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The Journal of Foot and Ankle Surgery :... Jan 2019Nonoperative management may result in calcaneal malunion with consequences of pain, deformity, and functional limitation. The aim of this review was to proffer an...
Nonoperative management may result in calcaneal malunion with consequences of pain, deformity, and functional limitation. The aim of this review was to proffer an evidence-based scientific account of the effectiveness of contemporary surgical procedures in the management of malunited calcaneal fractures after initial conservative management. This systematic review included studies that evaluated the surgical procedures in the management of calcaneal malunion and systematically searched studies published between January 2005 and June 2016. The search was conducted using the following search engines: the Cochrane Library, Web of Science, PubMed/ MEDLINE, EMBASE, CINAHL, Academic Search Premier, and Open Grey. Methodologic assessment was conducted using the Cochrane Risk of Bias In nonrandomized Studies- of Interventions assessment tool version 7. Ten observational studies (212 patients) were included in this review. Five articles explored various means of achieving subtalar arthrodesis, 2 articles evaluated joint-sparing osteotomies, 1 examined corrective osteotomy for extra-articular os calcis malunion, and 2 articles explored combined procedures based on the Stephen and Sanders calcaneal malunion classification. Clinical and methodologic heterogeneity did not allow quantitative pooling of results. The overall risk of bias was considered moderate in 7 studies and 3 were considered at high risk of bias. The inability for any study to be considered at low risk of bias in this review might be mainly attributed to the lack of a valid and reliable outcome measure for the assessment of foot and ankle conditions. There is clear evidence that appropriately indicated procedures are effective in terms of pain alleviation, correction of deformity, and improved function. However, long-term outcomes may improve the acceptability to joint-preserving osteotomies, subtalar arthrodesis with the VIRA implant and subtalar distraction osteogenesis.
Topics: Calcaneus; Fractures, Malunited; Humans
PubMed: 30583774
DOI: 10.1053/j.jfas.2018.08.034 -
The Journal of Rheumatology Apr 2019To evaluate the intraobserver and interobserver reliability of the ultrasonographic (US) assessment of subtalar joint (STJ) synovitis in patients with rheumatoid...
OBJECTIVE
To evaluate the intraobserver and interobserver reliability of the ultrasonographic (US) assessment of subtalar joint (STJ) synovitis in patients with rheumatoid arthritis (RA).
METHODS
Following a Delphi process, 12 sonographers conducted an US reliability exercise on 10 RA patients with hindfoot pain. The anteromedial, posteromedial, and posterolateral STJ was assessed using B-mode and power Doppler (PD) techniques according to an agreed US protocol and using a 4-grade semiquantitative grading score for synovitis [synovial hypertrophy (SH) and signal] and a dichotomous score for the presence of joint effusion (JE). Intraobserver and interobserver reliability were computed by Cohen's and Light's κ. Weighted κ coefficients with absolute weighting were computed for B-mode and PD signal.
RESULTS
Mean weighted Cohen's κ for SH, PD, and JE were 0.80 (95% CI 0.62-0.98), 0.61 (95% CI 0.48-0.73), and 0.52 (95% CI 0.36-0.67), respectively. Weighted Cohen's κ for SH, PD, and JE in the anteromedial, posteromedial, and posterolateral STJ were -0.04 to 0.79, 0.42-0.95, and 0.28-0.77; 0.31-1, -0.05 to 0.65, and -0.2 to 0.69; 0.66-1, 0.52-1, and 0.42-0.88, respectively. Weighted Light's κ for SH was 0.67 (95% CI 0.58-0.74), 0.46 (95% CI 0.35-0.59) for PD, and 0.16 (95% CI 0.08-0.27) for JE. Weighted Light's κ for SH, PD, and JE were 0.63 (95% CI 0.45-0.82), 0.33 (95% CI 0.19-0.42), and 0.09 (95% CI -0.01 to 0.19), for the anteromedial; 0.49 (95% CI 0.27-0.64), 0.35 (95% CI 0.27-0.4), and 0.04 (95% CI -0.06 to 0.1) for posteromedial; and 0.82 (95% CI 0.75-0.89), 0.66 (95% CI 0.56-0.8), and 0.18 (95% CI 0.04-0.34) for posterolateral STJ, respectively.
