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Injury Nov 2020Fractures of the posterior process of the talus are rare and frequently overlooked, possibly leading to pseudo-arthrosis and chronic pain. To gain more insight into the... (Review)
Review
BACKGROUND
Fractures of the posterior process of the talus are rare and frequently overlooked, possibly leading to pseudo-arthrosis and chronic pain. To gain more insight into the diagnosis, treatment and outcome of fractures of the posterior process of the talus (PPTF), a systematic review of the current literature was performed to provide recommendations for the management of PPTF.
METHODS
A literature search in the electronic databases of PubMed, EMbase, Google Scholar and Cochrane library was performed in January 2020 to identify all clinical studies on PPTF with more than three patients. Amongst other variables, the type of study, number of patients, mechanism of injury, type of fracture (anatomy), imaging modality, treatment, postoperative protocol, outcomes, complications and duration of follow-up were noted for systematic analysis of the available evidence, adherent to the PRISMA guidelines.
RESULTS
Seven original studies were included with a total of 66 patients. More than one third of patients presented with a (sub)talar joint dislocation (n = 25, 37.9%) and 51.5% sustained associated ipsilateral lower extremity fractures (n = 34). Delayed diagnosis occurred in 36.4% of patients (n = 24). Out of 48 patients with outcome data available, 41.7% (n = 20) reported impaired function. In the non-operative group, 64.7% (n = 11) had impaired functional outcome, compared to 33.3% (n = 6) in the ORIF group, and 30.8% (n = 4) in the fragment excision group (p < 0.001). One third of the patients developed one or more complications (n = 25, 37.9%), mostly found in the non-operatively treated group (73.7%, n = 14) compared to ORIF (25.0%, n = 8, p < 0.001).
CONCLUSION
Early recognition and timely treatment is warranted in order to achieve pre-injury functional outcome and reduce morbidity. Given the significantly higher complication rate and lower return to the previous level of functionality reported after non-operative treatment, ORIF is recommended if there is (even minimal) displacement, articular involvement or if the fracture extends into the talus body.
Topics: Fracture Fixation, Internal; Fractures, Bone; Humans; Joint Diseases; Joint Dislocations; Talus; Treatment Outcome
PubMed: 32972722
DOI: 10.1016/j.injury.2020.09.030 -
Osteoarthritis and Cartilage Dec 2020To determine how foot structure and lower limb function differ between individuals with and without midfoot osteoarthritis (OA).
OBJECTIVE
To determine how foot structure and lower limb function differ between individuals with and without midfoot osteoarthritis (OA).
DESIGN
Electronic databases were searched from inception until May 2020. To be eligible, studies needed to (1) include participants with radiographically confirmed midfoot OA, with or without midfoot symptoms, (2) include a control group of participants without radiographic midfoot OA or without midfoot symptoms, and (3) report outcomes of foot structure, alignment, range of motion or any measures of lower limb function during walking. Screening and data extraction were performed by two independent assessors, with disagreements resolved by a third independent assessor. The methodological quality of included studies was assessed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.
RESULTS
A total of 1,550 records were screened by title and abstract and 11 met the inclusion criteria. Quantitative synthesis indicated that individuals who had midfoot OA had a more pronated foot posture, greater first ray mobility, less range of motion in the subtalar joint and first metatarsophalangeal joints, longer central metatarsals and increased peak plantar pressures, pressure time integrals and contact times in the heel and midfoot during walking. Meta-analysis could not be performed as the data were not sufficiently homogenous.
CONCLUSIONS
There are several differences in foot structure and lower limb function between individuals with and without midfoot OA. Future research with more consistent case definitions and detailed biomechanical models would further our understanding of potential mechanisms underlying the development of midfoot OA.
Topics: Foot Joints; Gait Analysis; Humans; Lower Extremity; Osteoarthritis; Pronation; Range of Motion, Articular
PubMed: 32889086
DOI: 10.1016/j.joca.2020.08.012 -
Bone & Joint Research Jul 2020To systematically review the outcomes and complications of cosmetic stature lengthening.
