire (SEFAS) in patients with osteoarthritis or inflammatory arthritis before and/or after their ankle was replaced or fused.Patients and methods
The questionnaire was translated into Swedish and cross-culturally adapted according to a standardized procedure. It was sent to 135 patients with ankle arthritis who were scheduled for or had undergone surgery, together with the foot and ankle outcome score (FAOS), the short form 36 (SF-36) score, and the EuroQol (EQ-5D) score. Construct validity was evaluated with Spearman’s correlation coefficient when comparing SEFAS with FAOS, SF-36, and EQ-5D, content validity by calculating floor and ceiling effects, test-retest reliability with intraclass correlation coefficient (ICC), internal consistency with Cronbach’s alpha (n = 62), agreement by Bland-Altman plot, and responsiveness by effect size and standardized response mean (n = 37).Results
For construct validity, we correlated SEFAS with the other scores and 70% or more of our predefined hypotheses concerning correlations could be confirmed. There were no floor or ceiling effects. ICC was 0.92 (CI 95%: 0.88–0.95), Cronbach’s alpha 0.96, effect size was 1.44, and the standardized response mean was 1.00.Interpretation
SEFAS is a self-reported foot and ankle score with good validity, reliability and responsiveness, indicating that the score can be used to evaluate patients with osteoarthritis or inflammatory arthritis of the ankle and outcome of surgery.A self-administered ankle questionnaire based on the validated Oxford-12 questionnaire for total hip replacement has been constructed by the New Zealand National Joint Registry. The aim was to collect patient-based data after total ankle replacement (TAR) as an amendment to medically recorded joint-specific data and it proved to be useful, particularly in the prediction of failures (Hosman et al. 2007). However, the original version of the questionnaire has not been validated.Already existing self-administrated foot and ankle scores contain numerous questions and can be complicated to use. For osteoarthritis and inflammatory arthritis of the ankle, there are few validated instruments and they are seldom used (Budiman-Mak et al. 1991, Button and Pinney 2004, Naal et al. 2010). None can be regarded as the gold standard. The generic, self-administered questionnaires short form 36 (SF-36) (Sullivan et al. 1995, Patel et al. 2007) and EuroQol (EQ-5D) (EuroQol Group 1990) are useful when evaluating general health, but they may be less effective when evaluating joint-specific disability.Thus, there is a need for a simple, self-administered and ankle-specific score that is capable of evaluating pain and functional status in patients with osteoarthritis and inflammatory arthritis of the ankle, and the outcome of surgical interventions—not least when collecting data for national surgical registers. We therefore assessed the validity, the reliability, and the responsiveness of the modified Swedish version of the New Zealand total ankle replacement questionnaire, here called the self-reported foot and ankle score (SEFAS), in relation to 3 established self-administered scoring systems. The reason for choosing the foot and ankle outcome score (FAOS) for comparison was that this region-specific score is the only one available in Swedish and the reason for choosing the generic scores SF-36 and EQ-5D was because they are widely used. 相似文献12.
