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Foot and Ankle Clinics Mar 2022Open ankle arthrodesis remains a reliable solution for ankle arthritis, especially in the setting of deformity. Careful preoperative evaluation needs to be performed,... (Review)
Review
Open ankle arthrodesis remains a reliable solution for ankle arthritis, especially in the setting of deformity. Careful preoperative evaluation needs to be performed, both clinically and radiographically. The specific deformity present helps determine the approach used and the fixation choices. Deformity is most commonly seen intraarticularly, though deformity can also be present anywhere along the lower extremity, including compensatory deformity in the foot. Multiple different techniques can be used to address both the deformity and achieve a successful ankle arthrodesis. Patient outcomes reported in the literature are generally good, with high union rates and improved functional outcomes.
Topics: Ankle; Ankle Joint; Arthritis; Arthrodesis; Humans; Retrospective Studies
PubMed: 35219366
DOI: 10.1016/j.fcl.2021.11.009 -
Foot and Ankle Clinics Sep 2023The increase in competitive sports practice among children and lack of ionizing radiation have resulted in a higher demand for MRI examinations. MRI of the children... (Review)
Review
The increase in competitive sports practice among children and lack of ionizing radiation have resulted in a higher demand for MRI examinations. MRI of the children skeleton has some particularities that can lead orthopedists, pediatricians, and radiologists to diagnostic errors. The foot and ankle have several bones with abundant radiolucent and high signal intensity cartilage in several ossification centers, apophysis and physis, that can make this interpretation even harder. The present revision aims to show, how to differentiate between normal developmental findings and anatomic variants from pathologic conditions, whether mechanical, inflammatory, infectious, or neoplastic.
Topics: Humans; Child; Ankle; Ankle Joint; Magnetic Resonance Imaging
PubMed: 37536825
DOI: 10.1016/j.fcl.2023.04.007 -
Foot and Ankle Clinics Dec 2022Tibiotalocalcaneal arthrodesis (TTCA) is the most common and reliable procedure in the treatment of patients with end-stage ankle arthritis combined with severe... (Review)
Review
Tibiotalocalcaneal arthrodesis (TTCA) is the most common and reliable procedure in the treatment of patients with end-stage ankle arthritis combined with severe deformity. Many of these patients present with difficult previous sequelae that include nonunion, malunion, broken implants, vascular deficiencies, skin problems, or a combination of the previous. In that complex scenario, sometimes the only alternative treatment is a below-the-knee amputation. Image studies--weightbearing X-rays, tomography, and magnetic resonance - are fundamental to evaluate alignment and bone stock. When all conservative treatments fail to alleviate pain and dysfunction, the combination of osteotomies and arthrodesis is the procedure of choice. Surgical planning needs to be very detailed and thorough with a special focus on bone loss after debridement of non-healthy tissue and removal of metalwork. TTCA with grafting allows for the preservation of the limb in more than 80% of cases but at the expense of many complications with nonunion rates of approximately 20% of cases. There is controversy about the use of a retrograde nail versus specific TTCA plate and screws but results from biomechanical studies do not show a clear superiority of one specific construct. Amputation rates are close to 5% of cases after repeated failed surgeries. Bulk allografts increase the rate of nonunions but apparently do not have an influence on postoperative infections. Valgus positioning of the ankle/hindfoot is paramount to allow for maximal sagittal plane compensation from the midtarsal joints. Most patients are satisfied with the results of these salvage operations. The studies presented in this article have a considerable wide array of different scenarios that obviously bias some of the results, complications, and outcomes but together they present a persuasive pattern toward considering TTC with grafting and nail or plate fixation as a good salvage procedure that may help the patients to maintain their foot and ankle with a better alignment, function, and pain relief.
Topics: Humans; Retrospective Studies; Arthrodesis; Ankle Joint; Foot; Treatment Outcome
PubMed: 36368801
DOI: 10.1016/j.fcl.2022.08.008 -
Foot and Ankle Clinics Mar 2022This article introduces novel types of ankle arthritis related to a flatfoot deformity. There has been a long-held belief that severe unmanaged flatfoot deformity leads... (Review)
Review
This article introduces novel types of ankle arthritis related to a flatfoot deformity. There has been a long-held belief that severe unmanaged flatfoot deformity leads to valgus ankle arthritis, due to deltoid ligament insufficiency. However, flatfoot deformity can also give rise to varus ankle arthritis as the talus and calcaneus subluxate into opposite directions. Plantarflexion and posterior translation of the talus in the sagittal plane contributes to the eccentric narrowing of the posterior aspect of the tibiotalar joint, which the authors termed posterior ankle arthritis. Subtalar arthrodesis was performed to address the opposing dynamics of the talus and calcaneus, and was combined with a medial longitudinal arch reconstruction in most cases of posterior ankle arthritis and in selected cases of varus ankle arthritis, and satisfactory clinical and radiological results were achieved.
Topics: Ankle; Ankle Joint; Arthritis; Arthrodesis; Flatfoot; Humans
PubMed: 35219360
DOI: 10.1016/j.fcl.2021.11.010 -
Foot and Ankle Clinics Mar 2023This article discusses the biomechanics and tribology of total ankle replacements considering the influence of implant design and generation on functional outcome,... (Review)
Review
This article discusses the biomechanics and tribology of total ankle replacements considering the influence of implant design and generation on functional outcome, before discussing the interplay between biomechanics and tribology in the clinical success of total ankle replacement. It reflects on what we know and highlights areas for further research, as well as identifying factors to consider in clinical practice.
