Swelling is a body's natural reaction to foot and ankle injury to mount a healing inflammatory response. To some degree, swelling is necessary for healing and is something that cannot be avoided following injury. However, post-traumatic swelling may have an adverse effect on wound healing and surgery can often be delayed due to preoperative swelling. We report on a unique technique of making multiple meshed stab incisions around the site of injury to reduce soft tissue swelling and promote wound healing.
Ankle Injuries* ; Foot* ; Wound Healing

The checkrein deformity describes tethering of the flexor hallucis longus tendon, which mainly occurs after fracture of the distal tibia. The deformity increases with dorsiflexion of the ankle and decreases or disappears with plantarflexion of the ankle. In some cases, the deformity may occasionally include the second and third toes. In the current study, the authors experienced secondary checkrein deformity of all lesser toes after open reduction and plate fixation for comminuted fracture of the calcaneus. As a treatment, plate and screws were removed, followed by an additional medial incision which showed a partially ruptured flexor digitorum longus tendon with severe adhesion. Resection of the adhesed tendon and tenodesis of its distal portion to the flexor hallucis longus was performed for correction of the checkrein deformity. Then the lessor toe checkrein deformity recovered immediately. The authors report on this rare lessor toe checkrein deformity after calcaneal fracture fixation with a review of literature.
Ankle ; Calcaneus* ; Congenital Abnormalities* ; Fracture Fixation ; Fractures, Comminuted ; Tendons ; Tenodesis ; Tibia ; Toes

Accessory navicular is a congenital anomaly appearing in the secondary ossification center on the tuberosity of the navicular that may cause flatfoot. Bipartite medial cuneiform is another rare congenital anomaly occurring as two primary ossification centers in the medial cuneiform. The authors report a rare case of symptomatic bilateral accessory navicular with bipartite medial cuneiform and flatfoot deformity in a 19-year-old man with a review of the literature.
Congenital Abnormalities ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Flatfoot ; Foot ; Humans ; Young Adult

Intraosseous lipoma is a benign tumor that originates from proliferating mature lipocytes. It often occurs in the metaphysis of long bones of the lower extremity, and also in the calcaneus, humerus, mandible, sacrum, and rib bones. Frequently, it involutes spontaneously through a process of infarction, calcification, and cyst formation. It can either present as pain, or be asymptomatic and only discovered through an incidental radiological finding. In our case, the patient presented with heel pain. Intraoperatively, it was found that the intraosseous cavity was filled with fat along with an adjacent but separate area of cystic degeneration. There was also a cortical perforation at the cystic lesion which was communicating with the subtalar joint. This cortical breach is most likely the cause of diffuse lateral heel pain experienced by our patient, and such a pathological fracture due to intraosseous lipoma has never been reported.
Adipocytes ; Bone Neoplasms ; Calcaneus ; Fractures, Spontaneous ; Heel ; Humans ; Humerus ; Infarction ; Lipoma* ; Lower Extremity ; Mandible ; Ribs ; Sacrum ; Subtalar Joint

Arteriovenous malformations (AVMs) are characterized by the presence of abnormal connections between feeding arteries and draining veins. It is generally assumed that symptomatic lesions can preferably be treated. Due to high arterial blood flow, there is a risk of bleeding with surgical excision alone, which can be massive and life threatening during the operation. According to recent advances in interventional technique, a hybrid approach using embolization of the feeding artery with subsequent immediate excision of the AVM for successful management of vascular lesions could be applied to AVMs. Herein, we describe a case of successful excision of AVM in the left soleus muscle using a hybrid approach.
Arteries* ; Arteriovenous Malformations* ; Embolization, Therapeutic ; Hemorrhage ; Muscle, Skeletal* ; Vascular Surgical Procedures ; Veins

PURPOSE: The purpose of this study is to evaluate the incidence and cause of reamputation with respect to the location of foot amputation. MATERIALS AND METHODS: Eighty-six patients who received amputations below the ankle level from March 2002 to September 2012 with at least 1 year follow-up were enrolled in this study. We stratified the site of the initial amputation from first to fifth ray and into either the phalanx or metatarsal bone, and investigated the cause of reamputation. RESULTS: The reamputation rate below the ankle level was 53.5%. It was highest (62.1%) in patients with first ray amputations without statistical significance. Rays were divided into two columns, first to third rays as the medial column and others as the lateral column, and reamputation was performed in 61.2% of patients with medial column amputation. Comparing the results between phalanx and metatarsal amputations, reamputation was performed in 62.1% of patients with metatarsal bone amputation. The rate of reamputation was statistically significant in both the medial column and metatarsal amputations. The most common reamputation site, in accordance to the initial site of amputation, was the adjacent ray (57.4%), which was without statistical significance. Moreover, the most common cause of reamputation was osteomyelitis and focal infection in all rays. CONCLUSION: This study showed that reamputation after amputation below the ankle level was relatively common with highest rate in medial column and metatarsal amputations. Hence, surgeons should be aware of the risk of reamputation and put more preventive effort during medial column and metatarsal amputations.
Amputation* ; Ankle ; Focal Infection ; Follow-Up Studies ; Foot* ; Humans ; Incidence ; Metatarsal Bones ; Osteomyelitis