Dr. M.N. Magin 《Operative Orthopadie und Traumatologie》2014,26(2):184-195
Objective
Correction of hallux valgus deformities without loss of toe length. Achievement of full weight-bearing.Indications
Hallux valgus with intermetatarsal angle of more than 20°. Hypermobility of the first metatarsal bone combined with instability. Recurrence of hallux valgus deformity. Hallux limitus combined with metatarsus primus elevatus. Painful arthrosis of the metatarsal-cuneiform-medial joint (TMT 1).Contraindications
Arterial occlusive disease. Infection of the foot. Nicotine abuse. Strict verification of indication in patients with diabetes mellitus.Surgical technique
Lateral release of the proximal phalanx joint of the hallux with tenotomy of the adductor hallucis tendon. Resection of the medial pseudoexostosis. Cartilage removal at the joint basis of the metatarsus 1 and the joint basis of the medial cuneiform bone to prepare for the corrective arthrodesis. Proximal osteotomy of the metatarsus 1. Lateralization and, if required, derotation of the distal metatarsus 1 segments using a special L-type chisel to prepare the intramedullary bed for the plate, going right into the medial cuneiform. Insertion of the IVP plate and fixation using stable screws in the correct angle. Medial capsuloraphy.Postoperative management
Early functional rehabilitation with increasing weight-bearing using a special shoe for 6–8 weeks. Full weight-bearing usually after 2 weeks. Physical therapy, lymphatic drainage, cryotherapy. Leg elevation.Results
In all, 21 consecutive patients, 19 women, 2 men, between 41 and 75 years of age (mean age 62.3 years) were included. Mean follow-up was 21 months (12–27 months). Preoperative hallux valgus angle (48°; range 40–63°) improved to 15° (range 6–28°). The intermetatarsal angle averaged 18° (range 12–27°) preoperatively and 8° (range 7–10°) postoperatively. The Kitaoka score improved from 47 points (37–49 points) preoperatively to 81 points (77–86 points) postoperatively. Complications included loosening of screws in 4 cases. All were treated by partial hardware removal under local anesthesia without further sequelae. In 5 cases, prolonged wound secretion (up to 5 weeks) healed without infection. 相似文献13.
Objective
Realignment and stabilization of the hindfoot by subtalar joint arthrodesis.Indications
Idiopathic/posttraumatic arthritis, inflammatory arthritis of the subtalar joint with/without hindfoot malalignment. Optional flatfoot/cavovarus foot reconstruction.Contraindications
Inflammation, vascular disturbances, nicotine abuse.Surgical technique
Approach dependent on assessment. Lateral approach: Supine position. Incision above the sinus tarsi. Exposure of subtalar joint. Removal of cartilage and breakage of the subchondral sclerosis. In valgus malalignment, interposition of corticocancellous bone segment; in varus malalignment resection of bone segment from the calcaneus. Reposition and temporarily stabilization with Kirschner wires. Imaging of hindfoot alignment. Stabilization with cannulated screws. Posterolateral approach: Prone position. Incision parallel to the lateral Achilles tendon border. Removal of cartilage and breakage of subchondral sclerosis. Medial approach: Supine position. Incision just above and parallel to the posterior tibial tendon. Removal of cartilage and breakage of subchondral sclerosis. Stabilization with screws.Postoperative management
Lower leg walker with partial weightbearing. Active exercises of the ankle. After a 6?week X?ray, increase of weightbearing. Full weightbearing not before 8 weeks; with interpositioning bone grafts not before 10–12 weeks. Stable walking shoes. Active mobilization of the ankle.Results
Of 43 isolated subtalar arthrodesis procedures, 5 wound healing disorders and no infections developed. Significantly improved AOFAS hindfood score. Well-aligned heel observed in 34 patients; 5 varus and 2 valgus malalignments. Sensory disturbances in 8 patients; minor ankle flexion limitations. Full bone healing in 36 subtalar joints, pseudarthrosis in 4 patients.14.
