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Reading List: Foot and ankle by Professor Leslie Klenerman
This is a selective review of articles on the foot and ankle over the past five years. The object is to focus the attention of readers on topics which they may have overlooked.
Ankle Arthroplasty Wood PLR, Deakin S. Total ankle replacement: the results in 200 ankles. J Bone Joint Surg [Br]2003;85-B:334-41.
Arthroplasty of the ankle is a field that until relatively recently has been dogged by failures. This paper by Wood and Deakin is a report on 200 cementless mobile-bearing Scandinavian Total Ankle Replacements (STAR) 52 were followed for five years, which is encouraging. The follow-up is only midterm. The authors suggest, and rightly so, that in the future ankle replacement will find a place alongside the other major joint replacements but that is unlikely that it will displace fusion as has occurred in the knee. They recommend that ankle fusion should remain the treatment of choice for patients in whom heavy and prolonged activity is anticipated and that ankle replacement be recommended for those with more modest requirements. Ankle arthrodesis Fuchs S, Sandmann C, Skwara A, Chylarecki C. Quality of life 20 years after arthrodesis of the ankle: a study of adjacent joints. J Bone Joint Surg [Br] 2003;85-B:994-8. This is a rare paper – a long follow-up. Subjectively all patients remained satisfied with the outcome. Half had either only minor restrictions of activities of daily living or none. Two patients can only walk less than 1 km and one 1.5 km. A useful paper to bear in mind when discussing the pro’s and cons of arthrodesis with a prospective patient.
Footballer’s ankle (anterior impingement) Coull R, Raffiq J, James LS, Stephens MM. Open treatment of anterior impingement of the ankle. J Bone Joint Surg [Br] 2003;85-B:550-3. This condition, which is nowadays most commonly treated by an arthroscopic technique, is reported having been treated by open surgery. It is interesting to note that osteophytes usually recur. Overall 79% were able to return to sport at the same level. Sprained ankles Krips R, Brandsson S, Swensson C, van Dijk CN, Karlsson J. Anatomical reconstruction and Evans tenodesis of the lateral ligaments of the ankle: clinical and radiological findings after follow-up for 15 to 30 years. J Bone Joint Surg [Br] 2002;84-B:232-5. Anatomical repair is now much more commonly undertaken. When compared with Evans tenodesis anatomical reconstruction leads to better functional results, more effective restoration of stability and less osteoarthritis of the ankle and subtalar joints even after 15 to 30 years. Anatomical reconstruction rather than the more complex Evans tenodesis or its variations should be the primary choice of treatment in patients with chronic anterolateral instability of the ankle. Osteochondritis dissecans of the talus Whittaker J-P, Smith G, Makwana N, Roberts S, Harrison PE, Laing P, Richardson JB. Early results of autologous chondrocyte implantation in the talus. J Bone Joint Surg [Br] 2005;87-B:179-83. This paper reports good results for autologous cartilage grafting in a small group of patients. Schumann L, Struijs PAA, van Dijk CN. Arthroscopic treatment for osteochondral defects of the talus: results at follow-up at 2 to 11 years. J Bone Joint Surg [Br] 2002;84-B:364-8. This paper suggests that arthroscopic curettage and drilling are valuable for both primary and revision treatment of an osteochondral defect of the talus. Kolker D, Murray M, Wilson M. Osteochondral defects of the talus with autologous grafting. J Bone Joint Surg [Br] 2004;86-B:521-6. Autologous bone grafting produced an overall 46.2% patient satisfaction rate in 13 patients. The authors do not recommend autologous bone grafting along as primary treatment for the patient with symptomatic advanced osteochondral defect of the talus and deficient or absent overlying cartilage. Fractures Makwana NK, Bhowal B, Harper WM, Hui AW. Conservative versus operative treatment for displaced ankle fractures in patients over 55 years of age: a prospective, randomised study. J Bone Joint Surg [Br] 2001;83-B:525-9. This paper provides strong evidence for persisting with a policy of internal fixation for patients over 55 years of age who sustain fractures of the ankle. Anatomical reduction was significantly less reliable and loss of reduction more common in the group treated by closed treatment. Those managed by open reduction had a significantly higher functional score.
Hinterman B, Reggazzoni P, Lampert C, Stutz G, Gächter A. Arthroscopic findings in acute fractures of the ankle. J Bone Joint Surg [Br] 2001;82-B:345-51. This is a well illustrated paper in colour which is a useful indication of how much intra-articular damage occurs. It is certainly not a practice to be generally adopted. Calcaneum Brunet JA. Calcaneal fractures in children: long-term results of treatment. J Bone Joint Surg [Br] 2000;82-B:211-16. In this series of 17 children all except one was treated conservatively with excellent results at a mean 17 years after injury. Open management is only indicated for adolescents with severe displacement. Fractures of the tuberosity Squires B, Allen PE, Livingstone J, Atkins RM. Fractures of the tuberosity of the calcaneus. J Bone Joint Surg [Br] 2001;83-B:55-61. A new pattern is described. It is a fracture of the medial calcaneal process with a further fracture which separates the upper part of the tuberosity in the semi-coronal plane. An oblique tension band wire is the best method of internal fixation.
