Introduction: Triple Arthrodesis is the preferred surgical treatment of stage III Adult Acquired Flatfoot Deformity. However, studies have reported subsequent midfoot degenerative arthrosis, with medial column instability. Materials and methods: This is a retrospective study using prospectively collected registry data from a single tertiary institution. Between 2007 to 2014, all patients who had undergone Triple Arthrodesis with concomitant percutaneous Tendo-Achilles lengthening were included. Patients with previous foot surgery, revision surgeries, and concomitant surgical procedures were excluded. We aim to report on our two years outcomes using the hindfoot and midfoot AOFAS and VAS scores, as well as radiographic parameters such as first-metatarsal declination angle, medial cuneiform calcaneal angle, navicular height, medial cuneiform – first metatarsal cuneiform angle, calcaneal pitch and medial longitudinal arch. Results: There were 22 feet from 21 patients that met the criteria of having undergone Triple Arthrodesis with concomitant percutaneous Tendo-Achilles lengthening. Hindfoot and midfoot American Orthopaedic Foot and Ankle Society (AOFAS) scores improved by an average of 34.6 and 36.7 points at 24-months post-surgery (p<0.001). Between six months to two years post-operatively, there was evidence of mid-foot sagging as shown with an increase in CalcanealFirst metatarsal angle by a mean of 5.1° (p=0.001). Additionally, a decrease in the Calcaneal Pitch Angle by 2.9° (p=0.003) and Cuneiform-Calcaneal angle by 5.5° (p=0.000). Navicular Height also decreased significantly by 2.8mm (p=0.001) over this period. A total of 18 (85.6%) reported overall satisfaction being met at the time of a phone survey, at an average of 8.3 years (range 5.8 to 12.4) postsurgery. One patient required an ankle replacement, and another had removal of hardware done. Conclusion: Triple arthrodesis with concomitant TendoAchilles lengthening results in significant improvement in AOFAS mid-foot and hindfoot scores at two years. At two years mark, there was features of mid-foot sagging postoperatively, despite continued improvement in AOFAS scores. Eighteen of the 21 patients were satisfied with the outcomes, on a phone survey, at an average of 8.3 years postsurgery.

INTRODUCTIONTendo Achilles (TA), which is the confluence of the gastrocnemius and soleus muscles, is one of the most commonly injured tendons. The surgical repair of TA ruptures is associated with a significant risk of infection. This study examined several factors (i.e. gender, age, body mass index, history of diabetes mellitus, steroid use, acute or chronic TA injuries, type of surgical incision and type of sutures used) that may be associated with postoperative wound infection after open TA repair.

METHODSThis was a retrospective study involving 60 patients who underwent open TA repair over an 18-month period. Patients who had prior TA surgery or open TA injuries, or who needed soft tissues flaps were excluded.

RESULTSAmong the patients, 7 (11.7%) developed superficial wound infections that were successfully treated with oral antibiotics, while 3 (5.0%) developed deep wound infections that required at least one debridement procedure. No significant association was found between the risk of postoperative wound infection and gender, age, the presence of diabetes mellitus, acute or chronic ruptures, site of surgical incision and type of deep or superficial sutures used.

CONCLUSIONWhile diabetes mellitus and age did not appear to be associated with postoperative wound infections after open TA repair, obese patients were found to be two times more likely to develop a wound infection than normal-weight patients. The incidence of superficial wound infections in this study was similar to previously published results (11.7% vs. 8.2%-14.6%), but the incidence of deep infections was higher (5% vs. 1%-2%).

Achilles Tendon ; surgery ; Adult ; Aged ; Anti-Bacterial Agents ; therapeutic use ; Body Mass Index ; Diabetes Complications ; Diabetes Mellitus ; pathology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Postoperative Complications ; prevention & control ; Retrospective Studies ; Rupture ; surgery ; Surgical Wound Infection ; prevention & control ; Suture Techniques ; Tendon Injuries ; Wound Healing

Degenerative joint disease of the lower limbs and degenerative lumbar stenosis are commonly seen in the elderly population. Although hip arthroplasty is routinely performed, it is not without complications. We present a case of a 64-year-old lady with arthritic hip pain and asymptomatic lumbar spine stenosis. This patient underwent a primary total hip replacement for hip arthritis and developed an ipsilateral foot drop one day after surgery. A hip MRI showed likely sciatic nerve impingement over a tense capsule. Despite revision surgery, the foot drop persisted. Nerve conduction studies and a lumbosacral MRI revealed spinal canal stenosis at L4/5. When nerve palsies such as a foot drop occur after hip arthroplasty, spinal stenosis must be considered as part of differential diagnosis and should be radiologically excluded before performing exploratory surgery.

INTRODUCTIONBoth conservative and operative management have been described in the literature for the management of chronic Achilles tendon ruptures with surgical management generally having more favourable results. In our institution, the favoured reconstructive technique was the use of 2 turndown tendon fl aps fashioned from the proximal Achilles tendon augmented by a tenomyodesis of the flexor hallucis longus. The purpose of this study was to assess the clinical outcome of all patients who underwent this procedure.

MATERIALS AND METHODSFrom the records, a total of 9 patients underwent the above-mentioned procedure of whom 6 patients had complete data collection sets [including SF-36, Visual Analogue Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores, ankle range of motion (ROM), presence of residual symptoms and complications] at 2 years of follow-up.

RESULTSOur results showed an average AOFAS Ankle-Hindfoot score of 94.2, VAS of 0 in all but 1 patient, and generally high scores (75-96) in all 8 domains of the SF-36 questionnaire. Patient satisfaction was also rated to be high from the surgical procedure.

CONCLUSIONWe submit that the procedure adopted at our institution is able to reproduce satisfactory results with low morbidity in patients with this challenging condition.

Achilles Tendon ; injuries ; surgery ; Aged ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Muscle, Skeletal ; surgery ; Orthopedic Procedures ; methods ; rehabilitation ; Patient Satisfaction ; Recovery of Function ; Rupture ; surgery ; Suture Techniques ; Tendon Injuries ; surgery ; Tendons ; transplantation ; Transplantation, Autologous