Michael M. Stephens

Overuse ankle injuries in professional Irish dancers

BACKGROUND Overuse ankle injuries have been described in elite athletes and professional ballet dancers however the spectrum of injuries experienced by professional Irish dancers has not been defined. METHODS A troupe of actively performing dancers from an Irish-dance show were recruited (eight male, ten female; mean age, 26 years). The prevalence of overuse injuries in the right ankle was determined from magnetic resonance imaging. Foot and ankle self-report questionnaires were also completed (AOFAS and FAOS). RESULTS Only three ankles were considered radiologically normal. Achilles tendinopathy, usually insertional, was the most frequent observation (n=14) followed by plantar fasciitis (n=7), bone oedema (n=2) and calcaneocuboid joint degeneration (n=2). There were limited correlations between MRI patterns and clinical scores indicating that many conditions are sub-clinical. Dancers with ankle pain had poor low (p=0.004) and high (p=0.013) level function. CONCLUSIONS Overuse ankle injuries are common in Irish dancers. Incorporating eccentric exercises and plantar fascia stretching into a regular training program may benefit this population.

Giant cell tumour in the foot of a skeletally immature girl: a case report

We present a case of delayed diagnosis of a benign giant cell tumour (GCT) of the third metatarsal in a skeletally immature girl. The patient underwent en bloc excision of the tumour. The tumour had replaced the third metatarsal and had infiltrated the surrounding soft tissue and the second and fourth metatarsal bases. Deep, lateral and medial margins were all involved. A high index of suspicion is needed when evaluating any tumours of the foot, because the compact structure of the foot may delay diagnosis. Early detection is important for avoiding amputation, as the hindfoot and midfoot are classified as one compartment and radical resection is impossible to achieve. Tumours grow faster in the foot than in other bones. GCT in this location and age-group are rare and should be considered in the differential diagnosis of a destructive bony lesion in skeletally immature patients.

Foot and ankle surgery—The Achilles heel of medical students and doctors

BACKGROUND Numerous studies have shown that deficiencies exist in orthopaedic and musculoskeletal medical training resulting in students and doctors regularly failing basic orthopaedic exams. However, there have not been any studies addressing the attitudes of medical students towards the orthopaedic subspecialties. OBJECTIVES This study aimed (i) to determine if foot and ankle surgery was the orthopaedic specialty with which students and doctors have the most difficulty, (ii) to appraise attitudes towards teaching of foot and ankle surgery, and (iii) to suggest ways teaching might be improved. METHODS A questionnaire on orthopaedic teaching was given to 238 medical students in Ireland. Perceived difficulties with foot and ankle surgery were compared to seven other orthopaedic subspecialties and the results were analysed. Other aspects of teaching were assessed including why foot and ankle surgery is perceived as difficult and ways teaching could be improved. RESULTS Foot and ankle surgery is the orthopaedic subspecialty with which medical students and doctors have the most difficulty, least confidence and poorest knowledge in. This was due to: perceived complexity; insufficient exposure; and a lack of teaching. CONCLUSION Foot and ankle surgery is the least popular of the orthopaedic subspecialties and considerable deficiencies exist in its education.

Internet use in an orthopaedic outpatient population

BackgroundOver 60% of people nationally now have internet access. We aimed to assess the level of access to the internet within our practice population and gauge the level of internet use by these patients. MethodsThis was a questionnaire-based study. Patients attending a mixture of trauma and elective outpatient clinics were invited to complete a questionnaire collecting basic demographic details and history of information seeking. ResultsTwo-hundred and nintey-two patients completed the questionnaire (146 men, 146 women). Seventeen were incomplete and excluded from final analysis. Multiple logistic regression found younger age (O.R. 2.22 in 20-35 age group), possession of health insurance (O.R. 2.65) and higher levels of education (O.R. 8.22 for tertiary education) all were significantly associated with a higher level of access to the internet. Among patients with internet access, a second regression analysis showed that a positive history of surgery (O.R. 2.82) and possession of a trade qualification (O.R. 5.15) were the best predictors of internet use to research a patient’s orthopaedic condition. ConclusionsOur study was consistent with previous studies showing that younger and better educated patients had greater access to the internet. We believe there is a niche for increased information provision for those patients who require surgery, but we must be aware that access is not available to everyone in the community.

Plagiarism: an unprofessional and dishonest trend creeping into modern writing of research and review papers.

Plagiarism is defined by the Collins Concise Dictionary (1998) as ‘‘the act of plagiarizing’’ from the Latin Plagiarus, meaning ‘‘plunderer’’ from plagium ‘‘kidnapping’’. The verb ‘‘to plagiarize’’ is defined as ‘‘to appropriate (ideas, passages, etc.) from (another work or author)’’. It can manifest itself in many ways, often quietly, subtly and going unrecognised. In orthopaedic research it is most commonly found when papers fail to include citations of all the original sources. It is the duty of any author therefore to make sure that the bibliography must be complete and up-to-date. Much work is research and is collaborative and representing this work as one’s own is likewise ‘‘plagiarism’’. Therefore all people that have been involved in the work, that has been submitted for publication, must be acknowledged no matter how small their input. There are occasions when passages or ideas are summarised with improper paraphrasing without due acknowledgement of the original source. This is included in the concept of ‘‘plagiarism’’ but really is ‘‘stealing’’ or ‘‘theft’’. The writing of a thesis has now become common practice at all levels of learning from undergraduate to postgraduate and to higher degrees. Pressure is often intense on the author of the thesis to have it completed within a short time scale. With the amount available nowadays on the internet and within books and journals, etc. it is not surprising that presented work can be copied extensively with only minor technical changes from these sources. Authors or reviewers must include all references and sources, no matter how insignificant they may be. The presentation of research and papers in the public forum is now common place. Many times the presenter may not be the original researcher yet may claim it as his own. All sources must be referenced particularly when some sources can be quite obscure. Failure to do this is ‘‘plagiarism’’.

EFAS Score — Multilingual development and validation of a patient-reported outcome measure (PROM) by the score committee of the European Foot and Ankle Society (EFAS)

BACKGROUND A scientifically sound validated foot and ankle specific score validated ab initio for different languages is missing. The aim of a project of the European Foot and Ankle Society (EFAS) was to develop, validate, and publish a new score(the EFAS-Score) for different European languages. METHODS The EFAS Score was developed and validated in three stages: (1) item (question) identification, (2) item reduction and scale exploration, (3) confirmatory analyses and responsiveness. The following score specifications were chosen: scale/subscale (Likert 0-4), questionnaire based, outcome measure, patient related outcome measurement. For stage 3, data were collected pre-operatively and at a minimum follow-up of 3 months and mean follow-up of 6 months. Item reduction, scale exploration, confirmatory analyses and responsiveness were executed using analyses from classical test theory and item response theory. RESULTS Stage 1 resulted in 31 general and 7 sports related questions. In stage 2, a 6-item general EFAS Score was constructed using English, German, French and Swedish language data. In stage 3, internal consistency of the scale was confirmed in seven languages: the original four languages, plus Dutch, Italian and Polish (Cronbachs Alpha >0.86 in all language versions). Responsiveness was good, with moderate to large effect sizes in all languages, and significant positive association between the EFAS Score and patient-reported improvement. No sound EFAS Sports Score could be constructed. CONCLUSIONS The multi-language EFAS Score was successfully validated in the orthopaedic ankle and foot surgery patient population, including a wide variety of foot and ankle pathologies. All score versions are freely available at www.efas.co.