Maria C C?ster Ann Bremander Bj?rn E Rosengren H?kan Magnusson ?ke Carlsson Magnus K Karlsson 《Acta orthopaedica》2014,85(2):187-194
Background and purpose
The self-reported foot and ankle score (SEFAS) is a questionnaire designed to evaluate disorders of the foot and ankle, but it is only validated for arthritis in the ankle. We validated SEFAS in patients with forefoot, midfoot, hindfoot, and ankle disorders.Patients and methods
118 patients with forefoot disorders and 106 patients with hindfoot or ankle disorders completed the SEFAS, the foot and ankle outcome score (FAOS), SF-36, and EQ-5D before surgery. We evaluated construct validity for SEFAS versus FAOS, SF-36, and EQ-5D; floor and ceiling effects; test-retest reliability (ICC); internal consistency; and agreement. Responsiveness was evaluated by effect size (ES) and standardized response mean (SRM) 6 months after surgery. The analyses were done separately in patients with forefoot disorders and hindfoot/ankle disorders.Results
Comparing SEFAS to the other scores, convergent validity (when correlating foot-specific questions) and divergent validity (when correlating foot-specific and general questions) were confirmed. SEFAS had no floor and ceiling effects. In patients with forefoot disorders, ICC was 0.92 (CI: 0.85–0.96), Cronbach''s α was 0.84, ES was 1.29, and SRM was 1.27. In patients with hindfoot or ankle disorders, ICC was 0.93 (CI: 0.88-0.96), Cronbach''s α was 0.86, ES was 1.05, and SRM was 0.99.Interpretation
SEFAS has acceptable validity, reliability, and responsiveness in patients with various forefoot, hindfoot, and ankle disorders. SEFAS is therefore an appropriate patient- reported outcome measure (PROM) for these patients, even in national registries.In Sweden (with 9 million inhabitants), more than 20,000 elective foot and ankle surgical procedures were done annually during the period 2007–2009. There is a need for structured evaluation of disability before and after surgery. Subjective aspects of patients’ symptoms should be one part of this evaluation, preferably captured by patient-reported outcome measures (PROMs). Apart from being valid and reliable, such a measure must also be simple, patient-friendly, and usable in all types of foot and ankle disorders (Suk 2009). There are several PROMs, either generic or foot- and ankle-specific questionnaires, but there is no gold standard. The generic questionnaires short form 36 (SF-36) (Sullivan et al.1995, Patel et al. 2007) and EuroQol (EQ-5D) (Euroqol Group 1990) are useful for evaluation of general health, but they are of less value for region-specific disability. The foot and ankle outcome score (FAOS), a foot- and ankle-specific questionnaire (Roos et al. 2001), is only validated for ankle instability and a limited number of foot disorders, and is therefore not optimal for use in registries covering all kinds of disabilities of the foot and ankle. The FAOS contains 42 questions; this is too long. The American Orthopaedic Foot and Ankle Society score (AOFAS) (Kitaoka et al. 1994), another well-known and well-used region-specific score, includes a clinical examination and is therefore not a PROM. Based on the validated Oxford-12 questionnaire for total hip replacement (Dawson et al. 1996), the New Zealand National Joint Registry constructed a patient-reported ankle questionnaire (Hosman et al. 2007). This questionnaire has been culturally adapted and translated into Swedish, and then called the self-reported foot ankle score (SEFAS). In the first validation study, SEFAS was found to be a valuable PROM in patients with osteoarthritis (OA) or inflammatory arthritis in the ankle joint (Coster et al. 2012). But SEFAS must also be validated in patients with forefoot, midfoot, and hindfoot disorders—and also in patients with other diagnoses of the ankle joint—before it can be used in a national registry. We evaluated the psychometric properties of SEFAS in terms of reliability, validity, and responsiveness in patients with forefoot, midfoot, hindfoot, and ankle disorders. 相似文献15.
John C. Kelly Patrick J. Groarke Eoin Flanagan James Walsh Michael M. Stephens 《The Foot》2011,21(3):109-113
Background
Numerous studies have shown that deficiencies exist in orthopaedic and musculoskeletal medical training resulting in students and doctors regularly failing basic orthopaedic exams. However, there have not been any studies addressing the attitudes of medical students towards the orthopaedic subspecialties.Objectives
This study aimed (i) to determine if foot and ankle surgery was the orthopaedic specialty with which students and doctors have the most difficulty, (ii) to appraise attitudes towards teaching of foot and ankle surgery, and (iii) to suggest ways teaching might be improved.Methods
A questionnaire on orthopaedic teaching was given to 238 medical students in Ireland. Perceived difficulties with foot and ankle surgery were compared to seven other orthopaedic subspecialties and the results were analysed. Other aspects of teaching were assessed including why foot and ankle surgery is perceived as difficult and ways teaching could be improved.Results
Foot and ankle surgery is the orthopaedic subspecialty with which medical students and doctors have the most difficulty, least confidence and poorest knowledge in. This was due to: perceived complexity; insufficient exposure; and a lack of teaching.Conclusion
Foot and ankle surgery is the least popular of the orthopaedic subspecialties and considerable deficiencies exist in its education. 相似文献16.
