To assess the characteristic clinical features, management, and outcome of patients who present to orthopaedic surgeons with functional dystonia affecting the foot and ankle. We carried out a retrospective search of our records from 2000 to 2019 of patients seen in our adult tertiary referral foot and ankle unit with a diagnosis of functional dystonia.Aims
Methods
Cone beam CT allows cross-sectional imaging of the tibiofibular syndesmosis while the patient bears weight. This may facilitate more accurate and reliable investigation of injuries to, and reconstruction of, the syndesmosis but normal ranges of measurements are required first. The purpose of this study was to establish: 1) the normal reference measurements of the syndesmosis; 2) if side-to-side variations exist in syndesmotic anatomy; 3) if age affects syndesmotic anatomy; and 4) if the syndesmotic anatomy differs between male and female patients in weight-bearing cone beam CT views. A retrospective analysis was undertaken of 50 male and 50 female patients (200 feet) aged 18 years or more, who underwent bilateral, simultaneous imaging of their lower legs while standing in an upright, weight-bearing position in a pedCAT machine between June 2013 and July 2017. At the time of imaging, the mean age of male patients was 47.1 years (18 to 72) and the mean age of female patients was 57.8 years (18 to 83). We employed a previously described technique to obtain six lengths and one angle, as well as calculating three further measurements, to provide information on the relationship between the fibula and tibia with respect to translation and rotation.Aims
Patients and Methods
Gastrocnemius tightness predisposes to musculoskeletal pathology
and may require surgical treatment. However, it is not clear what
proportion of patients with foot and ankle pathology have clinically
significant gastrocnemius tightness. The aim of this study was to
compare the prevalence and degree of gastrocnemius tightness in
a control group of patients with a group of patients with foot and
ankle pathology. This prospective, case-matched, observational study compared
gastrocnemius tightness, as assessed by the lunge test, in a control
group and a group with foot and ankle pathology. Gastrocnemius tightness
was calculated as the difference in dorsiflexion of the ankle with
the knee extended and flexed.Aims
Patients and Methods
Smoking is associated with post-operative complications but smokers
often under-report the amount they smoke. Our objective was to determine
whether a urine dipstick test could be used as a substitute for
quantitative cotinine assays to determine smoking status in patients. Between September 2013 and July 2014 we conducted a prospective
cohort study in which 127 consecutive patients undergoing a planned
foot and ankle arthrodesis or osteotomy were included. Patients
self-reported their smoking status and were classified as: ‘never
smoked’ (61 patients), ‘ex-smoker’ (46 patients), or ‘current smoker’ (20
patients). Urine samples were analysed with cotinine assays and
cotinine dipstick tests.Aims
Patients and Methods
Metatarsalgia is a recognised complication following iatrogenic shortening of the first metatarsal in the management of hallux valgus. The traditional surgical treatment is by shortening osteotomies of the lesser metatarsals. We describe the results of lengthening of iatrogenic first brachymetatarsia in 16 females. A Scarf-type osteotomy was used in the first four cases and a step-cut of equal thicknesses along the axis of the first metatarsal was performed in the others. The mean follow-up was 21 months (19 to 26). Relief of metatarsalgia was obtained in the six patients in whom 10 mm of lengthening had been achieved, compared to only 50% relief in those where less than 8 mm of lengthening had been gained. One-stage step-cut lengthening osteotomy of the first metatarsal may be preferable to shortening osteotomies of the lesser metatarsals in the treatment of metatarsalgia following surgical shortening of the first metatarsal.
Whilst a few studies have associated various symptoms with the presence of a peroneus quartus muscle in the peroneal compartment of the leg, little is known of the clinical relevance of this muscle. We dissected 102 cadaver legs and reviewed the magnetic resonance images of 80 patients with symptoms from the ankle. The peroneus quartus, with a number of different attachments, was present in 6.6% of the legs. It most commonly arose from the peroneus brevis muscle and inserted into the retrotrochlear eminence of the calcaneum. Associated pathology included a longitudinal tear in the tendon of peroneus brevis, possible peroneal tendon subluxation or dislocation, and a prominent retrotrochlear eminence. On the MR scans its presence was associated with pain and weakness of the ankle. Orthopaedic surgeons and radiologists should be aware of the possible presence of the peroneus quartus muscle, not only because of possible associated pathology, but also for its potential use for surgical reconstruction.