AIMS
To systematically review the outcomes and complications of cosmetic stature lengthening.
METHODS
PubMed and Embase were searched on 10 November 2019 by three reviewers independently, and all relevant studies in English published up to that date were considered based on predetermined inclusion/exclusion criteria. The search was done using "cosmetic lengthening" and "stature lengthening" as key terms. The Preferred Reporting Item for Systematic Reviews and Meta-Analyses statement was used to screen the articles.
RESULTS
A total of 11 studies including 795 patients were included. The techniques used in the majority of the patients were classic 3- or 4-ring Ilizarov fixator (267 patients; 33.6%) and lengthening over nail (LON) (253 patients; 31.8%), while implantable lengthening nail (ILN) was used in the smallest number of patients (63 patients; 7.9%). Mean end lengthening achieved was 6.7 cm (SD 0.6; 1.5 to 13.0), and the mean follow-up duration was 4.9 years (SD 2.1; 41 days to 7 years). Overall, the mean number of problems, obstacles, and complications per patient was 0.78 (SD 0.5), 0.94 (SD 1.0), and 0.15 (SD 0.2), respectively. The most common problem and obstacle was ankle equinus deformity, while the most common complications were deformation of the regenerate after end of treatment and subtalar joint stiffness/deformity.
CONCLUSION
Cosmetic stature lengthening provides favourable height gain, patient satisfaction, and functional outcomes, with low rate of major complications. Clear indications, contraindications, and guidelines for cosmetic stature lengthening are needed.Cite this article: 2020;9(7):341-350.
PubMed: 32670567
DOI: 10.1302/2046-3758.97.BJR-2019-0379.R1 -
Journal of Wound Care Jun 2020A wide range of clinical presentations of Charcot neuroarthropathy of the foot with concomitant osteomyelitis in patients with diabetes has been described. Existing...
OBJECTIVE
A wide range of clinical presentations of Charcot neuroarthropathy of the foot with concomitant osteomyelitis in patients with diabetes has been described. Existing literature provides an equally diverse list of treatment options. The purpose of this systematic review was to assess the outcomes specifically for the surgical management of midfoot Charcot neuroarthropathy with osteomyelitis in patients with diabetes.
METHOD
A systematic review was conducted by three independent reviewers using the following databases and search engines: Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Library, EMBASE (Excerpta Medica dataBASE), Google Scholar, Ovid, PubMed and Scopus. Search terms used were: Charcot neuroarthropathy, osteoarthropathy, neuro-osteoarthropathy, neurogenic arthropathy, osteomyelitis, midfoot, foot, ankle, diabetes mellitus, ulceration, wound, infection, surgical offloading, diabetic reconstruction, internal fixation, external fixation. Studies meeting the following criteria were included: English language studies, studies published from 1997-2017, patients with diabetes mellitus surgically treated for Charcot neuroarthropathy of the midfoot (specified location) with concomitant osteomyelitis, with or without internal and/or external fixation, follow-up period of six months or more postoperatively, documentation of healing rates, complications, and need for revisional surgery. Studies which were entirely literature reviews, descriptions of surgical-only technique and/or cadaveric studies, patients without diabetes, studies that did not specify location of osteomyelitis and Charcot neuroarthropathy, and treatment proximal to and including Chopart's/midtarsal joint specifically talonavicular, calcaneocuboid, subtalar, ankle were excluded.
RESULTS
A total of 13 selected studies, with a total of 114 patients with diabetes of which 56 had surgical treatment for midfoot Charcot neuroarthropathy with osteomyelitis, met the above inclusion criteria and were used for data extraction.
