Treatment of Malunited Calcaneal Fracture With Posttraumatic Subtalar Osteoarthritis Using Lateral Endoscopic Calcaneoplasty With Posterior Arthroscopic Subtalar Arthrodesis

Malunion of calcaneal fractures is a common complication after improper nonoperative treatment. It may develop into posttraumatic subtalar osteoarthritis, lateral calcaneal wall prominence, and severe foot deformities. This Technical Note reports the technical aspects of lateral endoscopic calcaneoplasty with posterior arthroscopic subtalar arthrodesis for the treatment of malunited calcaneal fracture with lateral calcaneal wall prominence and posttraumatic subtalar osteoarthritis. This technique was chosen because it can reduce the risk of wound complication compared with a conventional lateral extensile approach. This Technical Note describes the use of the technique in a patient with prone position. This offers the advantages of easier access to the lateral surface of the calcaneus and posterior facet of the subtalar joint, and is less invasive to the soft tissue envelope on the lateral side of the foot. Moreover, the concomitant bone void area of the subtalar joint can be dealt with by an arthroscopic procedure

Effects of age and gender on gait characteristics using a wearable foot inertial-sensor device assessment

Category: Gait studies Introduction/Purpose: This study is to determine the effects of age and gender on the gait characteristics using a wearable foot inertial-sensor assessment in the patients with foot and ankle conditions. Methods: There were 53 patients with foot and ankle-related conditions (38 females and 15 males, mean age: 51.4 (±14.0) years) who were collected for this study. For all patients, the clinical assessments, including the evaluations with validated patient- reported outcome using visual analogue scale foot and ankle (VAS-FA) score and health-related quality of life using validated Short Form-36 (SF-36), diagnoses, and gait characteristics assessment using a wearable foot device with the Micro electro mechanical systems (MEMS) inertial-sensor technology during patients’ walking trial for a distance of 10-meter at their self-selected speed. This device captures the gait parameters as distance walked, step counts or length, cadence, and walking speed. Foot Pod output can be wireless synced to a compatible smartphone or tablet. Pearson’s correlation coefficient r or Analysis of variance (ANOVA) tests were used to express the correlation between age and gait parameters or to compare the parameters between male and female groups. Results: There were insignificantly negative Pearson’s correlation coefficients r between age and walking speed or between age and cadence (P>0.05). Male patients had significantly higher maximum walking speed (P=0.015) and step length than female patients (P=0.011). Conclusion: In contrary to the previous study, the present study demonstrated that higher age had no effect on the reduction of walking speed. However, the effects of gender on gait characteristics were proved as higher maximum walking speed and step length in men

The relationships between patient-reported outcome, quality of life, and gait characteristics using a wearable foot inertial-sensor assessment in patients with foot and ankle conditions

Category: Gait analysis Introduction/Purpose: The purpose of this study was to report the relationships between validated patient-reported outcome, health-related quality of life, and gait characteristics using a wearable foot inertial-sensor assessment in patients with foot-ankle conditions. In addition, the inter-metrics correlations were analyzed to determine the relationships between each spatiotemporal or gait parameter. Methods: Fifty-three patients with foot-ankle conditions (38 female/15 male, aged 21–75 years) were collected for this study. Clinical assessments, including evaluations with validated patient-reported outcomes using the visual analogue scale foot and ankle (VAS-FA) score, health-related quality of life using the validated Short Form-36 (SF-36)9, and gait characteristics assessment using a wearable foot inertial-sensor device, were performed and recorded in each patient. Results: Negative correlation between physical component summary (PCS) and maximal cadence only showed a significant value at Pearson’s correlation coefficient (r) = –0.308, P = 0.025. Positive correlations (r) were found between mean walking speed and mean cadence (r = 0.776, P < 0.001) and between maximal walking speed and mean step length (r = 0.498, P < 0.001). Negative correlations (r) were found between mean cadence and mean step length (r = –0.491, P < 0.001) and between maximal cadence and mean step length (r = –0.355, P = 0.009). Conclusion: Regarding relationships among several spatiotemporal parameters and patient-reported outcome measures, cadence is the only parameter that was significantly negatively related with PCS in health-related quality of life. Based on inter-metrics relationships, increased cadence might be used to maintain walking speed as a compensatory mechanism in patients with foot- ankle conditions

