Faculty Bibliography

Persistent recalcitrant dorsolateral foot pain after ankle sprain cannot always be explained by known anatomic nerve pathways. To determine whether an impingement of a lateral branch of the deep peroneal nerve might be responsible for atypical pain, we conducted a cadaveric anatomic study to identify the anatomy and course of the nerve. Furthermore, using this information, we conducted a clinical study to determine if targeted treatment to a lateral branch of the deep peroneal nerve would resolve these symptoms. We dissected 22 cadaveric feet to identify a large lateral branch of the deep peroneal nerve. This nerve arborized into five main branches. We identified two areas of compression in the lateral branch of the deep peroneal nerve. We also performed a prospective clinical study including 11 consecutive patients with a 1-year minimum followup. Pain and clinical findings corresponded to the anatomic compression sites in all 11 patients. All patients responded to a local anesthetic injection or surgical release of the lateral branch of the deep peroneal nerve. We identified a previously unreported complex course of the lateral branch of the deep peroneal nerve that correlated with clinical impingement syndrome and responded to specifically targeted treatment.

Cycling is an increasingly popular recreational and competitive activity, and cycling-related injuries are becoming more common. Many common cycling injuries of the lower extremity are preventable. These include knee pain, patellar quadriceps tendinitis, iliotibial band syndrome, hip pain, medial tibial stress syndrome, stress fracture, compartment syndrome, numbness of the foot, and metatarsalgia. Injury is caused by a combination of inadequate preparation, inappropriate equipment, poor technique, and overuse. Nonsurgical management may include rest, nonsteroidal anti-inflammatory drugs, corticosteroid injection, ice, a reduction in training intensity, orthotics, night splints, and physical therapy. Injury prevention should be the focus, with particular attention to bicycle fit and alignment, appropriate equipment, proper rider position and pedaling mechanics, and appropriate training.

Metatarsalgia is one of the most common forefoot pain presentations seen in orthopedics. Surgical management has often been suboptimal with more than 20 surgical methods reported, differing in indication, technique, fixation, and postoperative mobilization.The literature has not yet recorded a definitive surgical solution to this problem. Outcome parameters including patient satisfaction, pedobarographic, and radiologic measurements have indicated the relative success of the different surgical techniques and their adverse outcome trends.The current authors present their experience with the Weil, chevron, and oblique sliding diaphyseal techniques in the context of their indications, techniques, and outcomes, and review their success in the literature

Adult flat foot deformity, resulting from posterior tibial tendon (PTT) insufficiency has been treated traditionally with a combination of bony and soft tissue procedures with variable outcomes. Many techniques advocate repair of the spring ligament to optimize outcome. In cases of long standing PTT deficiency, however, the spring ligament may be significantly attenuated; compromising potential repair as a useful surgical strategy.The current authors describe a simple technique that uses the distal stump of the PTT to reconstruct and augment the spring ligament fibrocartilage complex. The advantage of this technique is the use of existing autogenous tissue to provide reconstruction of the attenuated spring ligament. The construct provides a broad proximal support; preventing midtarsal pronation and abduction by its Y shaped configuration without donor site morbidity

Repair of the Achilles tendon ruptures is becoming a more accepted means of treatment over casting. However, wound problems are still a problematic complication. Minimally invasive Achilles tendon repair using the Achillon® device is presented and discussed as a treatment method that combines the benefits of surgical repair with less wound complications caused by a smaller surgical approach. Cadaveric studies have shown this repair to be stronger than the traditional modified Krackow suture technique

Several methods of obtaining ankle fusion have been described, with numerous studies reporting on patient populations with varied diagnoses and various methods of fixation. This has led to outcome analyses that are difficult to interpret. Our hypothesis is that using a standard method of fusion, without the aid of allograft, a solid ankle fusion can be achieved in patients with end-stage ankle arthritis, and that this outcome can be reflected in standardized outcome tools. Forty-one consecutive ankle fusions in 40 patients were included in our study, with a minimum followup of 3 years. All patients had an ankle arthrodesis using two parallel retrograde 7.3-mm screws and local fibular graft. All but two patients obtained a solid talocrural union (95%), with a mean postoperative improvement in the American Orthopaedic Foot and Ankle Society score of 23 points. Results of our study showed that a simple technique based on sound mechanical and biologic principles can yield excellent outcomes for patients.

BACKGROUND:Ankle arthrodesis remains the benchmark of treatment for end-stage arthrosis of the ankle joint. Despite that, the incidence of nonunion can be as high as 15%. Various strategies have been used to reduce the incidence of nonunion, including multiple compression screws and larger diameter screws to improve mechanical stability and compression. The space occupied by an increasing amount of hardware across a finite surface area available for fusion has prompted concern that this strategy may be counterproductive and may reduce the biological potential of the construct. The purpose of this study was to look at 40 anatomic sawbone specimens of the ankle to determine the amount of talar surface contact area used by the screw fixation during arthrodesis. METHODS:Four groups were created to examine different techniques for arthrodesis. Simulated ankle arthrodeses were done using two- or three-screw fixation with 6.5-mm and 7.3-mm screws. Hardware was subsequently removed and the surface area used by the passing screws was measured. Total surface areas were calculated for each of the 40 specimens. RESULTS:The maximal surface area of the talus occupied by screws occurred when using three 7.3-mm screws. This configuration used 16% of the possible talar surface area available for arthrodesis. CONCLUSION/CONCLUSIONS:The use of additional screw fixation when performing an ankle arthrodesis does not sacrifice a major amount of the tibiotalar contact area and will most likely not affect the biologic environment needed to obtain fusion.