Results of operative treatment of double Morton’s neuroma in the same foot

Background  

Double Morton’s neuroma in one foot has rarely been reported in the literature.     

Correction of ankle and hind foot deformity in Charcot neuroarthropathy using a retrograde hind foot nail—The Kings’ Experience

Background

Corrective fusion for the unstable deformed hind foot and mid foot in Charcot Neuroarthropathy (CN) is quite challenging and is best done in tertiary centres under the supervision of multidisciplinary teams.

The aponeurosis of the “slacksole” of the foot

Summary A case is presented with folded sole of the foot caused by absence of the aponeurosis and hypertrophy of the muscles of the little toe. Operative treatment gave a good result.     

Is there a correlation between static radiographs and dynamic foot function in pediatric foot deformities?

BackgroundIdiopathic flexible flatfeet, congenital clubfeet and pes cavovarus are the most common foot deformities in children. Accurate assessment to quantify the severity of these deformities by clinical examination alone can be challenging. Radiographs are a valuable adjunct for accurate diagnosis and effective treatment. However, static radiographs during relaxed standing may not reflect the dynamic changes in the foot skeleton during functional activities such as walking. Therefore, the aim of this study is to predict dynamic foot movements during walking from planar standing radiographs to reveal the significance of the radiographic analysis for the assessment of foot function.MethodsPatients 8–17 years with flexible flatfeet (FFF, n = 217) recurrent clubfeet (RCF n = 38) and overcorrected clubfeet (OCCF, n = 71) of non-neurogenic or syndromic origin and pes cavovarus due to peripheral neuropathy (PNP, n = 48) were retrospectively included. Patients underwent gait analysis with the Oxford Foot Model and radiographic examination in anterior-posterior and lateral view during standing. Multilinear predictor analysis of selected gait parameters was performed based on radiographic measures.ResultsThe variance that was explained by radiography was greatest for the transverse plane forefoot abduction with 33% for OCCF, 50% for RCF and 59% for PNP. Flatfeet and foot kinematics in the other planes or between rearfoot and tibia showed little or no relation.ConclusionsThe static measures of foot deformities by radiography could explain only a small amount of variance in foot kinematics during walking, in particular for FFF. An explanation may be that the forces during weight bearing bear little resemblance to those during gait in terms of neither magnitude nor direction. These findings suggest that foot function cannot be accurately assessed solely from static radiographic observations of the foot, commonly undertaken in clinical practice.     

Can partial foot prostheses effectively restore foot length?

Our understanding of how partial foot prostheses function stems from static force analyses, where assumptions about the location of the ground reaction force during terminal stance have been made. While such assumptions seemed reasonably based on an understanding of normal gait, they are often illogical based on what is observed clinically. As such, the aim of this work was to evaluate the belief that partial foot prostheses are able to restore the effective foot length. Centre of pressure (CoP) excursion data were collected as part of a complete gait analysis incorporating an Advanced Mechanical Technology Inc. force platform. The CoP excursion patterns, observed in a cohort of eight partial foot amputees and matched control subjects, highlight the inability of toe fillers and slipper sockets to restore the 'effective' foot length in transmetatarsal and Lisfranc amputees, whereas clamshell prostheses fitted to the Chopart amputees were able to restore the effective foot length. In the transmetatarsal and Lisfranc amputees, the observed CoP excursion patterns could indicate a learned gait strategy necessary to reduce the requirement of the weak triceps surae musculature as well as spare the sensitive distal stump from extreme forces. The toe fillers and slipper sockets fitted to these amputees may not be stiff enough to support the amputee's body weight or the device may not be designed appropriately to assist the weakened triceps musculature to resist the external moments caused by loading the forefoot. The clamshell prostheses restored the 'effective' foot length due to the rigid toe lever and clamshell socket, which could allow and comfortably support the generation of substantial external moments during terminal stance.     

Growth factors in the treatment of diabetic foot ulcers: new technologies, any promises?

Foot ulcers remain a common problem, leading to increased morbidity in patients with diabetes. Despite the progress that has been achieved in revascularization techniques as well as in off-loading to relieve high-pressure areas, diabetic foot wounds remain a clinical challenge. Growth factors are a major technological advance that promised to change the face of wound healing. The most important of growth factors are recombinant human platelet-derived growth factor-BB and granulocyte colony-stimulating factor. The former has been approved by the FDA for the treatment of neuropathic ulcers when there is adequate blood supply. The latter is less demonstrably useful. Advances include methods of delivering growth factors.     

Effects of ankle–foot braces on medial gastrocnemius morphometrics and gait in children with cerebral palsy

PurposeIn children with cerebral palsy (CP), braces are used to counteract progressive joint and muscle contracture and improve function. We examined the effects of positional ankle–foot braces on contracture of the medial gastrocnemius (MG) and gait in children with CP while referencing to typically developing children.MethodsSeventeen independently ambulant children with CP and calf muscle contracture (age 10.4 ± 3.0y) and 17 untreated typically developing peers (age 9.5 ± 2.6y) participated. Children with CP were analysed before and 16 ± 4 weeks after ankle–foot bracing. MG muscle belly length and thickness, tendon and fascicle length, as well as their extensibility were captured by 2D ultrasound and 3D motion capturing during passive, manually applied stretches. In addition, 3D gait analysis was conducted.ResultsPrior to bracing, the MG muscle–tendon unit in children with CP was 22 % less extensible. At matched amounts of muscle–tendon unit stretch, the muscle belly and fascicles in CP were 7 % and 14 % shorter while the tendon was 11 % longer. Spastic fascicles displayed 32 % less extensibility than controls. Brace wear increased passive dorsiflexion primarily with the knees flexed. During gait, children walked faster and foot lift in swing improved. MG muscle belly and tendon length showed little change, but fascicles further shortened (−11 %) and muscle thickness (−8 %) decreased.ConclusionsUse of ankle–foot braces improves function but may lead to a loss of sarcomeres in series, which could explain the shortened fascicles. To potentially induce gastrocnemius muscle growth, braces may also need to extend the knee or complementary training may be necessary to offset the immobilizing effects of braces.     

Is there a learning curve in foot and ankle surgery?

BackgroundPrevious studies of orthopaedic learning curves have largely described the introduction of new techniques to experienced consultants. End points have usually involved technical considerations. A paucity of evidence surrounds foot and ankle surgery. This study investigates the learning curve during a foot and ankle surgeon's first year, defined by functional outcome.Methods150 patients underwent elective foot or ankle surgery during the whole period. Preoperative and 6 month postoperative functional scores were compared between the first and second 6 month groups.ResultsFunctional improvement was greater, approaching significance, in the second group (p = 0.0605). There was no difference for forefoot cases (p = 0.345). Functional improvement was significantly greater in the second group with forefoot cases removed (p = 0.0333).ConclusionsA learning curve exists in the first year of practice of foot and ankle surgery, demonstrated by functional outcome. This is confined to ankle, hindfoot and midfoot, but not forefoot surgery.