PURPOSE: To report the radiographic and clinical results of 6.5 mm cancellous full threaded buttress screw or Steinmann pin fixation to maintain a reduction of calcaneal posterior facet depression fracture. MATERIALS AND METHODS: From June 2009 to June 2012, 50 consecutive cases with calcaneal joint depression fracture that underwent open reduction and screw or pin fixation were enrolled in this study. A 6.5 mm cancellous full threaded screw was inserted from the posteroinferior aspect of the calcaneal tuberosity to the posterior facet (group A) or Steinman pin was inserted from the posterosuperior aspect of the calcaneal tuberosity to the calcaneocuboidal joint (group B). Both preoperative and postoperative Bohler and Gissane angles were measured radiographically, and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale on the final follow-up were assessed. RESULTS: The mean age of patients was 44.1 years, and the mean follow-up period was 27.2 months. According to the Sanders classification, 28 cases were type II and 22 cases were type III. In Sanders type II, Bohler and Gissane angles improved significantly from 10.1degrees and 126.2degrees preoperatively to 27.2degrees and 117.1degrees, respectively, in the immediate postoperative radiograph, and at the final follow-up, 26.6degrees and 118.6degrees, respectively. In Sanders type III, Bohler and Gissane angles improved significantly from 5.0degrees and 129.8degrees to 29.9degrees and 119.3degrees, respectively, in the immediate postoperative radiograph, and 26.9degrees and 120.2degrees at the final follow-up. All cases achieved bony union, and the average period until complete union was 13.3 weeks. AOFAS ankle-hindfoot scale was 82.6 in Sanders type II and 77.3 in Sanders type III at the final follow-up. CONCLUSION: A 6.5 mm cancellous full threaded buttress screw or Steinman pin fixation is a noninvasive treatment method with a merit of being able to maintain the bearing capacity of the posterior facet comparable to plate fixation.
Ankle ; Calcaneus ; Classification ; Depression* ; Follow-Up Studies ; Foot ; Humans ; Intra-Articular Fractures ; Joints*

Microfracture as a reparative strategy is the treatment of choice for an osteochondral lesion of talus. Although the results of microfracture are generally excellent, at least 30% of patients who received microfracture have acute or chronic ankle pain with several or unknown causes. The most important factor for unsatisfactory outcome after microfracture is the size of the lesion. For failed osteochondral lesion of talus, the second options are autologous osteochondral graft, autologous chondrocyte implantation, or re-microfracture. In this article, we present the autologous chondrocyte implantation as a second procedure for failed microfracture and compare its clinical outcome with other methods based on a literature review.
Ankle ; Chondrocytes* ; Humans ; Talus* ; Transplants

Total ankle replacement has been performed for treatment of end stage arthritis of the ankle, hopefully being an alternative to ankle arthrodesis. However, due to its high failure rates, earlier versions of ankle replacements were not regarded as successful procedures. The latest design has shown increasingly positive results. Total joint replacement of the ankle itself is still regarded as a demanding procedure and much more challenging than that of the hip and knee in many aspects. Several studies, however, have pointed out that it is becoming the viable, accepted alternative for arthrodesis with advanced implants, appropriate patient selection, and proper training experience of procedures. Compared with arthrodesis, it shows equal or better outcomes in pain relief, range of motion, and patient's satisfaction. We are attempting to review its biomechanical characteristics, implant design, indications, complications, clinical outcomes, and survival rate.
Ankle ; Arthritis ; Arthrodesis ; Arthroplasty* ; Arthroplasty, Replacement, Ankle* ; Hip ; Joints ; Knee ; Patient Selection ; Range of Motion, Articular ; Survival Rate

PURPOSE: The purpose of this study was to investigate the clinical results of conservative treatment for Morton's neuroma and to analyze the factors which influenced on the results. MATERIALS AND METHODS: In this retrospective study, 101 cases of 83 patients with interdigital neuroma were conservatively treated with follow-up period of at least 6 months. There was no significant difference in results among different age groups, sxes, and lesion sites. However, the results were significantly better if the treatment was started within 6 months after onset. RESULTS: We had 28 excellent results (28%), and 13 good results (13%). Patients were grouped by sex, age, duration of symptom before treatment, affected location. The result of treatment was evaluated by comparing the subject pain and discomfort score of the first vist and last follow-up. CONCLUSION: There are excellent results over 41% by conservative treatment. The results of conservative treatment were not related to age, sex, and lesion site, but were related to pre-treatment period. The shorter the pretreatment period was, the better the results.
Follow-Up Studies ; Foot ; Humans ; Neuroma* ; Retrospective Studies