Osteotomies around the knee alter alignment of the ankle and hindfoot: a systematic review of biomechanical and clinical studies

Purpose: Emerging reports suggest an important involvement of the ankle/hindfoot alignment in the outcome of knee osteotomy; however, a comprehensive overview is currently not available. Therefore, we systematically reviewed all studies investigating biomechanical and clinical outcomes related to the ankle/hindfoot following knee osteotomies. Methods: A systematic literature search was conducted on PubMed, Web of Science, EMBASE and Cochrane Library according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered on international prospective register of systematic reviews (PROSPERO) (CRD42021277189). Combining knee osteotomy and ankle/hindfoot alignment, all biomechanical and clinical studies were included. Studies investigating knee osteotomy in conjunction with total knee arthroplasty and case reports were excluded. The QUality Appraisal for Cadaveric Studies (QUACS) scale and Methodological Index for Non-Randomized Studies (MINORS) scores were used for quality assessment. Results: Out of 3554 hits, 18 studies were confirmed eligible, including 770 subjects. The minority of studies (n = 3) assessed both high tibial- and distal femoral osteotomy. Following knee osteotomy, the mean tibiotalar contact pressure decreased (n = 4) except in the presence of a rigid subtalar joint (n = 1) or a talar tilt deformity (n = 1). Patient symptoms and/or radiographic alignment at the level of the ankle/hindfoot improved after knee osteotomy (n = 13). However, factors interfering with an optimal outcome were a small preoperative lateral distal tibia angle, a small hip–knee–ankle axis (HKA) angle, a large HKA correction (>14.5°) and a preexistent hindfoot deformity (>15.9°). Conclusions: Osteotomies to correct knee deformity alter biomechanical and clinical outcomes at the level of the ankle/hindfoot. In general, these changes were beneficial, but several parameters were identified in association with deterioration of ankle/hindfoot symptoms following knee osteotomy

Predictive value of radiographic measurements compared to clinical examination.

BACKGROUND: The use of metatarsal osteotomies in the treatment of metatarsalgia is controversial, as is the best location of the osteotomies to prevent transfer metatarsalgia. To determine if metatarsal osteotomies used in forefoot reconstruction to restore the normal anatomical curve would decrease the risk of transfer metatarsalgia, the clinical outcomes of such osteotomies were correlated with the preoperative planning. MATERIALS AND METHODS: Between 2000 and 2005, 63 patients (73 feet) with persistent metatarsalgia had forefoot reconstructions that included one or more Weil osteotomies designed to restore the theoretically ideal foot morphotype described by Maestro et al. and based on the relative lengths of the lesser rays. RESULTS: The mean preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score of 36.2 improved to 82.2 postoperatively. Sixty-two (85%) of the 73 feet were pain-free after surgery. CONCLUSION: In spite of careful preoperative planning, it was difficult to obtain the ideal foot type, and the frequency of transfer metatarsalgia in our patients was similar to that reported in the literature. A significant (p = 0.03) relationship was identified between the amount of preoperative instability and the risk of developing transfer metatarsalgia. Preoperative dorsoplantar standing radiographs, although helpful in planning surgery to obtain appropriate metatarsal lengths, should not be the only method used for operative planning

Hallux varus: classification and treatment

Appropriate treatment for hallux varus requires comprehensive radiographic and systematic clinical assessment to identify the involved factors. A classification scheme must incorporate many variables in order to determine the best approach to correcting the deformity. This article focuses on iatrogenic hallux varus following bunion surgery, but the same principles apply to other causes of acquired hallux varus

The translating Weil osteotomy in the treatment of an overriding second toe: A report of 25 cases

We present a retrospective study of 25 feet operated for an overriding second toe deformity, whether or not associated with hallux valgus deformity and metatarsalgia. The surgical technique of a medial sliding and decompressive Weil osteotomy is described. All patients, operated between January 2002 and December 2007 for this condition in our institution, were reviewed clinically and radiologically. The mean AOFAS score improved with 47.6 points from 45.9 to 93.5. The theoretical advantages of such a translation Weil osteotomy are discussed trying to clarify the previously described pathologic anatomy of this condition

Stress fracture of the navicular bone.

Navicular stress fractures in athletes are notoriously difficult to diagnose, resulting in an average delay in diagnosis of 4 months after the onset of symptoms. There are various reasons for this delay. Navicular stress fractures are characterised by an unspecific symptomatology combined with a paucity of physical findings. Furthermore there is difficulty in visualising stress fractures on plain radiographs, with only 33% of fractures visible on the initial films. There are several factors contributing to this: the vast majority (83%) of fractures are incomplete fractures at initial presentation and those that are complete are often non displaced and not visible because bony resorption at the fracture site requires 10 days to 3 weeks to occur. For this reason, 3-phase Tc99bone scan is the examination of choice, with almost 100% sensitivity after 72 hours. A favourable outcome can be expected with early diagnosis and proper management. Delayed diagnosis and subsequent improper management can lead to a poor outcome with adverse effects on the activities of the athlete. Treatment consists of 6-8 weeks in a non weight bearing cast for incomplete fractures and non displaced complete fractures. Surgical treatment consists of screw fixation with or without bone graft. Some authors advocate aggressive treatment of non displaced complete fractures. It is imperative to maintain a high index of suspicion when treating patients, especially sprinting athletes, who present with vague mid-foot or ankle pain associated with weight bearing

Technique and early experience with posterior arthroscopic tibiotalocalcaneal arthrodesis.

