Tag Archive | calcaneus

What’s New in Foot and Ankle Surgery: Level I and II Studies

Every month, JBJS publishes a Specialty Update—a review of the most pertinent and impactful studies published in the orthopaedic literature during the previous year in 13 subspecialties. Here is a summary of selected findings from Level I and II studies cited in the May 20, 2015 Specialty Update on foot and ankle surgery:

Talar and Calcaneal Fractures

Ankle Instability

  • A prospective randomized study of treatments for severe lateral ankle sprains compared a walking boot with restricted joint mobilization for three weeks with immediate application of a functional brace. No between-group differences in pain scores or development of mechanical instability were found, but the immediate functional-brace group had better function scores and shorter recoveries.
  • A randomized trial comparing neuromuscular training, bracing, and a combination of the two for managing lateral ankle sprains concluded that bracing is the dominant secondary preventive intervention.

Total Ankle Arthroplasty

Ankle and Hindfoot Arthrodesis

  • A pilot RCT comparing B2A-coated ceramic granules with autograft in foot and ankle arthrodesis found that the B2A approach produced a 100% fusion rate, compared with a 92% rate in the autograft group.

Achilles Tendon

  • A Level II study found that weight-bearing cast immobilization provided outcomes that were similar to those of non-weight-bearing cast immobilization in non-operative management of acute Achilles tendon ruptures.

Peripheral Neuropathy

  • In an RCT comparing standard-of-care orthoses with experimental pressure-based orthoses to prevent plantar foot ulcers, the experimental orthoses outperformed the standard ones.
  • A Level I study investigating surgical-site infections after foot and/or ankle surgery found an increased risk of infection associated with concomitant peripheral neuropathy, even in patients without diabetes.

3D-Printed Heel Bone Averts Amputation for Australian Man

Len Chandler of Melbourne, Australia had a cancerous tumor in his left calcaneus and was facing a below-the-knee amputation because of the difficulty entailed in achieving a functional limb salvage procedure. Surgeon Peter Choong teamed with an implant manufacturer and Australia’s national science agency to create an exact titanium replica of the involved bone. The 3D-printed bone had to be both porous, to allow tissue in growth, and ultra-smooth so that it could articulate with hind and midfoot joints, and allow smooth tendon gliding.

After this ground-breaking surgery in July, Chandler is now able to carry more than half his body weight on that foot. The prognosis is for Chandler to be off crutches by the end of 2014. Click here to read the full story. Also, read the related OrthoBuzz article about the first 3D-printed cervical disc implanted in a minor.