We report a case of 20 year-old man who had unusual equinus and checkrein deformity following dislocation of his right ankle joint. He had been treated with distal tibiofibular screw fixation and external fixation. After removal of external fixator, he had suffered from progressive deformity of foot and ankle. Widening of distal tibiofibular joint and medial clear space was found on radiograph and it was revealed that posterior tibial tendon had been dislocated and incarcerated into the distal tibiofibular joint on MRI. We corrected the deformity with excision of incarcerated posterior tibial tendon, adhesiolysis and lengthening of flexor hallucis longus tendon, reconstruction of deltoid ligament and flexor digitorum longus tendon transfer.
Animals ; Ankle ; Ankle Joint ; Dislocations ; External Fixators ; Foot ; Foot Deformities, Acquired ; Joint Dislocations ; Ligaments ; Tendon Transfer ; Tendons

No abstract available.
Aged ; Arthritis, Rheumatoid/*diagnosis/pathology ; Female ; Foot Deformities, Acquired/*diagnosis/pathology ; Humans ; Metatarsophalangeal Joint/*pathology/radiography ; Tomography, X-Ray Computed

The foot drop functional electrical stimulation (FES) system consisting of various sensors has been widely applied to the disease of the foot drop. However, the current system is limited to the research on walking on the ground and ignores other important actions of foot in one's daily life, such as walking up and down the stairs, squatting and lying down, etc. In this work, we applied the dual axis angle sensor to the system of the foot drop FES for the first time. Such a system can not only stimulate the foot drop during normal walking, but also identify squatting, sitting, and lying down etc. and furthermore, the system can switch off automatically. In the meanwhile, it can also detect falls and other dangerous actions. The accuracy of our system can achieve 100%, 81.9%, 95.8%, 99.0% and 66.9% for normal walking, sitting-standing, walking up the stairs, walking down the stairs and squatting-standing respectively.
Adult ; Biosensing Techniques ; instrumentation ; methods ; Electric Stimulation ; instrumentation ; methods ; Equipment Design ; Female ; Foot Deformities, Acquired ; therapy ; Humans ; Male ; Middle Aged ; Young Adult

OBJECTIVETo evaluate clinical effect of neurotomy of muscular branch of tibial nerve for the treatment of equinovarus caused by cerebral palsy.

METHODSFifty-two cases of equinovarus caused by cerebral palsy were treated with neurotomy of muscular branch of tibial nerve. The male was 33 (38 feet) and the female 19 (26 feet) with the average age of 7.8 years old (from 6 to 10). The muscular tension according to Ashworsh grade, 34 cases were grade III and 18 cases were grade IV. The ankle clonus was positive in 42 cases.

RESULTSAll cases were followed up for 1-3 years with the average of 2.6 years. The spastic gait of cases had obviously improved and abnormity had no recurred. According to corrective degree of abnormity and satisfactive condition of patients, evaluation of the effect were excellent in 32 cases, good in 14, poor in 6.

CONCLUSIONNeurotomy of muscular branch of tibial nerve is the safe and effective method for the treatment of equinovarus caused by cerebral palsy.

Adolescent ; Cerebral Palsy ; complications ; Child ; Clubfoot ; surgery ; Female ; Follow-Up Studies ; Foot Deformities, Acquired ; surgery ; Humans ; Male ; Muscle, Skeletal ; innervation ; surgery ; Neurosurgical Procedures ; Tibial Nerve ; surgery ; Treatment Outcome

OBJECTIVETo explore the applications of ipsilateral reverse fascial pedicled posterolateral lower leg flap in foot defect repair.

METHODSA fasciocutaneous flap was designed over the gastrocnemius muscle to repair the defects in the foot or the lower third of the leg. The flap was based on a perforator branch between the lateral malleolus and the Achilles tendon, coming from the vessel network of the ankle as well as the deep fascia.

RESULTSThis method was used in 6 cases, including 2 children of 5-6 years old. All the flaps survived without necrosis and venous congestion.

CONCLUSIONSThe operation is simple and a large flap over the whole gastrocnemius muscle can be raised without sacrifice of a main blood vessel. It is an excellent method for repair of the defects in the heel, medial and lateral malleolus, dorsum pedis and the lower third of the leg.

Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Foot Deformities, Acquired ; surgery ; Humans ; Male ; Skin Transplantation ; methods ; Surgery, Plastic ; methods ; Surgical Flaps ; Treatment Outcome

OBJECTIVETo analyze the incidence, clinical features, deformity categories and orthopedic treatment of foot and ankle deformities caused by spinal bifida.

METHODSThe charts of the patients received surgical treatment between January 1990 and July 2009 were studied retrospectively, and the data were analyzed.