Tibiotalocalcaneal arthrodesis is indicated for pain relief in patients with combined arthritis of the ankle and subtalar joint. An arthroscopic posterior approach was designed to improve upon traditional methods by using a minimally invasive technique. The technique involves prone positioning of the patient, one anterolateral and two posterolateral portals, and arthroscopic debridement of both the tibiotalar and posterior talocalcaneal joint. Stabilisation is obtained with a retrograde intramedullary nail, with static interlocking. This article presents illustrative cases and discusses some of the technical advantages and disadvantages over conventional open surgery. For surgeons familiar with posterior ankle or subtalar arthroscopy, this minimally invasive debridement and nailing appears to offer superior exposure, high patient satisfaction and lower postoperative morbidity than traditional methods; fusion is encouraged by preserving the medullary reaming material at the site of the fusion

Technique et expérience initiale de l'arthrodèse tibio-talocalcanéenne postérieure par arthroscopie

Tibiotalocalcaneal arthrodesis is indicated for pain relief in patients with combined arthritis of the ankle and subtalar joint. An arthroscopic posterior approach was designed to improve upon traditional methods by using a minimally invasive technique. The technique involves prone positioning of the patient, one anterolateral and two posterolateral portals, and arthroscopic debridement of both the tibiotalar and posterior talocalcaneal joint. Stabilisation is obtained with a retrograde intramedullary nail, with static interlocking. This article presents illustrative cases and discusses some of the technical advantages and disadvantages over conventional open surgery. For surgeons familiar with posterior ankle or subtalar arthroscopy, this minimally invasive debridement and nailing appears to offer superior exposure, high patient satisfaction and lower postoperative morbidity than traditional methods; fusion is encouraged by preserving the medullary reaming material at the site of the fusion. © 2010 Elsevier Masson SAS

A new surgical procedure for iatrogenic hallux varus: reverse transfer of the abductor hallucis tendon: a report of 7 cases

Iatrogenic hallux varus is a possible complication of hallux valgus surgery following Mc Bride or Scarf osteotomy, with or without Akin osteotomy of the first phalanx. It may also occur following chevron osteotomy or Keller's procedure. One possibility for surgical revision of iatrogenic hallux varus is reconstruction of the lateral stabilising soft-tissue components of the first metatarsophalangeal joint. Until now, only dynamic tendon transfers, possibly combined with interphalangeal fusion, have been described. The aim of our study was to develop a static, anatomic reconstruction procedure. A new surgical technique of ligamentoplasty using the abductor hallucis tendon is described. The new method was applied in 7 feet (5 patients) with a mean follow-up over two years. Hallux varus deformities were operated by transplantation of the abductor hallucis tendon. Subsequent radiographs showed correction of most of the factors considered to be responsible for the iatrogenic deformity. The American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal (MTP-IP) score improved from 61 to 88. This new technique is a reliable, anatomic reconstruction with use of the tendon involved in the pathogenesis of the hallux varus deformity. No other functional tendon is used

Plantar pressure relief using a forefoot offloading shoe.

AIM: To assess the effectiveness of the Barouk(®) second-generation postoperative forefoot relief shoes during appropriate use of the shoe on healthy subjects. MATERIALS AND METHODS: A convenience sample of 35 volunteer subjects (17 women, 18 men) was recruited to participate in this study. Dynamic foot loading was evaluated with inshoe plantar pressure measurements. Subjects were asked to walk two trials at a self-selected speed: (a) in their mass-produced shoes to assess baseline pressure values, defined as 100% and (b) with the Barouk(®) postoperative shoe on the right foot and their own shoe on the left side. Data analysis was tested for statistical differences with paired Student's t-tests (with p<0.05 as a significance level). RESULTS: The Barouk(®) second-generation postoperative forefoot relief shoes relieved forefoot pressure in all trials. For all 35 volunteers, there was a 79-96% mean peak pressure reduction (p<0.001) of the forefoot except for the fifth metatarsal head during appropriate use of the postoperative shoe. In contrast to the results for the forefoot, a significant increase of the peak pressure values was observed in the heel region. Similar findings were observed for the pressure-time integral values. CONCLUSION: The data of our study provide evidence that the second-generation Barouk(®) shoe relieve pressure of the forefoot with appropriate use