CONCLUSION
Using a multisite assessment, US appears to be a reliable tool for assessing synovitis of STJ in RA.
Topics: Adult; Arthritis, Rheumatoid; Consensus; Delphi Technique; Female; Humans; Incidence; Male; Middle Aged; Reproducibility of Results; Research Design; Subtalar Joint; Synovitis; Ultrasonography, Doppler
PubMed: 30385707
DOI: 10.3899/jrheum.171490 -
Knee Surgery, Sports Traumatology,... Sep 2019To give a systematic overview of current diagnostic imaging options and surgical treatment for chronic subtalar joint instability.
PURPOSE
To give a systematic overview of current diagnostic imaging options and surgical treatment for chronic subtalar joint instability.
METHODS
A systematic literature search across the following sources was performed: PubMed, ScienceDirect, and SpringerLink. Twenty-three imaging studies and 19 outcome studies were included. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS 2) tool was used to assess the methodologic quality of the imaging articles, while the modified Coleman Score was used to assess the methodologic quality of the outcome studies.
RESULTS
Conventional radiographs were most frequently used to assess chronic subtalar joint instability. Talar tilt, anterior talar translation, and subtalar tilt were the three most commonly used measurement methods. Surgery often included calcaneofibular ligament reconstruction.
CONCLUSION
Current imaging options do not reliably predict subtalar joint instability. Distinction between chronic lateral ankle instability and subtalar joint instability remains challenging. Recognition of subtalar joint instability as an identifiable and treatable cause of ankle pain requires vigilant clinical investigation.
LEVEL OF EVIDENCE
Systematic Review of Level III and Level IV Studies, Level IV.
Topics: Ankle Joint; Humans; Image Processing, Computer-Assisted; Joint Instability; Lateral Ligament, Ankle; Magnetic Resonance Imaging; Orthopedics; Osteoarthritis; Outcome Assessment, Health Care; Radiography; Subtalar Joint; Translations
PubMed: 30367197
DOI: 10.1007/s00167-018-5232-8 -
The Journal of Foot and Ankle Surgery :... 2017Although numerous studies have linked smoking with lower extremity wound and bone healing complications, a comprehensive study on the effects of smoking in foot and... (Review)
Review
Although numerous studies have linked smoking with lower extremity wound and bone healing complications, a comprehensive study on the effects of smoking in foot and ankle surgery has not yet been reported. The purpose of the present study was to report the results of our systemic literature review, identifying the effects of tobacco use on common foot and ankle procedures. The systematic literature review was performed according to guidelines set by the PRIMSA statement (Preferred Reporting Items for Systematic Review and Meta-Analyses). Smoking, as a single risk factor, was analyzed and used to compare adverse outcomes in the postoperative setting of foot and ankle surgery. We reviewed 528 abstracts that met our initial identification criteria. After an extensive review process, 46 of the articles (8.71%) met the eligibility requirements to be included in the present study. Distal bunionectomy with osteotomy, first metatarsophalangeal joint arthrodesis, Lapidus bunionectomy, toe amputation, transmetatarsal amputation, Syme's amputation, open reduction internal fixation (ORIF) of calcaneal fractures, ankle fracture ORIF, pilon fracture ORIF, subtalar arthrodesis, rearfoot arthrodesis, tibiocalcaneal arthrodesis, ankle arthrodesis, total ankle arthroplasty, and plastic surgery procedures and their respective negative association with smoking was identified and described in our review. Our systematic literature review revealed that procedures involving arthrodesis, fracture ORIF, and plastic surgery were associated with negative outcomes in smokers. Procedures that did not involve osseous unions such as total ankle arthroplasty and amputations did not appear to have negative outcomes associated with smoking.
Topics: Foot; Humans; Orthopedic Procedures; Patient Selection; Refusal to Treat; Smoking; Wound Healing
PubMed: 28476393
DOI: 10.1053/j.jfas.2017.02.006 -
Journal of Geriatric Physical Therapy... 2018Lower extremity osteoarthritis (OA) is a common condition among older adults; given the risks of surgical and pharmaceutical interventions, conservative, lower-cost...
