Tiago Baumfeld

Reliability of Baropodometry on the Evaluation of Plantar Load Distribution: A Transversal Study

Introduction. Baropodometry is used to measure the load distribution on feet during rest and walking. The aim of this study was to evaluate changes in plantar foot pressures distribution due to period of working and due to stretching exercises of the posterior muscular chain. Methods. In this transversal study, all participants were submitted to baropodometric evaluation at two different times: before and after the working period and before and after stretching the muscles of the posterior chain. Results. We analyzed a total of 54 feet of 27 participants. After the working period, there was an average increase in the forefoot pressure of 0.16 Kgf/cm2 and an average decrease in the hindfoot pressure of 0.17 Kgf/cm2. After stretching the posterior muscular chain, the average increase in the forefoot pressure was 0.56 Kgf/cm2 and the hindfoot average pressure decrease was 0.56 Kgf/cm2. These changes were not statistically significant. Discussion. It was reported that the strength of the Achilles tendon generates greater forefoot load transferred from the hindfoot. In our study, no significant variation in the distribution of plantar pressure was observed. It can be inferred that baropodometry was a reliable instrument to determine the plantar pressure, regardless of the tension of the posterior chain muscles.

Does Foot Position and Location of Measurement Influence Ankle Medial Clear Space

Purpose. There is still controversy regarding normal and abnormal values of the medial clear space (MCS) of the ankle. The aim of this study was to assess how much different degrees of plantar flexion, with and without stress, influenced the MCS. Methods. We submitted 30 volunteers to 6 different anteroposterior ankle radiographs in the following positions: neutral, neutral with external rotation stress, physiologic plantar flexion (FPF), physiologic plantar flexion with external rotation stress, maximum plantar flexion (MPF), and maximum plantar flexion with external rotation stress. The MCS oblique (MCSo) and perpendicular (MCSp) were measured in all images by an experienced foot and ankle surgeon. Results. The data showed that the position of the foot does influence the value of MCSp and MCSo (P < .05), except for 3 comparisons. MCSo did not change between FPF with stress and MPF with stress. MCSp did not change in 2 situations: between FPF and neutral with stress and between MPF and FPF with stress. Conclusions. This study is unique in showing that different ways of positioning the foot and performing stress radiographs results in different MCS values and that these values differ depending on the anatomical site where they are measured. Levels of Evidence: Diagnostic, Level IV

All-arthroscopic AMIC® (AT-AMIC) for the treatment of talar osteochondral defects: case series

Introduction/Purpose: Various operative procedures have been used to treat osteochondral lesions of the talus. Among the new alternatives to treat these lesions, Autologous Matrix-Induced Chondrogenesis (AMIC®) has proven to provide satisfactory results through medium-term follow-up. The aim of this study is to report early post-operative clinical results of patients submitted to the AT-AMIC® technique and autologous bone graft, when necessary, for OLT’s at a six-month minimum follow-up.

Does Foot Position and Local of Measurement Influence on Ankle Medial Clear Space

Category: Ankle, Sports, Trauma Introduction/Purpose: The ankle Medial Clear Space (MCS) is frequently used in foot and ankle surgery for determining the competence of the deltoid ligament in Weber B ankle fractures. A widened MCS indicates deltoid ligament incompetence, requiring surgery to prevent lateral talar shift. Controversy still exists regarding Medial Clear Space (MCS) normal and abnormal values, and its possible variation in previously uncontrolled biases. Sex, height, foot position, and type of radiograph were all described as possible influencing factors. The objective of this study was to access how much different degrees of plantar flexion, all performed with and without stress, influence on MCS width. Methods: We submitted 30 volunteers to six different anteroposterior non-weight bearing digital radiographs of the ankle in the following positions: neutral, neutral with external rotation stress, physiologic plantar flexion (FPF), physiologic plantar flexion with external rotation stress, maximum plantar flexion (MPF) and maximum plantar flexion with external rotation stress. The medial clear space MCS oblique (MCSo) and perpendicular (MCSp) were measured in all images by an experienced foot and ankle surgeon. Results: The data analysis showed with statically significance that the position of the foot does influence in the value of both MCSp and MCSo (p<0,05), regardless of three exceptions. MCSo does not change statistically between FPF with stress and MPF with stress. On the other hand, MCSp did not change in two situations: between FPF and Neutral with stress and between MPF and FPF with stress. It is noteworthy that MCSo, on average, was 15% wider than MCSp in all positions tested. It is also noticeable that, from the neutral position, plantar flexing the ankle has a great impact on MCS than external rotation stress, increasing MCSp by 25% and 22% respectively. MCSo follows the same pattern, with 21% and 17% respectively. Conclusion: This study is unique on showing that many different ways of positioning the foot and making stress radiographs do result in completely different MCS values, and that these values differ depending on the anatomical site they are measured. All these data indicates that we need to establish a gold standard for measuring MCS, taking into account patient sex, height, local of measurement of MCS, position of the foot and type of radiograph (AP or Mortise). This study was not able to address all variables that influence directly on MCS and therefore did not intended to establish this new gold standard.

