The demand incidence of symptomatic ankle osteoarthritis presenting to foot & ankle surgeons in the United Kingdom

BackgroundAnkle arthritis is a cause of major disability; however reports in the literature on the incidence of ankle osteoarthritis are rare.ObjectivesTo explore the methodological challenges in obtaining an incidence of ankle osteoarthritis and to estimate the incidence of symptomatic osteoarthritis presenting to Foot & Ankle specialists in the UK.MethodsWe searched available national diagnosis databases and also sent out a questionnaire-based survey to all Consultant members of the British Orthopaedic Foot & Ankle Society (n = 180).Results123 completed survey questionnaires were returned (68%) with each surgeon seeing on average 160 cases of symptomatic ankle arthritis and performing on average 20 definitive procedures for end-stage ankle osteoarthritis per year. There are no internationally agreed diagnostic or treatment codes specific for ankle osteoarthritis.ConclusionThere are an estimated 29,000 cases of symptomatic ankle osteoarthritis being referred to specialists in the UK, representing a demand incidence of 47.7 per 100,000. 3000 definitive operations to treat end stage ankle osteoarthritis take place in the UK annually. We recommend that specific codes pertaining to ankle arthritis and its treatment be included in any future revisions of the WHO International Classification of Diseases (ICD) and operative procedure coding systems.     

Correction of valgus of fifth metatarsal and varus of the fifth toes by percutaneous distal osteotomy

In this paper, the Authors suggest the performance of percutaneous distal osteotomy of the fifth metatarsal neck by a rapid, mini-invasive technique, without joint capsule procedures for the correction of fifth ray deformities with a valgus fifth metatarsal and a varus fifth toe. The procedure was carried out in 25 foots who underwent surgery between January 2002 and May 2005, with an 8-month to 4-year follow-up. The clinical results were evaluated by the AOFAS score which identified an improvement of the obtained score, with over 90% of the results classified between excellent and good.     

Secondary surgery after total ankle replacement: The influence of preoperative hindfoot alignment

The aim of this study was to evaluate the need for secondary surgery in total ankle replacement (TAR) in ankles with hindfoot malalignment.MethodsOne hundred and ninety-six ankles (186 patients) underwent ankle arthroplasty. The mean follow up was 4.2 years. Preoperative hindfoot alignment was measured and revisions or reoperations were analysed.ResultsThere were 41 revisions (21%). The most common reasons for revision were instability (13), aseptic loosening (11) and technical errors (8). In the preoperative varus group the revision rate was 31% and in the valgus and neutral groups 17%, respectively. The results improved with time and experience.ConclusionThe demands in the TAR procedure are much higher in preoperatively varus malaligned ankles and the need to accomplish alignment at the prime operation is crucial. The surgery is challenging and has a long learning curve and should be performed by experienced foot and ankle surgeons.     

Giant Solitary Osteochondroma of the Inferior Medial Calcaneal Tubercle: A Case Report and Review of the Literature

Small osteophytes are frequently encountered in the foot and ankle, and are not to be confused with true osteochondromas, which are relatively uncommon in this region. They most often affect long bones of the appendicular skeleton but may involve flat bones as well. Osteochondromas are benign osseous neoplasms with a distinct hyaline cartilage cap originating from the physis and cease growing with skeletal maturity. Osteochondroma are often treated conservatively unless they become symptomatic, painful, demonstrate rapid or new growth, enlarge after skeletal maturity, and/or exhibit signs of malignant transformation. In this report, we present a case of a giant (8 cm x 4.2 cm x 2.1 cm) osteochondroma in an adult occurring on the inferior medial tubercle of the calcaneus that underwent excision, with 3.5 years of follow-up without recurrence. To our knowledge this is the largest osteochondroma affecting the inferior medial tubercle of the calcaneus. This case demonstrates that large osteochondromas may occur in the foot, and also confirms that benign osteochondroma growth may occur in adulthood. A detailed review of osteochondroma occurrence in the foot is presented along with a review of the diagnostic work-up to evaluate for malignant transformation. LEVEL OF CLINICAL EVIDENCE: 4.     

Screw and tension band fixation for triple arthrodesis: A technique report

Stabilisation of the talonavicular joint in arthrodesis can be difficult, particularly in osteopoenic bone, and this may lead to non-union. A tension band technique for stabilisation is described. This has been used as part of the fixation in 44 triple arthrodeses. One hundred percent union rate has been achieved with few complications.