BACKGROUND AND PURPOSE
Lower extremity osteoarthritis (OA) is a common condition among older adults; given the risks of surgical and pharmaceutical interventions, conservative, lower-cost management options such as footwear warrant further investigation. This systematic review investigated the effects of footwear, including shoe inserts, in reducing lower extremity joint pain and improving gait, mobility, and quality of life in older adults with OA.
METHODS
The CINAHL, SPORTDiscus, PubMed, RECAL, and Web of Knowledge databases were searched for publications from January 1990 to September 2014, using the terms "footwear," "shoes," "gait," "pain," and "older adult." Participants who were 50 years or older and those who had OA in at least one lower extremity joint narrowed the results. Outcomes of interest included measures of pain, comfort, function, gait, or quality of life. Exclusion criteria applied to participants with rheumatoid arthritis, amputation, diabetes, multiple sclerosis, use of modified footwear or custom orthotics, purely biomechanical studies, and outcomes of balance or falls only. Single-case studies, qualitative narrative descriptions, and expert opinions were also excluded.
RESULTS
The initial search resulted in a total of 417 citations. Eleven articles met inclusion criteria. Two randomized controlled trials and 3 quasiexperimental studies reported lateral wedge insoles may have at least some pain-relieving effects and improved functional mobility in older adults at 4 weeks to 2 years' follow-up, particularly when used with subtalar and ankle strapping. Three randomized controlled trials with large sample sizes reported that lateral wedges provided no knee pain relief compared with flat insoles. Hardness of shoe soles did not significantly affect joint comfort in the foot in a quasiexperimental study. A quasiexperimental designed study investigating shock-absorbing insoles showed reduction in knee joint pain with 1 month of wear. Finally, a cross-sectional prognostic study indicated poor footwear at early ages exhibits an association with hindfoot pain later in life.
DISCUSSION AND CONCLUSION
Because of the limited number of randomized control trials, it is not possible to make a definitive conclusion about the long-term effects of footwear on lower extremity joint pain caused by OA. There is mounting evidence that shock-absorbing insoles, subtalar strapping, and avoidance of high heels and sandals early in life may prevent lower extremity joint pain in older adults, but no conclusive evidence exists to show that lateral wedge insoles will provide long-term relief from knee joint pain and improved mobility in older adults with OA. More high-quality randomized control trials are needed to study the effectiveness of footwear and shoe inserts on joint pain and function in older adults with OA.
Topics: Aged; Arthralgia; Cross-Sectional Studies; Female; Foot Orthoses; Gait; Humans; Knee Joint; Male; Osteoarthritis, Knee; Quality of Life; Shoes
PubMed: 27824657
DOI: 10.1519/JPT.0000000000000108 -
Knee Surgery, Sports Traumatology,... Jun 2017To gain a better understanding of the precise anatomy of the lateral ligaments of the ankle through a systematic review of published cadaveric studies in order to... (Review)
Review
PURPOSE
To gain a better understanding of the precise anatomy of the lateral ligaments of the ankle through a systematic review of published cadaveric studies in order to improve anatomical minimally invasive surgery (MIS) for treatment of chronic ankle instability (CAI).
METHODS
A systematic review of the literature was performed using the PubMed, EMBASE, Cochrane databases and Web of Science on June 2015 with the two search concepts: "lateral ligament of the ankle" and "anatomy". Anatomical studies that reported gross anatomy of the anterior talar fibular ligament (ATFL) and calcaneal fibular ligament (CFL) in English were included to assess the morphology and origins and insertions of the ligaments. All records found in the literature search were screened by title and abstract. Potentially relevant articles were selected for full-text review. Each of the identified articles was reviewed and included in qualitative synthesis. The following data were abstracted from the included articles: authors, date of publication, sample size, mean age, the length and the width of the each ligament, number of bundle of the ATFL and the location and the footprint of the origins and insertions for the ATFL and CFL.
RESULTS
Sixteen studies were identified indicating the length of the ATFL and CFL was 12-24.8 and 18.5-35.8 mm, respectively, while the width was 5-11.1 and 4.6-7.6 mm, respectively. Fibular origins of the ATFL and CFL were located on the anterior border of distal fibula at a distance of 10-13.8 and 5.3-8.5 mm proximal to the tip of the fibula, respectively. The talar insertion of the ATFL was located 14.2-18.1 mm to the subtalar joint or 11.3-14.8 mm to the anterolateral corner of the talar body. The calcaneal insertion of the CFL was located 12.1-13 mm to the subtalar joint or 13.2-27.1 mm to the peroneal tubercle on the lateral wall of calcaneus.