Patient Satisfaction versus Patient Reported Outcomes

Category: Other Introduction/Purpose: Several researches focused on patient reported outcomes (PROs), however, little is known about the actual correlation between the patient satisfaction and PROs. The present study is to determine the correlation between patient satisfaction and PROs. Methods: A total of 35 patients with foot and ankle disability participated in this study to complete the data in terms of the patient satisfaction score and PROs. All of them were treated by a single foot and ankle surgeon. The Thai patient satisfaction score or Foot and Ankle Satisfaction Score [FASS] (0 [worst] -100 [best]) consisted of 4 items regarding patient’s perspectives as 1) symptoms, 2) function, 3) other complaints, and 4) recommendation of his/her treatment for other patients. PROs measures consisted of validated Thai visual analogue scale foot and ankle (VASFA) (0 [worst] -100 [best]) and Thai Short Form-36 (SF-36) (0 [worst] -100 [best]). Results: Mean total FASS was 92.0 ± 11.8, 87.7 ± 17.0, 98.6 ± 6.0, 98.6 ± 8.5 and for the items: symptoms, function, other complaints, and recommendation of his/her treatment for other patients, respectively. Mean total FASS was 94.2 ± 6.8. Mean VASFA was 67.7 ± 18.3. Mean SF-36 was 82.7 ± 10.7.There were no significant correlations between mean total FASS and PROs (VASFA [p-value < 0.05], SF-36 [p-value <0.05]). There were no significant correlations between mean FASS in all items and PROs (VASFA, SF-36) with all p-values < 0.05. The significant correlation was found between VASFA and SF-36 (Pearson correlation coefficient = 0.734; p-value<0.01). Conclusion: One of the successful treatment results is the improvement of patient satisfaction. Even if several researches focused on the assessment of PROs to achieve the successful outcome, this kind of measures was no significant correlation with patient satisfaction. PROs were not able to reflect the patient satisfaction following treatments. Patient satisfaction may be related to other parameters, in addition to the PROs, such as the patient expectation, the post-treatment level of physician-patient relationship, the patient’s confidence in his/her physician capability, etc. Further study is needed to clarify these factors

Factors Affecting the Formation of Post-Traumatic Subtalar Arthritis Following the Intra-Articular Calcaneal Fracture

Category: Hindfoot Introduction/Purpose: The present study was performed to prospectively follow up the arthritic changes of subtalar joint following the intra-articular calcaneal fractures in 38 patients. Methods: A total of 38 patients with intra-articular calcaneal fractures were prospectively studied with a mean follow-up as 17.4 months. Conventional fixations were performed in 27 patients by several surgeons. Arthroscopic-assisted reduction and internal fixations were performed in 11 patients by a single foot-ankle fellowship trained surgeon. Baseline data, including postoperatively radiographic alignment, arthritic changes, osteochondral lesion characteristics via modified Outerbridge classification and locations of lesions at calcaneal/talar side, and arthroscopic treatment procedures, were collected. Statistical analyses were performed to compare the prevalence and characteristics of the osteochondral lesions between the group with or without post-traumatic arthritic changes. Results: Based on the interpretation of radiographic parameters by a single foot-ankle fellowship trained surgeon, there were 8 patients (21.1%) showed the arthritic progression. Acceptable reduction (fracture step/gap < 2 mm) was found in 31 patients (81.6%) in overall. No significant difference of the quality of fracture reduction was found among the groups (none, mild, significant progression of arthritis). In subgroup analysis in patients with arthroscopic-assisted reduction and internal fixations, there was no significant difference of the prevalence of osteochondral lesions among the groups. Conclusion: The prevalence of post-traumatic subtalar arthritis was found in X-rays around one in 5 patients with the intra- articular calcaneal fractures in short-term follow-up. No definitive factors affecting arthritic changes were found in this study. Further investigation is needed to identify these factors in longer term of follow-up

The Osteochondral Lesions of Talus in the Subtalar Joint following the Intra-articular Calcaneal Fractures

Category: Hindfoot, Trauma Introduction/Purpose: The cartilage delamination was frequently associated at the posterior articular facet of calcaneus following displaced intra-articular calcaneus fractures. However, little is known about the osteochondral lesion of the posterior facet of talus (OLPT) following an intraarticular calcaneal fracture. This study is to report the prevalence and characteristics of these lesions. Methods: This study retrospectively reviewed 34 patients who had the intraarticular calcaneal fractures. The CT scan was used to preoperatively evaluate the fracture type, the presence, area of lesion, and severity of OLPT following the intraarticular calcaneal fracture. These data were recorded in accordance with Akiyama mapping system, Sanders, and Ferkel classification. Results: The OLPT was found as 94.1% from a total of 34 patients. The most common area of OLPT was anterocentral part (26.5%) of posterior facet of talar surface in accordance with Akiyama mapping system. The most common fracture type was Sanders IV (44.1%). The most common severity of OLPT was Ferkel grade I (82.4%). The OLPT was predominantly associated in Sanders type IV fractures (46.9%; p = 0.412). Conclusion: This study demonstrated the high prevalence of OLPT following the intra-articular calcaneal fracture. Most lesions were mild severity; however, there was a tendency of the association of lesion occurrence with higher grade of fracture severity. The OLPT may play an important role in the formation of post-traumatic osteoarthritis of subtalar joint which can be found following the intraarticular calcaneal fracture. The preoperative evaluation of this lesion is recommended via CT. The lesion treatment may be encouraged to be performed during calcaneal fracture fixation for the reduction of post-traumatic osteoarthritis formation