Eric So

Surgical Planning for Flexor Digitorum Longus Tendon Transfers: An Anatomic Study

Abstract Posterior tibial tendon dysfunction is often coupled with various degrees of hindfoot valgus and equinus. Preoperative planning is essential to appropriate procedure choice and surgical efficiency. The purpose of the present study was to assess the anatomy at the harvest site for flexor digitorum longus tendon transfer, specifically at the master knot of Henry. Thirty fresh‐frozen below‐the‐knee cadavers were used for dissection. A standard anatomic approach was performed for posterior tibial tendon debridement and flexor digitorum longus tendon transfer. The flexor digitorum longus tendon was harvested and measured at the master knot of Henry. The present anatomic study evaluated the tendon width of the flexor digitorum longus tendon at a common harvest site. Of the 30 specimens, 20 (67%) measured 5 mm and 10 (33%) measured 4 mm. A 5.0‐mm interference screw would be acceptable in each specimen and therefore would be the safest choice. A 4.0‐mm interference screw would be acceptable in only 33% of the specimens. Males have a slightly more robust flexor digitorum longus tendon than females at the harvest site. This information will assist surgeons in preoperative planning during stage II flatfoot correction for posterior tibial tendon dysfunction. &NA; Level of Clinical Evidence: 5

Intermediate- to Long-Term Longevity and Incidence of Revision of the Modified Broström-Gould Procedure for Lateral Ankle Ligament Repair: A Systematic Review

&NA; The Broström‐Gould procedure is an effective procedure for chronic lateral ankle instability. However, long‐term studies are limited, and the durability of this procedure remains unclear. A systematic review of the published data was undertaken to determine the outcomes and incidence of revision after long‐term follow‐up. Eleven studies involving 669 Broström‐Gould procedures met the inclusion criteria. The revision rate was 1.2% at a weighted mean follow‐up period of 8.4 years. Our systematic review of the available data revealed that the Broström‐Gould procedure results in low revision rates for chronic lateral ankle instability. However, additional prospective comparative analyses are needed regarding this topic. &NA; Level of Clinical Evidence: 3

What Is the Current Role and Factors for Success of the Journal Club in Podiatric Foot and Ankle Surgery Residency Training Programs

&NA; The journal club (JC) is a traditional part of postgraduate medical education, although little has been written on its current role in podiatric surgical training programs. The goal of the present study was to determine how JCs are conducted and the factors associated with their success. Anonymous electronic surveys were distributed to all podiatric foot and ankle surgical training program directors in the United States with a valid e‐mail address. A total of 202 surveys were initially e‐mailed to training program directors, with a second and third round sent to those who did not respond. The eventual response rate was 47.5%. The variables associated with success included high faculty attendance, dissemination of articles in advance, and regularly scheduled meetings. Of the residency programs that responded, 39.0% provided some type of handout or supplemental session and 39.8% provided supplemental session or handouts regarding the process of critical review, epidemiology, or biostatistics. A structured review instrument or checklist was used to guide critical appraisal in 21.5% of the JCs, and 11.8% of the programs provided feedback to residents. The JC was perceived by residency directors to be valuable and worthy of maintaining. Residency directors perceived the following factors to be associated with a successful JC: faculty participation, a designated leader, mandatory attendance, dissemination of materials in advance, and regularly scheduled meetings. Areas cited for improvement included implementation of a structured review instrument, delineation of clear goals, and periodic evaluation. We believe these findings could aid residency directors interested in maximizing the educational benefits of their JC. &NA; Level of Clinical Evidence: 5

Pitted keratolysis: a case report and review of current literature

The article offers a brief history of pitted keratolysis (PK), research regarding PK etiology, evaluation of PK, and current treatment modalities. The main objective of this article focuses on the current literature on PK, its presentation and symptomatology, prevalence, and available therapeutic options. We present a case report and review on PK of a patient treated with an over the counter antiperspirant, topical erythromycin, oral erythromycin, and proper education on hygiene, with complete resolution and without recurrence after a follow up of greater than 12 months.

Plantar fasciitis: A review of treatments

ABSTRACT Plantar fasciitis is the most common cause of heel pain in the United States. Many treatments are available and differ in efficacy and cost. This article discusses the theorized causes for plantar fasciitis and various treatments.

Large Osseous Defect Reconstruction Using a Custom Three-Dimensional Printed Titanium Truss Implant

ABSTRACT Treatment of large osseous defects remains a difficult surgical challenge. Autografts and allografts have been known to undergo late collapse, because these options are not specifically designed to withstand the high loads of the foot and ankle. The inability to achieve the correct shape for reconstruction further limits their application. Large osseous defects will result during salvage after failed Lapidus bunionectomy, explantation of failed total ankle replacements, and nonunion of Evans calcaneal osteotomy. Each of 3 patients received a 4WEB custom 3‐dimensional (3D) titanium truss implant (Patient Specific Custom Implant; 4WEB Medical, Inc., Frisco, TX) for reconstruction. The mean follow‐up period was 17.33 ± 3.51 months. Significant improvement was seen in pain, with a successful return to activities of daily living. The 12‐month postoperative computed tomography findings demonstrated incorporation of the implant to the surrounding cortical and cancellous bone. No signs of delayed complications, such as stress shielding or implant failure, were found. This is the first case series to describe the use of a custom 3D‐printed titanium truss implant to successfully contribute to reconstruction in the setting of failed elective foot and ankle surgery. This technology might play an important role in limb salvage of osseous defects that would otherwise require bone block arthrodesis with structural allograft or autograft bone. Level of Clinical Evidence: 4