Early Postoperative Results of Endoscopic Transfer of Flexor Hallucis Longus for Chronic Achilles Rupture

Category: Ankle, Arthroscopy, Hindfoot Introduction/Purpose: Background Achilles tendon chronic rupture lead to proximal retraction of the tendon and have a greater tendency to show poorer functional outcomes than acute ruptures. Numerous surgical procedures have been described to treat this pathology. The transfer of the flexor hallucis longus is a well-established treatment option, usually performed as an open procedure. The aim of this paper is to report a case series of six patients with chronic Achilles tendon rupture treated with endoscopic transfer of FHL. Methods: Six patients with Achilles tendon chronic injuries or re-ruptures were treated with endoscopic FHL transfer. There were four man and two women, average of 50 years, with four left and two right tendons involved, and no bilateral cases. All lesions were at zone 2 (between 2-6 cm proximal to insertion). We describe the surgical technique and report our results at an average of a nine-month follow-up. Results: The average follow-up of the series was 9 months (range, 5–12 months). Three patients had an associate procedure at the Achilles tendon to repair the pre-existent gap, using a minimally invasive technique. On average, we expend 56 minutes to perform the surgery, ranging from 45 to 70 minutes. All patients had a major increase in ATRS score values postoperatively, with an average of 17.8 preoperatively and 83,3 postoperatively No major complications or wound healing problems were noted. Tiptoe stance was possible for all patients without limitation. None of the patients noticed functional weakness of the hallux during daily life activity. Conclusion: Endoscopic FLH transfer is a reliable option for patients with higher skin risk and soft tissue complications. Other studies are needed to compare this technique with the open procedure, gold standard by now, to ensure its safety and efficacy.

Anterograde Percutaneous Treatment for Lesser Metatarsal Fractures: Technique Description and Clinical Results

Metatarsal (MTT) fractures are common injuries in the outpatient orthopedic setting. Lesser MTT fractures, although often technically simple, can lead to an inordinate number of unsatisfied patients. The objective of our study was to evaluate the results obtained using an anterograde percutaneous technique for lesser MTT fractures. To our knowledge, there are no previous publications about this technique. We performed a prospective study with 14 patients from 2003 to 2008, in which we evaluated the fracture location, mechanism of trauma, associated comorbidities, and American Orthopaedic Foot and Ankle Society’s functional score for postoperative clinical assessments. The most common fracture location was the MTT neck (79%). Involvement of multiple MTTs (53%) was more common than isolated fractures (47%), and low-energy trauma (79%) was more frequent than high-energy trauma (21%). Female patients with diabetes had the worst functional postoperative results. There were no postoperative complications related to our chosen technique. The surgical technique proposed was effective for treating lesser MTT fractures and had lower complication rates compared with other established techniques.

Percutaneous Lag Screw Fixation for Lateral Malleolar Fracture: Technique Description and Case Report

Open reduction and internal fixation with plate and screws is the standard treatment for displaced or unstable lateral malleolar fractures. Despite functional satisfactory results obtained using this technique, complications including infection, skin necrosis, and discomfort caused by the plate are reported in 10-20% of cases. Several minimally invasive techniques have emerged as alternatives to avoid these complications. The present study aims to describe a technique and case report for percutaneous treatment of lateral malleolar fractures applying only screw fixation.