Akinobu Nishimura Ko Kato Aki Fukuda Shigeto Nakazora Tomomi Yamada Atsumasa Uchida Akihiro Sudo 《Journal of orthopaedic science》2014,19(2):257-262
Background
To investigate the prevalence and severity of radiographically detected hallux valgus (HV) as well as associated risk factors among Japanese residents of Miyagawa, a mountain village located in the center of Mie Prefecture.Methods
The height, weight and body mass index (BMI) of 403 participants (male n = 135, female n = 268) recruited from among the residents of Miyagawa Village, Japan aged ≥65 years were measured, and baseline data, including age, sex and medical history were obtained from interviews and questionnaires. Knee osteoarthritis (KOA) was determined from radiographs of the feet and knees, and osteoporosis was determined by measuring bone mineral density. Hallux valgus, defined as angulation of the big toe at the first metatarsophalangeal joint of >20°, was classified as: mild (20°–30°), moderate (30°–40°) or severe (>40°). Risk factors for HV were calculated using multivariate logistic regression analysis that included age, sex, obesity (BMI ≥25), KOA, osteoporosis, Heberden’s nodes and low back pain as variables.Results
The overall prevalence of definite radiographic HV was 22.8 % (184/806), and mild, moderate and severe HV was found in 66.3, 27.2 and 6.5 % of the participants, respectively. Hallux valgus was found in at least one foot in 120 (29.8 %) of the participants and the prevalence significantly differed between females with and without HV and KOA (odds ratios: 2.54 and 1.71, respectively).Conclusions
The prevalence of definite radiographic HV was 29.8 %. Female sex and KOA were significantly associated with increased risk for radiographic HV. 相似文献17.
Background
Pedobarography offers dynamic information about the foot, but the interpretation of its large data is challenging. In a prior study it was shown that attention can be restricted to pedobarographic midfoot load data. We aim to verify this observation in ankle osteoarthritic and contralateral feet.Methods
We assessed both feet of 120 patients with end-stage ankle osteoarthritis (OA) and 35 healthy volunteers with AOFAS-score and dynamic pedobarography in barefoot condition. We introduce a new parameter, the Relative Midfoot Index (RMI), representing the depth of the midfoot weighted by the maximal force (MF) in the hindfoot and forefoot. Main outcome measures were the RMI, MF and contact times in the hindfoot, midfoot and forefoot. Ankle OA, contralateral and healthy feet were compared with ANOVA.Results
The RMI was significantly smaller in OA feet (0.65?±?0.19) and contralateral feet (0.69?±?0.15) than in healthy feet (0.84?±?0.08, p?<?0.0001). There was no significant difference between OA and contralateral feet. The RMI showed a correlation of 0.48 with the AOFAS score. Contralateral and OA feet were significantly different from healthy feet (p?<?0.001) in all parameters except the hindfoot MF. An RMI <0.8 showed a positive predictive value of 80% and sensitivity of 78% for being unhealthy.Conclusion
The RMI assists the interpretation of pedobarographic parameters and provides a user-friendly indicator for unhealthy foot conditions with a cut-off value of 0.8. The contralateral feet of ankle OA patients differed significantly from healthy feet and are therefore not suitable as control group.Level of Evidence: 3 case control study18.
