Foot & Ankle
You are looking at 31 - 40 of 60 items
Search for other papers by Nikolaos Gougoulias in
Google Scholar
PubMed
Search for other papers by Hesham Oshba in
Google Scholar
PubMed
Search for other papers by Apostolos Dimitroulias in
Google Scholar
PubMed
Search for other papers by Anthony Sakellariou in
Google Scholar
PubMed
Search for other papers by Alexander Wee in
Google Scholar
PubMed
-
Surgical complications are more common in patients with complicated diabetes (presence of inner organ failure, neuropathy).
-
Of all patients undergoing ankle fracture fixation, approximately 13% are diabetic and 2% have complicated diabetes mellitus.
-
Non-operative management of ankle fractures in patients with complicated diabetes results in an even higher rate of complications.
-
Insufficient stability of ankle fractures (treated operatively, or non-operatively) can trigger Charcot neuroarthropathy, and result in bone loss, deformity, ulceration, and the need for amputation.
-
Rigid fixation is recommended. Hindfoot arthrodesis (as primary procedure or after failed ankle fracture management) can salvage the limb in approximately 80% of patients.
-
Early protected weight bearing can be allowed, provided rigid fixation without deformity has been achieved.
Cite this article: EFORT Open Rev 2020;5:457-463. DOI: 10.1302/2058-5241.5.200025
Search for other papers by José Nuno Ferreira in
Google Scholar
PubMed
Search for other papers by João Vide in
Google Scholar
PubMed
Search for other papers by Daniel Mendes in
Google Scholar
PubMed
Search for other papers by João Protásio in
Google Scholar
PubMed
Search for other papers by Rui Viegas in
Google Scholar
PubMed
Search for other papers by Manuel Resende Sousa in
Google Scholar
PubMed
-
Ankle sprains are one of the most common musculoskeletal injuries, being the most frequent musculoskeletal trauma among athletes.
-
Most of these injuries are successfully treated conservatively; however, up to 70% of patients can develop long-lasting symptoms. Therefore, understanding prognostic factors for an ankle sprain could help clinicians identify patients with poor prognosis and choose the right treatment.
-
A suggested approach will be presented in order to positively identify the factors that should warrant a more aggressive attitude in the initial conservative treatment.
-
There are some prognostic factors linked to a better recovery and outcome; nevertheless, prognostic factors for full recovery after initial ankle sprain are not consistent.
Cite this article: EFORT Open Rev 2020;5:334-338. DOI: 10.1302/2058-5241.5.200019
Search for other papers by Haroon Majeed in
Google Scholar
PubMed
-
Silastic implants for the first metatarsophalangeal joint (MTPJ) have been in use for over 50 years. Initial reports were associated with high failure rates leading to development of new designs that are currently in use.
-
The aim of this article is to review the historical evolution and the outcomes of silastic implants for the treatment of end-stage OA of the first MTPJ. Databases were searched for studies reporting the outcomes of silastic implants for the first MTPJ. Various relevant search terminologies were used. Studies reporting the outcomes of metallic implants or arthrodesis were excluded.
-
The literature search revealed 522 studies, of which 28 were included. Eight studies used single-stemmed implants and 20 used double-stemmed implants for their patients. Twenty-eight studies had a total of 2354 feet with silastic replacements in 1884 patients (1968 to 2003) with an average age of 53 years and the average follow-up was 85.3 months. There were a total of 5.3% (124 feet) failed prostheses. Improvement in pain was reported in 76.6% (1804 feet) with an average patient satisfaction rate of 84%. Radiological changes around the implants were found to be significantly higher with single-stemmed implants (30.3%) compared to the double-stemmed implants (14.7%) (p < 0.05).
-
Significantly more single-stemmed implants failed (11%) than the double-stemmed implants (3.6%) (p < 0.05). Despite the initial reports of failed implants and complications, first- and second-generation silastic implants were associated with high patient satisfaction and pain improvement. Current literature lacks long-term outcomes of implants currently in use.
Cite this article: EFORT Open Rev 2019;4:77-84. DOI: 10.1302/2058-5241.4.180055
Search for other papers by Nikolaos Gougoulias in
Google Scholar
PubMed
Search for other papers by Vasileios Lampridis in
Google Scholar
PubMed
Search for other papers by Anthony Sakellariou in
Google Scholar
PubMed
-
The terminology ‘Morton’s neuroma’ may represent a simplification of the clinical condition as the problem may not be a benign tumour of the nerve, but neuropathic foot pain associated with the interdigital nerve.