RESULTSOne hundred and seven cases of foot and ankle deformities caused by spinal bifida received surgical treatment and were included. There were 44 male and 63 female patients. The average age was 17.7 years (range, 1.3 - 52.0 years). And 50.5% (54/107) of cases were over 18 years old and had spinal bifida occulta, and the other 49.5% had spinal bifida manifesta. There was only one case of thoracic spinal bifida (T(3-8)), while the other 106 cases had lumbosacral vertebrae cleft (mainly L(3) to Sacrum). Among a total of 165 feet, unilateral involvement was found in 49 cases (22 cases on the left side, 27 cases on the right side), bilateral involvement in 58 cases. Combined ankle-foot deformities included 76 varus talipes, 23 talipes valgus, 15 flail feet, and 51 other foot deformities. Other site deformities, as a result of spinal bifida, included knee flexion or hyperextension deformity in 4 cases, hip deformity (hip adduction, flexion, or hip dislocation, pelvic tilt, lower extremity discrepancy, etc.) in 17 cases, and urinatory dysfunction and defecation in 30 cases. Twenty-nine of 54 cases with spinal bifida occulta failed to be diagnosed in other hospitals and the misdiagnosed rate reached 53.7% (29/54). Corrective surgery was performed in only 26 patients. And 50.5% (54/107) of patients (over 18 years old) had severe foot and ankle deformities due to a failure of prior surgical treatment.

CONCLUSIONSSpinal bifida is the most commonly found in the lumbosacral vertebrae. Although the main pathogenesis is developmental abnormalities of spinal cord and nerve, the secondary deformity is usually located on the foot and ankle. Some young orthopedic surgeons may not have enough awareness and treatment experience about this disease due to over-specialty of the orthopaedics, so the delay of early diagnosis and treatment is often found and many severe foot and ankle deformities occur.

Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Foot Deformities, Acquired ; diagnosis ; etiology ; surgery ; Humans ; Infant ; Male ; Middle Aged ; Orthopedic Procedures ; Retrospective Studies ; Spinal Dysraphism ; complications ; Young Adult

A 7-yr-old girl presented with progressive shortening of the right upper arm and limitation of shoulder motion. Pseudohypoparathyroidism associated with Albright's hereditary osteodystrophy was diagnosed by biochemical, hormonal and radiographic studies. Her condition was complicated by severe humerus varus on the right side. Proximal humeral valgization osteotomy and concomitant humeral lengthening resulted in an improvement of the shoulder joint motion and activity in daily life.
Bone Diseases/*complications/*diagnosis ; Bone Diseases, Developmental/diagnosis ; Bone Lengthening ; Child ; Female ; Foot/radiography ; Hand/radiography ; Humans ; Humerus/*radiography ; Joint Deformities, Acquired/diagnosis ; Osteotomy ; Pseudohypoparathyroidism/*complications ; Time Factors

BACKGROUND: The Maasai are the most widely known African ethnic group located in Kenya and northern Tanzania. Most spend their days either barefoot or in their traditional shoes made of car tires. Although they walk long distances of up to sixty kilometers a day, they do not suffer from any foot ailments. Little is known about their foot structure and gait. The goal of this investigation was to characterize various aspects of Maasai foot in standing and walking. METHODS: Foot length, calf circumference, hindfoot alignment, step length, cadence, and walking velocity were obtained from 1,096 adult Maasai people (545 males and 551 females; mean age, 40.28 +/- 14.69 years; age range, 16 to 65 years). All included subjects were from rural areas, where the primary terrain was sandy soil, who spend most of their lifetime barefoot, walking. They all denied any medical history or previous symptoms related to foot problems. A trained clinician scanned all feet for deformities. Static (standing) and dynamic (walking) Harris mat footprints were taken to determine the distribution of forefoot pressure patterns during walking. RESULTS: The average foot length was 250.14 +/- 18.12 mm (range, 210 to 295 mm) and calf circumference was 32.50 +/- 3.22 cm (range, 25 to 41 cm). The mean hindfoot alignment was 6.21degrees +/- 1.55degrees of valgus. Sixty-four subjects (5.84%) had bilateral flat-shaped feet with a low medial longitudinal arch that exactly matched the broad pattern of their static footprints. Step length, cadence, and walking velocity were 426.45 +/- 88.73 cm (range, 200 to 690 cm), 94.35 steps/min (range, 72 to 111 steps/min), and 40.16 +/- 8.36 m/min (range, 18.20 to 63.36 m/min), respectively. A total of 83.39% subjects showed unilateral or bilateral deformities of multiple toes regardless of age. The most frequent deformity was clawing (98.79%) of which the highest incidence occurred with the fifth toe (93.23%). Dynamic footprints showed even pressure patterns throughout the forefoot (64.87%), followed by lateral forefoot pressure concentration patterns (21.81%). CONCLUSIONS: Our study shows the distinct parameters that provide more insight into the Maasai foot.
Adolescent ; Adult ; Aged ; Biomechanical Phenomena ; Ethnic Groups ; Female ; Foot/*anatomy & histology/*physiology ; Foot Deformities, Acquired/*epidemiology/ethnology ; Gait/*physiology ; Humans ; Kenya ; Male ; Middle Aged ; Rural Population ; Tanzania ; Walking/*physiology ; Young Adult

OBJECTIVETo investigate the efficacy of Ilizarov fixator on cicatricial foot drop after burn.