Topics: Humans; Arthroplasty, Replacement, Ankle; Ankle Joint; Joint Prosthesis; Biomechanical Phenomena; Prosthesis Design
PubMed: 36822680
DOI: 10.1016/j.fcl.2022.10.002 -
Foot and Ankle Clinics Mar 2022After isolated ankle (tibiotalar) arthrodesis, the triceps progressively shifts the subtalar joint into varus thus blocking compensatory motion from the midtarsal... (Review)
Review
After isolated ankle (tibiotalar) arthrodesis, the triceps progressively shifts the subtalar joint into varus thus blocking compensatory motion from the midtarsal joints. In a tibiotalocalcaneal arthrodesis, the subtalar may be fixed with the correct valgus. Comparison between ankle and tibiotalocalcaneal arthrodesis does not clearly favor one over another for pain relief, satisfaction, and gait analysis. Compensatory sagittal plane motion through the midtarsal joints when the subtalar is fixed in valgus may be responsible for these results. Tibiotalocalcaneal arthrodesis has become our procedure of choice over isolated tibiotalar for end-stage ankle arthritis regardless of the radiographic state of the subtalar.
Topics: Ankle; Ankle Joint; Arthritis; Arthrodesis; Humans; Subtalar Joint
PubMed: 35219367
DOI: 10.1016/j.fcl.2021.11.012 -
Seminars in Musculoskeletal Radiology Jun 2022Postoperative ankle imaging requires knowledge of the underlying surgical techniques, the usefulness of various imaging modalities, as well as an appreciation for the...
Postoperative ankle imaging requires knowledge of the underlying surgical techniques, the usefulness of various imaging modalities, as well as an appreciation for the desired clinical outcomes. Surgical procedures discussed in this article are tibiotalar fracture fixation, tibiotalar, subtalar, and tibiotalocalcaneal arthrodesis, total ankle arthroplasty, talar osteochondral lesion repair and grafting, lateral ligamentous repair and reconstruction, and peroneal and Achilles tendon repair and reconstruction. Imaging can play a vital role in determining if the expected outcome has been achieved and identifying complications, with particular emphasis placed on the use of radiographs, computed tomography (including weight-bearing), magnetic resonance imaging, and ultrasonography.
Topics: Ankle; Ankle Joint; Arthrodesis; Arthroplasty, Replacement, Ankle; Humans; Radiography
PubMed: 35654090
DOI: 10.1055/s-0042-1750841 -
JBJS Reviews May 2020Ankle impingement presents with painful and limited range of motion with dorsiflexion or plantar flexion, originating from pathological contact between bone and/or... (Review)
Review
Ankle impingement presents with painful and limited range of motion with dorsiflexion or plantar flexion, originating from pathological contact between bone and/or soft-tissue structures. Diagnosis is made primarily through clinical examination with adjunct radiographs and magnetic resonance imaging, with care taken to rule out a plethora of similarly presenting pathologies. Arthroscopic surgical approaches bring satisfactory short, mid, and long-term outcomes, with the current body of evidence dominated by Level-IV studies. Minimally invasive techniques offer improvements in time to return to play and complication rates relative to open approaches. Recent advances in the arthroscopic management of ankle impingement include long-term outcome studies, novel prognostic classification systems, and strategies for concomitant lesion management.
Topics: Ankle Joint; Arthroscopy; Humans; Joint Diseases; Treatment Outcome
PubMed: 32427779
DOI: 10.2106/JBJS.RVW.19.00215 -
Clinics in Podiatric Medicine and... Oct 2023The supramalleolar osteotomy (SMO) is a joint-preserving surgical procedure that allows realignment of the ankle joint in severe deformity secondary to arthritis. This... (Review)
Review
The supramalleolar osteotomy (SMO) is a joint-preserving surgical procedure that allows realignment of the ankle joint in severe deformity secondary to arthritis. This osteotomy realigns the mechanical axis to provide better weight distribution through the ankle joint. With an aligned mechanical axis, the overloaded asymmetric ankle joint will shift toward the preserved joint area in a valgus or varus ankle joint. The SMO also can be used via a staged approach to correct severe deformity in an end-stage arthritic ankle before total ankle arthroplasty to optimize the implant's longevity and improve overall functional outcomes.
Topics: Humans; Ankle; Arthritis; Ankle Joint; Arthroplasty, Replacement, Ankle; Osteotomy
PubMed: 37716751
DOI: 10.1016/j.cpm.2023.05.017 -
Clinics in Podiatric Medicine and... Jul 2021Pathologic affects from a cavus foot deformity range from flexible subtle to rigid severe deformities and are related to many pathologic conditions of the foot and... (Review)
Review
Pathologic affects from a cavus foot deformity range from flexible subtle to rigid severe deformities and are related to many pathologic conditions of the foot and ankle. Understanding the underlying deformity and the deforming force is essential in treating the cavus ankle and foot. Every deformity is different and unique to a given patient; therefore, surgical plans should be modified to each patient.
Topics: Ankle Joint; Conservative Treatment; Humans; Joint Instability; Medical History Taking; Orthopedic Procedures; Physical Examination; Talipes Cavus
PubMed: 34053655
DOI: 10.1016/j.cpm.2020.12.015