Yousef Alrashidi

How To Diagnose and Treat Infection in Total Ankle Arthroplasty

Periprosthetic infection after total ankle arthroplasty (TAA) is a serious complication, often requiring revision surgery, including revision arthroplasty, conversion to ankle arthrodesis, or even amputation. Risk factors for periprosthetic ankle infection include prior surgery at the site of infection, low functional preoperative score, diabetes, and wound healing problems. The clinical presentation of patients with periprosthetic ankle joint infection can be variable and dependent on infection manifestation: acute versus chronic. The initial evaluation in patients with suspected periprosthetic joint infections should include blood tests: C-reactive protein and erythrocyte sedimentation rate. Joint aspiration and synovial fluid analysis can help confirm suspected periprosthetic ankle infection.

Posterior Tibial Tendon Lesions and Insufficiency

The rate of occurrence of Posterior Tibial Tendon (PTT) injuries and insufficiency in sports is not yet clear based on the available literature. However, literature review may point to a link between some sports with specific lesions such as PTT dislocation, PTT tear, and PTT Insufficiency (PTTI) stage I or II. High index of suspicion is needed to diagnose and treat those lesions to prevent their progression to advanced stages.

Medial Ankle Instability

Diagnosis and treatment of medial ankle instability (MAI) are still controversial and poorly discussed in literature. The purpose of this review is to highlight different clinical presentations of MAI and develop a guide for its management. The deltoid ligament complex is injured more commonly than expected, because deltoid ligament injuries may either be isolated or occur in combination with other lesions, such as lateral ankle ligament injury, posterior tibial tendon insufficiency, osteochondral lesion, and others. The presence of a pes planovalgus deformity in a patient without posterior tibial tendon insufficiency may indicate MAI.

Surgical Treatment Options for the Diabetic Charcot Midfoot Deformity

Management of diabetic Charcot midfoot deformity is one of the most demanding aspects of foot and ankle surgery. Its treatment should aim at reducing the rate of complications, including foot and ankle amputations or limb loss. Attempting reconstruction at Eichenholtz stages I and II carries the risk of infection and loss of fixation. It is advisable to limit surgical reconstruction to Eichenholtz stage III in the absence of any evidence of infection or vascular insufficiency. Achilles lengthening or gastrocnemius-soleus release is an essential initial step in surgery. Addressing the medial foot column first is a key to a successful reconstruction.

Plantar Fasciitis in Sport

Plantar fasciitis is a common musculoskeletal condition among sport-active people. Careful history taking and appropriate clinical examination is essential to exclude other causes of plantar heel pain. Following a step-wise approach is recommended in plantar fasciitis treatment, as it is usually self-limiting condition. Inadequate response to non-operative treatment and persistence of symptoms more than 6 months may warrant surgical intervention. Provision of health instructions to athletes would help in prevention of plantar fasciitis. Athletes should watch for their training mistakes and should maintain good muscular strength and balance.

Morton’s Neuroma in Sports

Morton’s neuroma is a common cause of metatarsalgia which characterized by enlargement of interdigital nerve possibly due to nerve entrapment. Morton’s neuroma is usually common among middle age population with female gender predominance. Diagnosis of Morton’s neuroma is essentially clinical. Imaging modalities may help to delineate and localize the nerve lesion. Prone position foot MRI is associated with higher visibility of Morton’s neuroma. Identification of Morton’s neuroma, as a cause of metatarsalgia, tends to be missed by clinicians. Hence, high index of suspicion should be invested for this purpose. Proper footwear awareness should be emphasized among athletes. The cross-training shoes are discouraged for long distance running. Local steroid injection may provide temporary relief. Ultrasound-guided injection can improve the localization of injection. Neurectomy of the thickened nerve is considered the standard surgical treatment to date. Majority of surgeons prefer dorsal approach for first-time excision of Morton’s neuroma despite of its limited exposure reserving the plantar approach to the revision cases. Plantar surgical approach provides direct anatomical access and allows wide exploration of the area of neuroma. Recurrent neuroma is a major concern after neurectomy. Deep burial of nerve stump within the intermetatarsal soft tissues might minimize the risk of recurrent neuroma formation.

Anatomical Lateral and Medial Ligament Reconstruction in Rotational Chronic Ankle Instability

Category: Sports. Introduction/Purpose: Rotational (combined lateral and medial) chronic ankle instability (CAI) can present with pain and tenderness at the ankle joint, and can be associated with feeling of giving way, repetitive sprains, and life quality limitation. In case of surgery, anatomical reconstruction of the ligaments and treatment of comorbidities are essential for a solid outcome. Methods: A retrospective chart review of 81 rotational CAI patients (average age: 35.3 years, age range: 16-64; right sided: 41(50.6%); left sided: 40(49.4%)) was performed. The average latest follow-up visit was 10.8 months (range: 3-47 months). The patients underwent in our center a standardized surgical treatment protocol. Following diagnostic ankle arthroscopy, a combined lateral and medial anatomical ligament reconstruction was performed. Hindfoot realignment procedures and treatment of associated pathologies (such as talar osteochondral lesions) were carried out at the same time. Postoperatively, all patients were mobilised with partial weight bearing (15 kg) for six weeks in an Aircast walker ® (DJO, LLC, USA). Adequate postoperative analgesia and physiotherapy were initiated. Results: Combined lateral and medial ligament reconstruction without additional surgeries was performed in 20 cases (24.7%). In the other cases, to address associated pathologies, additional surgeries were performed, such as: lateral calcaneal lengthening osteotomy (LCLO) in 42 cases (51.9%), medial sliding calcaneal osteotomy (MSCO) in 3 Cases (3.7%), osteochondral lesion reconstruction in 20 cases (24.7%), peroneal tendon pathology treatment in 3 cases (3.7%), cavovarus foot correction in 1 case (1.2%), supramalleolar osteotomy in 1 case (1.2%), and calcaneonavicular coalition excision in 1 case (1.2%). The outcome variables will be presented at the conference. Conclusion: Anatomical lateral and medial ligament reconstruction of rotational CAI is a safe surgical treatment and leads to a favourable outcome. Beside the ligament reconstruction, associated comorbidities, as malalignment, osteochondral lesions, and others, have to be addressed at the same surgery to achieve physiological biomechanics and a complete pain relieve.