METHODSSix patients with cicatricial foot drop after burn were treated with Ilizarov fixator during June 2004 approximately October 2007, the fixator was set on the leg and foot by fixed bone needles. Nuts on the threaded rod were turned from 3 post operation day, 2 approximately 4 rounds per time and 4 times per day in the first week, then 1 approximately 2 rounds per time and 4 times a day, which corrected the deformity of talipes equinus by shortening or lengthening the thread rod in the front and at the back. Ankle joint was maintained in neutral position for 2 approximately 3 months after effective correction. Weight carrying for patients was increased gradually after removal of fixator. Ankle joint was maintained in neutral position with fixator at least three months. Patients were followed up 5 approximately 10 months.

RESULTSAnkle joints from all patients were restored to neutral position after application with fixator for 4 approximately 6 weeks. All patients achieved 0 degrees dorsiflexion in weight carrying for whole planta pedis after use of fixator for 12 approximately 15 weeks with good locomotion function.

CONCLUSIONIlizarov fixator is safe and mini-injury, which is an effective method for treatment of cicatricial foot drop.

Adolescent ; Adult ; Burns ; complications ; surgery ; Child ; Cicatrix ; etiology ; surgery ; Clubfoot ; etiology ; surgery ; Contracture ; etiology ; surgery ; External Fixators ; Female ; Foot Deformities, Acquired ; etiology ; surgery ; Humans ; Male ; Middle Aged ; Young Adult

OBJECTIVETo introduce the procedure of the 1st ray stabilization combined with resection of the lesser metatarsal heads for patient with severe forefoot deformity caused by rheumatoid arthritis (RA) and evaluate the short to mid-term clinical results.

METHODSFrom Oct. 2006 to Aug. 2010,97 patients (129 feet) aged from 36 to 67 years (average 54), with forefoot deformity caused by rheumatoid arthritis were reviwed. There were 88 males and 9 females,65 single lateral involved and 32 bilateral involved, the average duration of disease was 17 years (6 to 32 years). The 1st ray instability and lesser metatarsophalangeal (MTP) joint stiff dislocation were found in all cases. The first ray stabilization combined with resection of the lesser metatarsal head procedure were performed for all cases. The radiographic Hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measurde and the JSSF (Japanese Society for Surgery of the Foot) score were evaluated before operation and every follow up.

RESULTSThe average followed-up was 37 months (6 to 52 months) for all patients except 5 (7 feet) and 1 died for acute cardiac infarction 1 year after operation. The average JSSF score improved from (33.2 +/- 8.2) points preoperative to (67.3 +/- 3.1) points at final followed-up (P < 0.01); the average HVA was corrected from (50.0 +/- 11.8) degrees preoperative to (21.2 +/- 3.2) degrees at final follow up (P < 0.01); the average IMA was corrected from (15.5 +/- 3.6) degrees preoperative to (9.7 +/- 6.6) degrees at final follow up (P < 0.01). MTP joint nonunion was found in 4 feet. A radiographic high density mass was found in the 1st cuneiform bone during 8 to 11 months followed-up in 3 feet; delayed wound healing was happened in 9 feet; MTP joint infection was happened in 2 feet; tarsometatarsal joint infection was happened in 1 foot; lesser MTP joints deformity recurrence were found in 16 feet.

CONCLUSIONThe characters of forefoot with RA in later stage are the 1st ray deformity and instability compound with the lesser toes deformity. The 1st ray stability procedure which include the 1st MTP arthrodesis and the Lapidus procedure can correct the 1st ray deformities and rebuilt its stability. The lesser toes metatarsal head resection is effective in correct their deformity. This combined procedure is reliable. It is suitable for patients with severe Hallux valgus, increased IMA, tarsometatarsal joint instability and the lesser MTP joint stiff dislocation.

Adult ; Aged ; Arthritis, Rheumatoid ; complications ; surgery ; Female ; Foot Deformities, Acquired ; surgery ; Forefoot, Human ; abnormalities ; surgery ; Hallux Valgus ; surgery ; Humans ; Joint Instability ; surgery ; Male ; Metatarsal Bones ; surgery ; Metatarsophalangeal Joint ; surgery ; Middle Aged