CONCLUSION
Surgical intervention for midfoot Charcot neuroarthropathy with osteomyelitis in patients with diabetes demonstrated a relatively high success rate for a range of procedures including debridement with simple exostectomy, arthrodesis with or without internal or external fixation, and advanced soft tissue reconstruction. However, this systematic review emphasises the need for larger, better designed studies to investigate the efficacy and failure rates of surgical treatment in this group of patients.
Topics: Adult; Aged; Aged, 80 and over; Arthropathy, Neurogenic; Diabetes Complications; Diabetic Foot; Foot Deformities, Acquired; Humans; Male; Middle Aged; Osteomyelitis; Treatment Outcome
PubMed: 32530758
DOI: 10.12968/jowc.2020.29.Sup6.S19 -
Archives of Orthopaedic and Trauma... May 2021Subtalar arthroereisis has been increasingly accepted as a solution to manage symptomatic pes planus. However, despite the recent developments related to arthroereisis,... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Subtalar arthroereisis has been increasingly accepted as a solution to manage symptomatic pes planus. However, despite the recent developments related to arthroereisis, no other published literature has aimed to review the outcomes in paediatric patients since 2010. This systematic review and meta-analysis, therefore, aims to evaluate the current outcomes of subtalar arthroereisis in the treatment of symptomatic pes planus among the paediatric population.
MATERIALS AND METHODS
The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies reported on the clinical outcomes of subtalar arthroereisis in children aged 21 or younger were included.
RESULTS
A total of 17 publications were included, with 1536 feet. The average duration of follow-up of the studies included in the review is 43.52 months. The studies consistently reported improvement in the radiological outcomes, approximating that of a normal population. Subtalar arthroereisis has shown to restore the collapsed medial longitudinal arch, supported by the decrease in Meary's angle to 5.267° (95% CI: 4.695°-5.839°, normal: 0°-10.0°) post-operatively and an increased calcaneal pitch of 15.70° (95% CI: 15.41°-15.99°, normal 18.0°-20.0°). Deformities associated with pes planus such as heel valgus was also significantly reduced, evident by the post-operative lateral talocalcaneal angle of 27.19° (95% CI: 26.44°-27.93°, normal: 25.0°-45.0°) and a post-operative Kite's angle of 18.13° (95% CI: 17.73°-18.52°, normal: 15.0°-30.0°). Subjectively, subtalar arthroereisis has generally resulted in an improvement in the grading of outcomes postoperatively from the patient's point of view.
CONCLUSIONS
Subtalar arthroereisis could serve as a procedure to correct radiological abnormalities, as well as relieve pain in selected patients with symptomatic pes planus.
Topics: Adolescent; Child; Child, Preschool; Female; Flatfoot; Humans; Male; Orthopedic Procedures; Subtalar Joint
PubMed: 32377845
DOI: 10.1007/s00402-020-03458-8 -
Foot & Ankle International Apr 2020Subtalar distraction arthrodesis (SDA) was developed as a means of treating the symptoms of subtalar arthritis. Despite almost 30 years of research in this field, many...
BACKGROUND
Subtalar distraction arthrodesis (SDA) was developed as a means of treating the symptoms of subtalar arthritis. Despite almost 30 years of research in this field, many controversies still exist regarding SDA. The objective of this study was to present an overview of outcomes following SDA, focusing on surgical technique as well as clinical and radiographic results.
METHODS
MEDLINE and EMBASE were queried and data abstraction was performed by 2 independent reviewers. Inclusion criteria for the articles were (1) English language, (2) peer-reviewed clinical studies with evidence levels I to IV, (3) with at least 5 patients, and (4) reporting clinical and/or radiographic outcomes of SDA.
RESULTS
Twenty-five studies matched the inclusion criteria (2 Level III and 23 Level IV studies) including 492 feet in 467 patients. The most common indication for SDA was late complications of calcaneus fractures. Many different operative techniques have been described, and there is no proven superiority of one method over the other. The most commonly reported complications were nonunion, hardware prominence, wound complications, and sural neuralgia. All studies showed both radiographic and clinical improvement at the last follow-up visit compared with the preoperative evaluation. Pooled results (12 studies, 237 patients) demonstrated improved American Orthopaedic Foot & Ankle Society ankle-hindfoot scores with a weighted average of 33 points of improvement.
