Foot & Ankle International

Twenty-two cases of multiple hereditary exostoses revealed pathological changes in two areas: the first group caused by epiphyseal disturbances, and the second group due to mechanical problems created by the exostoses. The epiphyseal disturbances resulted in ankle valgus, shortened metatarsals, and angular deformities of the necks of the metatarsals. The exostoses produced local tenderness, synostosis of the medial subtalar facet resulting in loss of subtalar motion, and asymptomatic synostosis of the lower tibial fibular syndesmosis.

One hundred feet in 50 children between the ages of 3 and 9 years with a diagnosis of idiopathic hypermobile flatfoot had a custom-molded insert ordered. A specific method of casting, correcting the various components of the deformity was utilized. An 1/8-inch polypropolene insert was fabricated from the positive cast. The insert was worn in leather shoes with a long counter, steel shank, and Thomas heel. The flatfoot was evaluated and classified by measurement of the talometatarsal angle on a standing lateral X-ray. The insert was fabricated so that the standing lateral talometatarsal angle was corrected to neutral with the insert on the foot and the foot in the shoe.

The preliminary reports indicate that a correction can be obtained at the rate of 0.41° per month or approximately 5° per year. There was no significant loss of motion of the foot or the ankle. Perhaps this regimen may be utilized in those children with a hypermobile flatfoot for whom treatment is advised.

Various radiographic measurements of the normal adult foot have been reported in both early and recent literature; however, a complete description of radiographic quantitative data has yet to be reported. The purpose of this study is to describe the range of the normal foot using standard radiographic techniques that can be applied to the clinical setting. This should provide the data necessary for the accurate interpretation of foot radiographs.

This study demonstrates the wide variation in bony relationships of the normal adult foot. When certain recognized criteria of radiographic measurements were evaluated, some were found to be defined as too narrow or inaccurate. Most importantly, because of this wide range, surgical procedures to produce radiographic homogeneity are not indicated. Treatment should be directed specifically toward areas of pain and not radiographic appearance.

A series of 41 first toe metatarsophalangeal joint arthrodeses performed in 28 patients was subjectively and objectively evaluated by personal interview, physical examination, and follow-up X-rays. The length of the postoperative follow-up ranged from 5 to 58 months, with an average of 35 months. The overall rate of fusion was 95%. Excellent or good results were obtained in 28 procedures, representing 68% of the study of the patients. Utilizing this procedure in the treatment of severe forefoot deformities, secondary to rheumatoid arthritis, demonstrated that 85% of the patients obtained excellent or good results, and, in the treatment of patients with failed bunion surgery, 53% obtained excellent or good results.

If one were to characterize the clinical presentation of Reiter's syndrome in the feet and ankles, it would be that of pain associated with mild to moderate swelling and tenderness without significant erythema. These changes would occur most commonly at the posterior calcaneus, metatarsophalangeal joint, and phalangeal regions. The ankles will usually show an effusion. It is very uncommon for the subtalar region, midfoot region, or even the metatarsal shaft area to be involved.

Roentgenographic changes were present in a similar frequency as in physical findings.

Erosions and soft tissue swelling affect the forefoot and ankle while “spurring” and erosions affect the hindfoot. It is readily apparent that no single clinical finding or radiographic change indicates Reiter's syndrome. The type and location of foot pain is what should prompt the physician to seek further elements allowing the diagnosis of Reiter's syndrome.

With improved methods of medical care, the survival rates in all types of diabetes are improving. There are increasing numbers of older diabetics with complicated soft tissue problems. This is a report of our experiences in treating 15 consecutive patients with soft tissue defects involving the hindfoot. Each of these patients had an intact forefoot.

This entity consists of a chronic inflammatory process of the peritenon of the tendo Achilles (usually bilateral) at variable points of the tendon itself but usually near the insertion in the Achilles. Its occurrence, not only in runners but in relatively sedentary individuals of both sexes, seems to be the result of microtrauma of stress with insidious onset of local pain in increasing degree with physical activity.

Clinically, in the advanced cases, fibrillation, nodulation, and “yellowing” of the edematous tendon occur and probably are a precursor to later ruptures.

Pathological changes consist of one or more of the following: a myxomatous degeneration of collagenous tissue; fibrosis; round cell inflammatory infiltrate; and proliferation of fibrovascular connective tissue. The use of steroid injections seems to be of no help and probably is contraindicated.

Surgery consists of excision of the entire pseudosheath, allowing the tendon to assume a new, nonconstricting alignment. All but one of the nine patients with a follow-up of at least 1 year went on to clinical, painless recovery, with unrestricted future activity, in just a few months.