Purpose
Despite some theoretical reservations, the AOFAS clinical rating system with its scales for ankle-hindfoot, midfoot, hallux and lesser toes is one of the most widely used assessment tools in foot and ankle surgery. This study was designed to generate age- and gender-related norm values for all four subscales.Methods
Despite not being used in a self-administered manner, the AOFAS score underwent cross cultural adaptation to guarantee unrestricted comparability of data. A data pool was generated using the results of personal interviews and clinical examination of 625 individuals, including staff and visitors to our hospital, and excluding people scheduled for foot surgery or in after-treatment. These data served as a basis to calculate all four parts of the AOFAS clinical rating system.Results
Mean value for the ankle-hindfoot scale was calculated as 91.6 points (±0.9 confidence interval), and 89.3 points for the midfoot scale (±1.0 CI), 88.3 for the hallux metatarsophalangeal-interphalangeal scale (± 0.9 CI) and 91.0 for the lesser metatarsophalangeal-interphalangeal scale (± 0.8 CI). Results showed a decrease with age in all four scales. Males showed better results than females. Individuals with previous surgery showed lower results in the respective score.Conclusions
While lowered scoring results prior to surgery reflect the degree of restrictions due to pain, function and alignment problems, post-operative increases in clinical scoring should indicate return to age-related norm values. Our data calculated these norm values for the first time for all four AOFAS scales, giving a basis for better interpretation of published results in foot and ankle surgery. Our data showed and quantified the decrease of norm values with age, especially for hallux and lesser toes scores, as well as lower norm values for females and for individuals that had had surgery of the foot.Level of Evidence: Level I, diagnostic study.19.
Background
The main purpose of this study was to investigate the presence of an association between intermetatarsal neuroma and foot type, as measured by the Foot Posture Index. The study also examined whether there was a relationship between foot type and the interspace affected with intermetatarsal neuroma, and whether ankle equinus or body mass index had an effect.Methods
In total, 100 participants were recruited from The University of Western Australia’s Podiatry Clinic, 68 of whom were diagnosed with inter-metatarsal neuroma from 2009 to 2015. There were 32 control participants recruited from 2014 to 2015. The age of subjects was recorded, as were weight and height, which were used to calculate body mass index. The foot posture index and ankle dorsiflexion were measured using standard technique. Independent t-tests and Kruskal-Wallis tests were used to compare differences in foot posture index, body mass index and ankle dorsiflexion between the inter-metatarsal neuroma and control groups. Multivariable logistic regression was also used to model relationships for outcome.Results
The 68 intermetatarsal neuroma subjects had a mean age of 52 years (range 20 to 74 years) and comprised of 56 females and 12 males. The 32 control subjects had a mean age of 49 years (range 24 to 67 years) with 26 females and six males. There were no significant differences between the control and the intermetatarsal neuroma groups with respect to the mean foot posture index scores of the left and right foot (p?=?0.21 and 0.87, respectively). Additionally no significant differences were detected between the affected intermetatarsal neuroma interspace and foot posture index (p?=?0.27 and 0.47, respectively). There was no significant difference in mean body mass index between the intermetatarsal neuroma (26.9?±?5.7) and control groups (26.5?±?4.1) (p?=?0.72). There was, however, a significant difference in mean ankle dorsiflexion between the intermetatarsal neuroma and control groups (p?<?0.001 for both feet). Logistic regression models, adjusted for age, sex, foot posture index and body mass index estimated that the odds of having an intermetatarsal neuroma in the right foot increased by 61% (OR 1.61; 95% CI 1.32–1.96) with each one degree reduction of ankle dorsiflexion, and in the left foot by 43% (OR 1.43; 95% CI 1.22–1.69).Conclusion
No relationships were found between foot posture index and body mass index with intermetatarsal neuroma, or between foot posture index and the interspaces affected. However, a strong association was demonstrated between the presence of intermetatarsal neuroma and a restriction of ankle dorsiflexion.20.
Ossama El Shazly Mohammed Mokhtar Nasef Abdelatif Mohamed Hegazy Rana El Hilaly Abeer El Zohairy Eman Tawfik 《International orthopaedics》2014,38(12):2513-2517