Incidence of Nonunion of the Hallux Interphalangeal Joint Arthrodesis: A Systematic Review

ABSTRACT Hallux interphalangeal joint arthrodesis is an effective procedure to treat pain and provide stability and is often performed for intrinsic pain to the hallux interphalangeal joint. Additionally, this procedure is typically used in concert with the Jones tenosuspension. Although this as an accepted technique, the available data are scant, and questions remain regarding nonunion rates and contributory factors to poor healing. A systematic review of the reported data were undertaken to determine the rate of nonunion for hallux interphalangeal joint arthrodesis. Seven studies involving 313 hallux interphalangeal joint arthrodeses met the inclusion criteria. The nonunion rate was 28.3% at a weighted mean follow‐up period of 8.4 months. The overall complication rate was 33.0%. Considering the increased rate of complications and nonunion rate for this commonly used procedure, additional prospective comparative analyses are needed regarding this topic to identify important patient demographic data and determine superior fixation constructs. Level of Clinical Evidence: 4

Split Peroneus Longus Free Tendon Autograft Transplantation for the Treatment of Neglected Extensor Hallucis Longus Tendon Laceration: A Case Report

A neglected laceration of the extensor hallucis longus (EHL) tendon is rare. Retraction of the tendon ends often occurs when a laceration is neglected, leading to a substantial tendon deficit. A paucity of case reports is available describing the treatment of EHL laceration with a large area of gap secondary to retraction. Therefore, the treatment recommendations are limited. We present the case of a neglected EHL tendon laceration with a 10.5-cm gap in a healthy 22-year-old female. The EHL tendon laceration was repaired using a split peroneus longus tendon autograft that, to the best of our knowledge, has not been previously reported. At the 3-year follow-up evaluation, the patient retained full function of her hallux and was free of symptoms.

Structures at Risk from an Intermetatarsal Screw for Lapidus Bunionectomy: A Cadaveric Study

Category: Midfoot/Forefoot Introduction/Purpose: The Lapidus procedure is a common procedure for the treatment of hallux abducto valgus. Traditional fixation consists of two crossing screws in the sagittal plane. Despite arthrodesis of the first tarsometatarsal joint, recurrence of the hallux abducto valgus deformity remains a concern. A transverse screw spanning the base of the first metatarsal to the base of the second metatarsal has been advocated to provide transverse plane stability. However, the neurovascular bundle is located within the proximity of this screw. The literature is sparse with a standard technique to safely provide appropriate fixation. An anatomic cadaver study was undertaken to assess the risk of injury to the neurovascular bundle. Methods: Ten unmatched cadaveric limbs that had been disarticulated at the knee were used. Under fluoroscopic guidance, the guide wire to a 4.0-mm screw was driven across the base of the first metatarsal and into the second metatarsal. A 4.0-mm screw was inserted, taking care to obtain osseous purchase into the second metatarsal. A longitudinal incision was made and careful dissection was carried to identify the neurovascular bundle and screw. The neurovascular bundle was inspected for trauma and the proximity of the screws was measured using a digital caliper. Results: There were three left-sided and seven right-sided specimens. Five of the specimens were male and five were female. The mean age of the specimens at date of death was 71.4 years. The mean body mass index was 20.5. The mean distance from the 4.0-mm screw to the first metatarsal base 11.24 mm distal to the first tarsometatarsal joint. The deep plantar artery and deep peroneal nerve was free from injury in 10/10 (100%) specimens. However, the screw was measured to be less than 5 mm in three specimens. In these instances, the average distance of the screw distal to the first tarsometatarsal joint was 12.1 mm. Conclusion: The addition of the intermetatarsal screw for Lapidus bunionectomy is widely accepted clinical practice. Descriptions of the operative technique for the placement of hardware into the second metatarsal have not included specific recommendations to avoid potential risk to the neurovascular bundle as it courses between the bases of the first and second metatarsals. According to this cadaveric study, the neurovascular bundle was avoided with placement of the intermetatarsal screw, if placed approximately 11.24 mm distal to the first tarsometatarsal joint. Further study is warranted to evaluate the optimal distance distal to the first tarsometatarsal joint.

The Rare Lateral Cuneo-Cuboid Coalition: A Case Report

BACKGROUND Tarsal coalitions typically occur at the talocalcaneal or calcaneonavicular joints. Common findings are pain, limited range of motion, and a pes planus deformity. METHODS The focus of this case report will include the presentation, imaging, treatment, and outcomes for a 21-year-old female diagnosed with a rare lateral cuneo-cuboid coalition with chronic pain. Clinical and radiographic examinations, typically utilized to diagnose the common coalition, were unremarkable. An MRI was diagnostic of the lateral cuneo-cuboid coalition and was successfully treated with surgical resection. RESULTS At 6-year follow-up, she reports resolution of symptoms and has returned to her normal pre-surgical activity level pain-free. CONCLUSIONS This case is only the third lateral cuneo-cuboid coalition reported in the literature. The rarity of this coalition and unsuspecting clinical presentation makes it worthy of acknowledgement.