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Equinus Deformity
Published in Benjamin Joseph, Selvadurai Nayagam, Randall T Loder, Anjali Benjamin Daniel, Essential Paediatric Orthopaedic Decision Making, 2022
Christopher Prior, Nicholas Peterson, Selvadurai Nayagam
Correction of equinus Serial manipulation and castingSofttissue procedures Revision of Achilles tendon lengtheningPosterior ankle releasePlantar fascia releaseGradual correction of ankle equinus With a circular external fixator with or without foot osteotomiesAnterior distal tibial hemiepiphyseodesisArthrodesis Triple arthrodesis (Lambrinudi)Ankle arthrodesis
The rheumatoid foot
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Patricia Allen, Jasdeep Giddie
Ankle arthrodesis has been the gold standard surgical treatment for many years. The ability of the hindfoot to compensate for the loss of movement following tibiotalar arthrodesis may be limited in rheumatoid patients due to stiffness of the remaining hindfoot joints. This, in turn, will increase stresses on adjacent joints as well as increase the amount of forefoot overload. The long period of immobilisation following an arthrodesis, requiring the use of ambulatory aids, can be a challenge for patients with upper extremity involvement, although this can be minimised with an early weight-bearing protocol.
Surgery of the Ankle
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Matthew Welck, Laurence James, Dishan Singh
Arthrodesis can be performed arthroscopically (see ‘Ankle arthroscopy’ p. 374) or open. Arthroscopic ankle arthrodesis has been shown to have equivalent union rates with shorter hospital stay; however, it is more difficult to correct deformity. Open ankle arthrodesis is usually via an anterior approach (see ‘Ankle arthroplasty’ p. 371). The lateral transmalleolar approach may be used if soft tissues determine it, or if the subtalar joint is also to be arthrodesed (tibio-talo-calcaneal arthrodesis). Where possible the fibula is preserved for an isolated ankle arthrodesis to provide increased surface and vascularity for fusion and to enable potential conversion to arthroplasty in the future. Internal fixation is with crossed or parallel screws and/or plates for isolated ankle arthrodesis. Screws, plates or intramedullary nails are used for tibio-talo-calcaneal fusion. It is essential to obtain good hold and adequate compression (Figure 13.1). Thorough preparation of all joint surfaces is vital. This is achieved by removal of remaining articular cartilage and exposure of subchondral bleeding cancellous bone to aid biological union.
Are Patient Reported Outcome Measurement Information System scales responsive in patients attending physical therapy with foot and ankle diagnoses?
Published in Physiotherapy Theory and Practice, 2023
Christopher Neville, Judith Baumhauer, Jeff Houck
This sample of patients referred to physical therapy from an academic foot and ankle orthopedic clinic reported low levels of function (average = 38.5 ± 8.8) but less severe self-reported PI (average = 56.8 ± 8.8). A PF score around 38 suggest that patients perceive “some difficulty” with chores or going up and down stairs but “quite a lot of difficulty” when doing two hours of physical labor (Rothrock, Amtmann, and Cook, 2020). A PI score around 57 suggest that patients report pain interfering with day-to-day activities or things they do for fun only “a little bit.” When compared to 88 patients who underwent an ankle arthrodesis procedure, this study sample had comparable baseline function (PF 36.5 ± 6.1) but less pain (PI 63.2 ± 7.2) (Kohring et al., 2020). These types of comparisons across diagnoses can be helpful when planning physical therapy treatment.
Effectiveness of ankle fusion in patients with hemophilia, advanced ankle degeneration, and unbearable pain for whom nonsurgical and surgical treatments have been ineffective
Published in Expert Review of Hematology, 2021
E. Carlos Rodriguez-Merchan, Carlos A. Encinas-Ullan, Primitivo Gomez-Cardero
In 2013, Bluth et al analyzed the outcomes of 57 ankle arthrodeses performed in 45 individuals over a 40-year interval (1971–2010) [22]. The mean follow-up was 6.6 years, and there were no early intraoperative or postoperative adverse events associated with the tibiotalar fusion. The comprehensive nonunion rate was 10.4% for tibiotalar fusion and 8.3% for subtalar fusion, which decreased to 3.7% and 5.6%, respectively, following the implementation of new surgical operations in 1995. None of the aforementioned nonunions required revision surgery. The modified AOFAS scale showed that, after a mean period of 7.2 years following the surgical procedure, 75% of the patients experienced no pain in the operated ankle. The remaining 25% had a mean pain level of 3 (on a scale of 0 [no pain] to 10 [maximum pain]); however, none of the patients presented ankle misalignment. The patients had no significant activity restrictions or abnormal gait and were able to walk long distances. The conclusion was that ankle arthrodesis effectively alleviated pain and yielded good functional results, proving to be an adequate treatment for advanced hemophilic ankle arthropathy [22].
Recent advances in surgery and its perioperative treatment in people with hemophilia
Published in Expert Review of Hematology, 2021
Wang et al. have analyzed the outcomes of 14 ankle arthrodeses (fusions) utilizing the Ilizarov external fixator in treating advanced hemophilic ankle arthropathy [27]. All patients accomplished radiographic osseous fusion. The time to consolidation was 12.9 weeks on average. In two subjects, there was superficial infection of the pin tracks. In one patient, subtalar ostearthritis was encountered. The following parameters analyzed improvement after surgery: (a) The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score; (b) the VAS (visual analog scale) score; and (c) the physical component summary and the mental component summary of the short-form 12-item questionnaire score (SF-12). Every patient was pleased with the operation. Therefore, ankle fusion with an Ilizarov external fixator seemed to be efficacious, and secure. In fact, it can be an alternative for PWH with advanced arthropathy of the ankle. Other way to perform ankle arthrodesis is by means of arthroscopic surgery [28].