CONCLUSION
SDA provides good clinical results at short-term and midterm follow-up, with improvement in ankle function as well as acceptable complication and failure rates. Higher quality studies are necessary to better assess outcomes between different operative techniques.
LEVEL OF EVIDENCE
Level III.
Topics: Arthrodesis; Bone Screws; Humans; Osteoarthritis; Postoperative Complications; Subtalar Joint; Surveys and Questionnaires; Treatment Outcome
PubMed: 31958992
DOI: 10.1177/1071100719899050 -
Gait & Posture Jul 2019Medial longitudinal arch characteristics are thought to be a contributing factor to lower limb running injuries. Running biomechanics associated with different foot... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Medial longitudinal arch characteristics are thought to be a contributing factor to lower limb running injuries. Running biomechanics associated with different foot types have been proposed as one of the potential underlying mechanisms. However, no systematic review has investigated this relationship.
RESEARCH QUESTION
The aim of this study was to conduct a systematic literature search and synthesize the evidence about the relationship between foot posture and running biomechanics.
METHODS
For this systematic review and meta-analysis different electronic databases (Pubmed, Web of Science, Cochrane, SportDiscus) were searched to identify studies investigating the relationship between medial longitudinal arch characteristics and running biomechanics. After identification of relevant articles, two independent researchers determined the risk of bias of included studies. For homogenous outcomes, data pooling and meta-analysis (random effects model) was performed, and levels of evidence determined.
RESULTS
Of the 4088 studies initially identified, a total of 25 studies were included in the qualitative review and seven in the quantitative analysis. Most studies had moderate and three studies a low risk of bias. Moderate evidence was found for a relationship between foot posture and subtalar joint kinematics (small pooled effects: -0.59; 95%CI -1.14 to - 0.003) and leg stiffness (small pooled effect: 0.59; 95%CI 0.18 to 0.99). Limited or very limited evidence was found for a relationship with forefoot kinematics, tibial/leg rotation, tibial acceleration/shock, plantar pressure distribution, plantar fascia tension and ankle kinetics as well as an interaction of foot type and footwear regarding tibial rotation.
SIGNIFICANCE
While there is evidence for an association between foot posture and subtalar joint kinematics and leg stiffness, no clear relationship was found for other biomechanical outcomes. Since a comprehensive meta-analysis was limited by the heterogeneity of included studies future research would benefit from consensus in foot assessment and more homogenous study designs.
Topics: Adolescent; Adult; Ankle; Biomechanical Phenomena; Female; Foot; Humans; Kinetics; Male; Posture; Rotation; Running; Tibia; Young Adult
PubMed: 31195310
DOI: 10.1016/j.gaitpost.2019.05.031 -
Foot and Ankle Surgery : Official... Feb 2020Subtalar joint instability (STI) is considered as a potential source of chronic lateral hindfoot instability. However, clinical diagnosis of STI is still challenging....
BACKGROUND
Subtalar joint instability (STI) is considered as a potential source of chronic lateral hindfoot instability. However, clinical diagnosis of STI is still challenging. This systematic review was conducted to assess the consistency of the clinical entity "subtalar instability", to investigate the reliability of available diagnostic tools and to provide a critical overview of related studies.
METHODS
A systematic review of the Medline, Web of Sciences and EMBASE databases was performed for studies reporting on tests to investigate subtalar instability or lesions of the subtalar ligaments. To investigate the relation with chronic STI, studies focusing on sinus tarsi syndrome (STS) or acute lesions of the subtalar ligaments were also included in the search strategy and were assessed separately.