-
Foot and ankle pathomechanics leading to metatarsalgia, clinical examination and differential diagnosis of the condition and imaging of the condition, for differential diagnosis, are discussed.
-
Nonoperative management is recommended initially. Physiotherapy, injections (local anaesthetic, steroid, alcohol), cryotherapy, radiofrequency ablation and shockwave therapy are discussed.
-
Operative treatment is indicated after nonoperative management has failed. Neuroma excision has been reported to have good to excellent results in 80% of patients, but gastrocnemius release and osteotomies should be considered so as to address concomitant problems.
-
Key factors in the success of surgery are correct diagnosis with recognition of all elements of the problem and optimal surgical technique.
Cite this article: EFORT Open Rev 2019;4:14-24. DOI: 10.1302/2058-5241.4.180025.
University of Brighton, UK
Search for other papers by Sohail Yousaf in
Google Scholar
PubMed
Brighton and Sussex Medical Schools, UK
Search for other papers by Edward J.C. Dawe in
Google Scholar
PubMed
Search for other papers by Alan Saleh in
Google Scholar
PubMed
Search for other papers by Ian R. Gill in
Google Scholar
PubMed
Search for other papers by Alex Wee in
Google Scholar
PubMed
-
Acute Charcot foot is a diagnostic challenge.
-
The exact pathophysiology is not fully understood.
-
Acute Charcot foot is often present with a history of trauma or cellulitis which does not respond to antibiotics.
-
The condition is best managed within a multidisciplinary team.
-
The mainstay of the treatment is mechanical off-loading and total contact casting.
-
Surgery is reserved for select cases.
Cite this article: EFORT Open Rev 2018;3:568-573. DOI: 10.1302/2058-5241.3.180003
Search for other papers by Andreas F. Mavrogenis in
Google Scholar
PubMed
Search for other papers by Panayiotis D. Megaloikonomos in
Google Scholar
PubMed
Search for other papers by Thekla Antoniadou in
Google Scholar
PubMed
Search for other papers by Vasilios G. Igoumenou in
Google Scholar
PubMed
Search for other papers by Georgios N. Panagopoulos in
Google Scholar
PubMed
Search for other papers by Leonidas Dimopoulos in
Google Scholar
PubMed
Search for other papers by Konstantinos G. Moulakakis in
Google Scholar
PubMed
Search for other papers by George S. Sfyroeras in
Google Scholar
PubMed
Search for other papers by Andreas Lazaris in
Google Scholar
PubMed
-
The lifetime risk for diabetic patients to develop a diabetic foot ulcer (DFU) is 25%. In these patients, the risk of amputation is increased and the outcome deteriorates.
-
More than 50% of non-traumatic lower-extremity amputations are related to DFU infections and 85% of all lower-extremity amputations in patients with diabetes are preceded by an ulcer; up to 70% of diabetic patients with a DFU-related amputation die within five years of their amputation.
-
Optimal management of patients with DFUs must include clinical awareness, adequate blood glucose control, periodic foot inspection, custom therapeutic footwear, off-loading in high-risk patients, local wound care, diagnosis and control of osteomyelitis and ischaemia.
Cite this article: EFORT Open Rev 2018;3:513-525. DOI: 10.1302/2058-5241.3.180010
Search for other papers by Manuel Monteagudo in
Google Scholar
PubMed
Search for other papers by Pilar Martínez de Albornoz in
Google Scholar
PubMed
Search for other papers by Borja Gutierrez in
Google Scholar
PubMed
Search for other papers by José Tabuenca in
Google Scholar
PubMed
Search for other papers by Ignacio Álvarez in
Google Scholar
PubMed
-
Plantar fasciopathy is very prevalent, affecting one in ten people in their lifetime.
-
Around 90% of cases will resolve within 12 months with conservative treatment.
-
Gastrocnemius tightness has been associated with dorsiflexion stiffness of the ankle and plantar fascia injury.
-
The use of eccentric calf stretching with additional stretches for the fascia is possibly the non-operative treatment of choice for chronic plantar fasciopathy.
-
Medial open release of approximately the medial third of the fascia and release of the first branch of the lateral plantar nerve has been the most accepted surgical treatment for years.
-
Isolated proximal medial gastrocnemius release has been reported for refractory plantar fasciopathy with excellent results and none of the complications of plantar fasciotomy.