CONCLUSION
Systematic review of the literature of the research for the ATFL and CFL has identified the morphology of the ligaments and their location of origins and insertions. This is the best available data about the ATFL and CFL which will facilitate more precise anatomical MIS for treatment of CAI.
LEVEL OF EVIDENCE
Systematic review, Level IV.
Topics: Ankle Joint; Cadaver; Humans; Joint Instability; Lateral Ligament, Ankle; Minimally Invasive Surgical Procedures
PubMed: 27295109
DOI: 10.1007/s00167-016-4194-y -
Knee Surgery, Sports Traumatology,... Apr 2016The 2-portal hindfoot endoscopic technique with the patient in prone position, first introduced by van Dijk et al. (Arthroscopy 16:871-876, 2000), is currently the most... (Review)
Review
PURPOSE
The 2-portal hindfoot endoscopic technique with the patient in prone position, first introduced by van Dijk et al. (Arthroscopy 16:871-876, 2000), is currently the most used by foot and ankle surgeons to address endoscopically pathologies located in the hindfoot. This article aims to review the literature to provide a comprehensive description of the level of evidence available to support the use of the 2-portal hindfoot endoscopy technique for the current generally accepted indications.
METHODS
A comprehensive review was performed by use of the PubMed database to isolate literature that described therapeutic studies investigating the results of different hindfoot endoscopy treatment techniques. All articles were reviewed and assigned a classification (I-V) of level of evidence. An analysis of the literature reviewed was used to assign a grade of recommendation for each current generally accepted indication for hindfoot endoscopy. A subscale was used to further describe the evidence base for indications receiving a grade of recommendation indicating poor-quality evidence.
RESULTS
On the basis on the available evidence, posterior ankle impingement syndrome, subtalar arthritis and retrocalcaneal bursitis have the strongest recommendation in favour of treatment (grade Cf).
CONCLUSION
Although a low level of evidence of the included studies, the review showed that adequate literature to support the use of the 2-portal endoscopic techniques for most currently accepted indications exists. Future "higher quality" evidence could strengthen current recommendations and further help surgeons in evidence-based practice.
LEVEL OF EVIDENCE
Level V, Review of Level III, IV and V studies.
Topics: Ankle Joint; Arthroscopy; Endoscopy; Foot; Humans
PubMed: 26744282
DOI: 10.1007/s00167-015-3965-1 -
Knee Surgery, Sports Traumatology,... Apr 2016The purpose of this systematic review was to report the effects of gastrocnemius recession on ankle dorsiflexion range of motion, function, and push-off power. (Review)
Review
PURPOSE
The purpose of this systematic review was to report the effects of gastrocnemius recession on ankle dorsiflexion range of motion, function, and push-off power.
METHODS
The MEDLINE and EMBASE databases were reviewed with terms "gastrocnemius recession". The inclusion criteria were: (1) clinical studies, (2) published in a peer-reviewed journal within the past 10 years, and (3) published in English. Excluded were: (1) review articles, (2) cadaveric studies, (3) studies including patients under the age of 18 years, (4) studies evaluating a neurologic condition, (5) level of evidence 5, and (6) Quality of Evidence Score <3. Data were then extracted and analysed for trends. The PearlDiver Database was also used to review de-identified patient information retrospectively between 2007 and 2011.
RESULTS
Full-text review yielded 23 articles that fit the inclusion criteria. Twenty-one of 23 (91%) and 2/23 (9%) studies were level of evidence 4 and 3, respectively. Twelve of 23 (52%) studies reported follow-up assessment between 12 and 36 months, and no studies reported longer-term follow-up. Twelve of 12 (100%) studies reported improved dorsiflexion range of motion 9/9 (100%) reported improved AOFAS, and 11/11 (100%) reported improved VAS. Five of 23 (22%) studies reported strength in a measured and controlled fashion with variable results, but of these, no study reported a return to normal power. The mean complication rate was 14%.