Fractures of the body Paul M, Peter R, Hoffmeyer P. Fractures of the calcaneum: a review of 70 patients. J Bone Joint Surg [Br] 2004;86-B:1142-5. 70 patients were assessed at a mean of 6.5 years. Undisplaced fractures had a good outcome. Those with displaced fractures treated surgically who had a Bohler Angle greater than 10° at follow-up had a satisfactory functional outcome and there was a poor functional outcome when surgery did not restore the Bohler angle. The worst outcome occurred after surgery without restoration of the Bohler angle. The main conclusion was that open reduction and internal fixation can only be expected to benefit those patients in whom nearly anatomical reconstruction is achieved.
Tendo Achillis
Möller M, Movin T, Granhed H, Lind K, Faxén E, Karlsson J. Acute rupture of tendo Achillis: a prospective, randomised study of comparison between surgical and non-surgical treatment. J Bone Joint Surg [Br] 2001;83-B:843-8. This was a prospective randomised study of conservative or non-surgical treatment. Surgical and non-surgical treatment produced equally good functional results. Re-rupture is the main complication of non-operative treatment, 20.8% contrasted with 1.7% after surgery. It does look as if provided the patient is fit surgical repair is the treatment of choice. Maffuli N, Kaker D. Tendinopathy of tendo Achillis. J Bone Joint Surg [Br] 2002;84-B:1-8. This review article is a broad overview of the problem with a sensible conservative bias. Tibialis Posterior Tendon Wacker JT, Hennessy MS, Saxby TS. Calcaneal osteotomy and transfer of the tendon of flexor digitorum longus for stage-II dysfunction of tibialis posterior: three- to five-year results. J Bone Joint Surg [Br] 2002;84-B:54-8. The outcome in 43 patients was rated as good to excellent for pain and function. 36 patients were rated good excellent for alignment. There were no poor results.
Trnka H-J. Dysfunction of the tendon of tibialis posterior. J Bone Joint Surg [Br] 2004;86-B:939-46. This review is comprehensive and supplements the previous paper.
Petersen W, Hohmann G, Stein V, Tillmann B. The blood supply of the posterior tibial tendon. J Bone Joint Surg [Br] 2002;84-B:141-4. The blood supply is reduced at the common site for rupture in the region behind the medial malleolus.
The forefoot Coughlin MJ. Common causes of pain in the forefoot in adults. J Bone Joint Surg [Br] 2000;82-B:781-90. This is a valuable source of up-to-date knowledge of common problems such as interdigital neuroma, oblique osteotomy of the distal metatarsal shaft (Weil’s osteotomy), management of soft corns etc. It is well worth careful reading. Peicha G, Labovitz J, Seibert FJ, Greckenig W, Wiglein A, Prendler KW, Quehenberger F. The anatomy of the joint as a risk factor for Lisfranc dislocation and fracture dislocation: an anatomical and radiological case control study. J Bone Joint Surg [Br] 2002;84-B:981-5. The mortise in patients with injuries to the Lisfranc joint is shallower than in a control group and the shallower it is the greater the risk of injury.
Calder JDF, Whitehouse SL, Saxby TS. Results of isolated Lisfranc injuries and the effect of compensation claims. J Bone Joint Surg [Br] 2004;86-B:527-530. The presence of a compensation claim and a delay in diagnosis of more than six months were associated with a poor outcome. Morton’s Neuroma Sharp RJ, Wade CM, Hennessy MS, Saxby TS. The role of MRI and ultrasound imaging in Morton’s neuroma and the effect of size of lesion on symptoms. J Bone Joint Surg [Br] 2003;85-B:999-1005. Despite the availability of advanced techniques for imaging the diagnosis is essentially clinical based on the history and physical signs. The use of imaging does not improve the accuracy of diagnosis. Stamatis ED, Myerson MS. Treatment of recurrence of symptoms after excision of an interdigital neuroma: a retrospective review. J Bone Joint Surg [Br] 2004;86-B:48-53. A broad survey of the various factors to be considered. Hallus Valgus Schneider W, Aigner N, Pinggera O, Knahr K. Chevron osteotomy in hallux valgus: ten-year results of 112 cases. J Bone Joint Surg [Br] 2004;86-B:1016-20. Excellent results which not only proved to be consistent but show further improvement over a longer period of follow-up.
Jones S, Al. Hussainey HA, Ali F, Betts RP, Flowers MJ. Scarf osteotomy for hallux valgus: a prospective clinical and pedobarographic study. J Bone Joint Surg [Br] 2004;86-B:830-6. A scarf osteotomy combined with an Akin closing wedge osteotomy is safe and effective. It looks as if the less demanding Chevron osteotomy should be reserved for mild to moderate cases and the scarf osteotomy for the severe deformities. Professor Leslie Klenerman, Emeritus Associate Editor |
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