The surgical management of ankle arthritis with tibiotalar arthrodesis
is known to alter gait, as compared with normal ankles. The purpose
of this study was to assess post-operative gait function with gait
before arthrodesis. We prospectively studied 20 patients who underwent three-dimensional
gait analysis before and after tibiotalar arthrodesis. Cadence,
step length, walking velocity and total support time were assessed.
Kinetic parameters, including the moment and power of the ankle
in the sagittal plane and hip power were also recorded.Aims
Patients and Methods
A comprehensive review of the literature relating to the pathology and management of the diabetic foot is presented. This should provide a guide for the treatment of ulcers, Charcot neuro-arthropathy and fractures involving the foot and ankle in diabetic patients.
Forefoot reconstructive surgery can be complex and intricate, and even though performed by orthopaedic surgeons, it can be delicate, too. Despite the most ingenious techniques, patients routinely walk (stomp) all over this work, and the resulting forces applied to the foot have been extensively studied in gait analysis laboratories. But the everyday clinical challenge is how to employ durable reconstructive techniques, and how to salvage these case when they fail? Hallux valgus surgery is replete with complications of malunion, non-union, over-correction and recurrence. Salvage often requires a revision of the patient’s expectations in addition to another surgery. First metatarso-phalangeal joint (MTP) arthrodesis, which has been demonstrated to have excellent functional outcomes, including return to sports activities, is an excellent salvage technique. Failed first MTP arthroplasty leaves a large bone defect, both in the metatarsal and phalanx. Salvage by arthrodesis requires bone grafting, rigid internal fixation, and long healing times. Tricortical iliac graft can be used to enhance restoration of length. Associated meta-tarsalgia may persist due to shortening of the first ray. Lesser metatarsal salvage sometimes can be accomplished with distal metaphyseal osteotomy. Some cases previously treated with a pan-metatarsal head resection can now be successfully salvaged by using these osteotomies to shorten multiple metatarsals. Meticulous technique is an advantage. First MTP arthrodesis itself can be complicated. One uncommonly recognized problem is the painful pressure under the residual sesamoid bone following an otherwise successful fusion. This is caused by arthritic enlargement of the sesamoid, and should be anticipate, and prevented by sesamoidectomy. Surgical technique for obtaining ideal position of the hallux will be presented. The distinction between true recurrence of interdigital (Morton’s) neuroma, and metatarsalgia can be subtle. The cause of failed neuroma surgery is as frequently an error in patient selection as it is failure of surgical technique. Case presentations will be employed to illustrate forefoot salvage principles.