CONCLUSION
The available evidence supports that GR improves functional outcomes and increases dorsiflexion range of motion. Furthermore, GR affects gait kinematics, which may cause compensatory effects at the knee, ankle, and subtalar joints. Evidence has shown that power does not return to normal levels. Clinicians may utilize these data clinically to determine whether patients may benefit from GR or not.
LEVEL OF EVIDENCE
IV.
Topics: Ankle Joint; Biomechanical Phenomena; Contracture; Gait; Humans; Muscle, Skeletal; Orthopedic Procedures; Range of Motion, Articular
PubMed: 26685692
DOI: 10.1007/s00167-015-3939-3 -
Medicine Nov 2015The aim of this study is to determine whether surgery offers protection against early subtalar arthrodesis in displaced intraarticular calcaneal fractures. Systematic... (Meta-Analysis)
Meta-Analysis Review
The aim of this study is to determine whether surgery offers protection against early subtalar arthrodesis in displaced intraarticular calcaneal fractures. Systematic review and meta-analysis: searches of electronic databases 1980 to August 2014, checking of reference lists, hand searching of journals, and contact with experts. Randomized controlled trials (RCTs) in which surgical treatment was compared with nonsurgical treatment of displaced intra-articular calcaneal fractures from 1980 to 2014. The modified Jadad scale was used for trial quality and effective data were pooled for meta-analysis. Study results related to early subtalar arthrodesis were extracted and risk assessment was combined with surgical treatment and nonsurgical treatment. The primary analysis included 4 studies and 966 participants. The estimated overall risk ratio was 4.40 (95% confidence interval 2.67-7.39), indicating the incidence of early subtalar arthrodesis in nonsurgical group is 4.4 times the surgical group. The results showed that surgical treatment was superior to nonsurgical treatment in protection against early subtalar arthrodesis in displaced intra-articular calcaneal fractures (Z = 5.600, P < 0.001).Surgery offers protection against early subtalar arthrodesis in displaced intra-articular calcaneal fractures.
Topics: Arthrodesis; Calcaneus; Foot Injuries; Humans; Intra-Articular Fractures; Subtalar Joint
PubMed: 26559281
DOI: 10.1097/MD.0000000000001984 -
The Journal of Bone and Joint Surgery.... Mar 2015Ankle arthrodesis traditionally has been regarded as the treatment of choice for many patients with end-stage ankle arthritis. However, a major reported risk of ankle... (Review)
Review
BACKGROUND
Ankle arthrodesis traditionally has been regarded as the treatment of choice for many patients with end-stage ankle arthritis. However, a major reported risk of ankle arthrodesis is adjacent-joint degeneration. There are conflicting views in the literature as to the causative link between ankle arthrodesis and progression to adjacent-joint arthritis. Recent studies have challenged the causative link between arthrodesis and adjacent-joint arthritis, purporting that preexisting adjacent-joint arthritis is present in many patients. The aim of the present study was to systematically review the available literature to determine if there is sufficient evidence to support either hypothesis.
METHODS
A literature search of the EMBASE and PubMed/MEDLINE databases (1974 to present) was performed. A total of twenty-four studies were included for review. The studies were reviewed, and the relevant information was extracted, including research methodology, postoperative outcomes in the adjacent joints of the foot, and whether pre-arthrodesis radiographs and medical records were available for analysis.
RESULTS
The twenty-four manuscripts included eighteen clinical studies, five biomechanical studies, and one gait-analysis study. The majority of biomechanical studies showed altered biomechanics in the fused ankle; however, there was no clear consensus as to whether these findings were causes of adjacent-joint arthritis. In studies assessing clinical outcomes, the reported prevalence of subtalar joint arthritis ranged from 24% to 100% and the prevalence of talonavicular and calcaneocuboid arthritis ranged from 18% to 77%. Correlation between imaging findings of arthritis in adjacent joints and patient symptoms was not established in a number of the clinical studies reviewed.
CONCLUSIONS
There is no true consensus in the literature as to the effects of ankle arthrodesis on biomechanics or whether ankle arthrodesis leads to adjacent-joint arthritis. Similarly, a correlation between postoperative imaging findings and clinical presentation in this cohort of patients has not been conclusively demonstrated.
Topics: Ankle Joint; Arthritis; Arthrodesis; Humans; Tarsal Joints
PubMed: 25788309
DOI: 10.2106/JBJS.N.00426