Cite this article: EFORT Open Rev 2018;3:485-493. DOI: 10.1302/2058-5241.3.170080.
Search for other papers by Haroon Majeed in
Google Scholar
PubMed
Search for other papers by James Barrie in
Google Scholar
PubMed
Search for other papers by Wendy Munro in
Google Scholar
PubMed
Search for other papers by Donald McBride in
Google Scholar
PubMed
-
The aim of this article is to systematically identify and analyse research evidence available to compare the outcomes of minimally invasive reduction and percutaneous fixation (MIRPF) versus open reduction and internal fixation (ORIF) for displaced intra-articular calcaneal fractures.
-
Articles from 2000 to 2016 were searched through MEDLINE (PubMed), Cochrane Library, Embase, ScienceDirect, Scopus and ISI Web of Knowledge using Boolean logic and text words. Of the 570 articles identified initially, nine were selected including three randomized controlled trials and six retrospective comparative studies.
-
All nine studies had a total of 1031 patients with 1102 displaced intra-articular calcaneal fractures. Mean follow-up was 33 months. Of these, 602 (54.6%) were treated with MIRPF and 500 (45.4%) were treated with ORIF.
-
Overall incidence of wound-related complications in patients treated with MIRPF was 4.3% (0% to 13%) compared with 21.2% (11.7% to 35%) in the ORIF group
-
Functional outcomes were reported to be better in the minimally invasive group in all studies; however, the results did not reach statistical significance in some studies. All the studies had methodological flaws that put them at either ‘unclear’ or ‘high’ risk of bias for multiple domains.
-
Overall quality of the available evidence is poor in support of either surgical technique due to small sample size, flaws in study designs and high risk of bias for various elements. Individual studies have reported minimally invasive techniques to be an effective alternative with lower risk of wound complications and better functional outcomes.
Cite this article: EFORT Open Rev 2018;3:418-425. DOI: 10.1302/2058-5241.3.170043
Search for other papers by Farhan Syed in
Google Scholar
PubMed
Search for other papers by Anthony Ugwuoke in
Google Scholar
PubMed
-
Total ankle arthroplasty offers a reasonable alternative to ankle arthrodesis in carefully selected patients.
-
It is debatable whether rheumatoid arthritis patients have better outcomes compared with those who have ankle arthroplasty for either primary osteoarthritis or post-traumatic arthritis.
-
Aseptic loosening and infection are the most common complications requiring revision.
-
It is worth noting that some of the best survival rates are seen in the surgeon-designer case series.
-
The uncemented mobile or fixed bearing prostheses have better outcomes compared with their older counterparts.
-
There is no convincing evidence to suggest superiority of one design over another among the currently available prostheses.
-
Ankle arthroplasty surgery has a steep learning curve; the prosthesis choice should be driven by the surgeon’s training and experience.
Cite this article: EFORT Open Rev 2018;3:391-397. DOI: 10.1302/2058-5241.3.170029
Search for other papers by Önder İ. Kılıçoğlu in
Google Scholar
PubMed
Search for other papers by Mehmet Demirel in
Google Scholar
PubMed
Search for other papers by Şamil Aktaş in
Google Scholar
PubMed
-
Although there are various types of therapeutic footwear currently used to treat diabetic foot ulcers (DFUs), recent literature has enforced the concept that total-contact casts are the benchmark.
-
Besides conventional clinical tests and imaging modalities, advanced MRI techniques and high-sensitivity nuclear medicine modalities present several advantages for the investigation of diabetic foot problems.
-
The currently accepted principles of DFU care are rigorous debridement followed by modern wound dressings to provide a moist wound environment. Recently, hyperbaric oxygen and negative pressure wound therapy have aroused increasing attention as an adjunctive treatment for patients with DFUs.
-
For DFU, various surgical treatments are currently available, including resection arthroplasty, metatarsal osteotomies and metatarsal head resections.
-
In the modern management of the Charcot foot, surgery in the acute phase remains controversial and under investigation. While conventional fixation techniques are frequently insufficient to keep alignment postoperatively, superconstruct techniques could provide a successful fixation.
-
Retrograde intramedullary nailing has been a generally accepted method of achieving stability. The midfoot fusion bolt is a current treatment device that maintains the longitudinal columns of the foot. Also, Achilles tendon lengthening remains a popular method in the management of Charcot foot.
Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170073