RESULTS
This review identified 25 studies focusing on different topics: chronic STI (16), acute lesions of the subtalar ligaments (5) and STS (4). Twelve studies, assessing STI, demonstrated the existence of a subgroup with instability complaints related to abnormal increased subtalar motion (7) or abnormalities of the subtalar ligaments (6). We found insufficient evidence for measuring subtalar tilting using stress radiographs. MRI was able to assess abnormalities of the ligaments and stress-MRI detected abnormally increased motion.
CONCLUSION
Complaints of instability can be related to subtalar ligaments injuries and an abnormally increased motion of the subtalar joint. Stress radiographs should be interpreted with caution and should not have the status of a reference test. Clinical diagnosis should rely on several parameters including MRI.
Topics: Foot Diseases; Humans; Joint Instability; Ligaments; Ligaments, Articular; Magnetic Resonance Imaging; Range of Motion, Articular; Reproducibility of Results; Subtalar Joint
PubMed: 30827926
DOI: 10.1016/j.fas.2019.02.001 -
Clinics in Podiatric Medicine and... Apr 2019One of the most severe complications in calcaneal fractures is a malunion. When a malunion occurs, subtalar bone block distraction arthrodesis provides restoration of... (Meta-Analysis)
Meta-Analysis
One of the most severe complications in calcaneal fractures is a malunion. When a malunion occurs, subtalar bone block distraction arthrodesis provides restoration of calcaneal height, length, correction of varus deformity, and elimination of subtalar joint arthritis. A systematic review showed the union rate for all procedures was 95.78%. The overall complication rate was 38% for all procedures. This is the first study to categorically break down complications with statistical analysis. The data presented indicate the level of difficulty of the subtalar distraction bone block arthrodesis for calcaneal malunions and may even suggest the need for newer techniques.
Topics: Arthrodesis; Calcaneus; Fracture Fixation, Internal; Fractures, Malunited; Humans; Osteogenesis, Distraction; Subtalar Joint
PubMed: 30784539
DOI: 10.1016/j.cpm.2018.10.011 -
International Orthopaedics May 2019This systematic review aimed to compare radiographic correction, clinical outcomes, complications, and re-operations between lateral column lengthening (LCL) and... (Comparative Study)
Comparative Study
PURPOSE
This systematic review aimed to compare radiographic correction, clinical outcomes, complications, and re-operations between lateral column lengthening (LCL) and arthroereisis (AR) for treating symptomatic flatfoot in children.
METHODS
We conducted a comprehensive search on MEDLINE, EMBASE, and Cochrane Library databases. Literature search, data extraction, and quality assessment were conducted by two independent reviewers. The outcomes analyzed included radiographic parameters, clinical scores, satisfaction, complications, and re-operations.
RESULTS
Twenty-one and 13 studies were included in the LCL and AR groups, respectively. The change in anteroposterior talo-first metatarsal angle was greater in the LCL (9.5° to 21.7°) than in the AR group (10.6° to 12.8°). The change in calcaneal pitch was greater in the LCL (2.1° to 26.53°) than in the AR group (- 1.3° to 3.23°). Improvements in the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were greater in the LCL (27.7 to 39.1) than in the AR group (17 to 22). The percentage of satisfaction was similar between the LCL (68% to 89%) and AR (78.5% to 96.4%) groups. The complication rate was higher in the LCL (0% to 86.9%) than in the AR group (3.5% to 45%). The most common complications were calcaneocuboid subluxation and persistent pain in the LCL and AR groups, respectively. The re-operation rate was similar between the LCL (0% to 27.3%) and AR (0% to 36.4%) groups.
CONCLUSIONS
The LCL group has achieved more radiographic corrections and more improvements in the AOFAS score than the AR group. Complications were more common in the LCL group than in the AR group, and the re-operation rates were similar between the two groups.
Topics: Bone Transplantation; Child; Flatfoot; Foot Bones; Humans; Retrospective Studies; Subtalar Joint
PubMed: 30701302
DOI: 10.1007/s00264-019-04303-3