1/9. Determining foot and ankle impairments by the AMA fifth edition guides.The fifth edition of the Guides has been criticized for its failure to provide a comprehensive, valid, reliable, unbiased, and evidenced-based system for rating impairments and the way in which workers' compensation systems use the ratings, resulting in inappropriate compensation [8]. The lower extremity chapter utilizes numerous functional and anatomic methods of assessment, as well as diagnosis-based estimates. Though this process of using multiple approaches to measure impairment increases the chances that an underlying physical impairment may be detected, it is time-consuming and may increase rating variability [9]. McCarthy et al studied the correlation between measures of impairment for patients with fractures of the lower extremity. They found that the anatomic approach of evaluation was better correlated than functional and diagnostic methods with measures of task performance based on direct observations as well as the patient's own assessment of activity limitation and disability. Also, muscle strength assessment as described in the Guides was a more sensitive measure of impairment than range of motion [9]. The most elusive part of the foot and ankle evaluation is the inability to capture the added impairment burden caused by pain. The assessment of pain is the most problematic part of any evaluation. Pain is considered and incorporated into the impairment ratings found in the foot and ankle section, as well as the other individual chapters. chronic pain is often not adequately accounted for, however, and the examiner must evaluate permanent impairment from chronic pain separately. The examiner has the ability to increase the percentage of organ system impairment from 1% to 3% if there is pain-related impairment that increases the burden of illness slightly. If there is significant pain-related impairment, a formal pain assessment is performed. Chapter 18 provides guidance in making these determinations. Impairments for Complex Regional Pain syndrome (CRPS), type 1 (reflex sympathetic dystrophy), and CRPS, type 2 (causalgia) should incorporate the use of a formal pain assessment in addition to the standard methods of assessment. The formal pain evaluation relies mostly on self-reports from the individual and is most heavily weighted for ADL deficits. The physician must make assessments of the individual's pain behavior and credibility for this evaluation. The formal pain assessment classifies the pain-related impairment into categories of mild, moderate, moderately severe, or severe and determines whether this impairment is ratable or not. These categories do not have impairment percentages associated with them. The individual's symptoms or presentation should match known conditions or syndromes in order to be ratable. If not ratable, the examiner should report that the individual has apparent impairment that is not ratable on the basis of current medical knowledge. In the end, pain evaluations are used administratively and, depending on the situation, may be given equal weight with the standard evaluation or may be totally disregarded.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/9. Management of Lisfranc's fracture-dislocation.Lisfranc's joint injuries are rare and complex. A car driver who sustained a traffic accident, was admitted because of partial dorsolateral fracture-dislocation of the Lisfranc's joint. The diagnosis was made by physical examination and radiographs. Reduction and pin fixation were performed under general anesthesia. At the end of the ninth month, range of motion of the foot and ankle was full, with no pain on daily activities.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/9. Aeromonas hydrophilia infections after penetrating foot trauma.The bacterium aeromonas hydrophila is an anaerobic gram-negative bacillus commonly found in natural bodies of water and can cause infection in patients who suffer water-associated trauma or in immunocompromised hosts. The authors present 5 cases of penetrating wound trauma that did not involve any aquatic environment and developed rapidly forming infections. All patients presented with severe pain, cellulitis, ascending lymphangitis, fever, and pain on range of motion of the joint near the traumatic site. Presentation of clinical symptoms mimicked that of a septic joint or of severe streptococcal infection. All patients required surgical incision and drainage, intravenous and oral antibiotics using levofloxacin or bactrim, and local wound care. Results from cultures taken intraoperatively showed only A hydrophilia in every case. Resolution of symptoms occurred rapidly after surgery, and clinical resolution was seen within 72 hours. Each patient healed uneventfully and returned to preinjury status.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/9. Combined rupture of the tibialis anterior and the extensor hallucis longus tendons--functional reconstruction.BACKGROUND: Traumatic rupture of the tibialis anterior (TA) tendon represents a very rare foot injury. A combined injury of both the TA and the extensor hallucis longus (EHL) tendons has not yet been reported. Within the scope of this work we will prove that tendon transfers in cases of combined tendon injuries are a reasonable course of action in order to achieve the aim of a functional reconstruction. methods: A combined rupture of the tibialis anterior (TA) and the extensor hallucis longus (EHL) tendons was treated by suturing the EHL tendon to the distal TA tendon stump. The TA insertion was secured and the distal portion of the EHL tendon attached to an extensor digitorum slip. The TA muscle was proximally attached to the tendinous EHL segment. RESULTS: A 1 year follow-up verified very good results, showing the patient without complaints in regard to the trauma. Compared with the contralateral non-affected side, the repaired foot showed very satisfactory results in reference to range of motion, strength and gait. CONCLUSION: With this work we proved that tendon transfers in cases of combined tendon injuries make sense in order to achieve functional reconstruction. This approach preserves function and strength and avoids the problems and risks of alternate treatment techniques, including tendon grafting.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/9. Spontaneous rupture of the plantar fascia.In this study, rupture of the plantar fascia was seen in five feet, of which four had had plantar fasciitis. At the time of the injury, which is an acceleration type of motion, there is severe pain in the heel followed by the development of ecchymosis in the sole and toward the heel of the foot. With conservative symptomatic care, the acute symptoms as well as the plantar fasciitis symptoms subside, generally allowing full activity in 3 to 4 weeks.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/9. Complications following traumatic incidents with STA-peg procedures.The authors describe use of a Silastic plug to limit subtalar joint motion in symptomatic pediatric flatfeet. Three patients sustained postoperative injury resulting in pedal complications. Successful resolution of these cases is discussed.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/9. Correction of equinus deformity following midtarsal amputation by tibiotalar arthrodesis: a case report.Transtarsal amputation in a 49-year-old man was unacceptible because of associated equinus deformity of the ankle and callus formation on the sole of the foot. The equinus deformity and callus formation were corrected by fusion of the ankle in 10 degrees of dorsiflexion and advancement of the talus and os calcis anteriorly. The operation produces a larger weight-bearing area than Syme's amputation, does not disturb the normal weight-bearing fat pad underneath the os calcis, and preserves the length of the extremity as well as the motion in the subastragalar joint.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/9. Successful revascularization of a partially avulsed foot in a 6-year-old child.The foot of a 6-year-old child was revascularized successfully following an avulsion and partial amputation through the tibiotalar joint. Partial degloving had disrupted the anterior and posterior tibial arteries with resultant ischemia. We excised the entire damaged segment of the posterior tibial artery and performed a reverse saphenous vein graft, end-to-end reconstruction of the defect. Peroneal and tibial nerve function returned within 5 months. Four years later, the patient has regained full, painless range of motion and normal strength and sensibility with no evidence of premature growth plate closure or avascular necrosis of the talus.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/9. Use of cross-extremity flaps stabilized with external fixation in severe pediatric foot and ankle trauma: an alternative to free tissue transfer.Pedicled cross-extremity flaps for wound coverage have been replaced, in most cases, by free tissue transfer. Classically, cross-leg flaps have been problematic because of difficulties with immobilization and positioning of the extremities from the time of initial coverage to detachment. Three children with severe foot and ankle trauma had cross-extremity flaps using linkage of bilateral lower-extremity external fixators in place of traditional casting. Cross-leg flaps were used in two patients, and a cross-foot flap was applied in one. Each flap survived completely, and the linking fixators were disassembled at the time of flap detachment. No complications were related to the donor site or the flap itself or were caused by the fixation. Lower-extremity range of motion was regained rapidly, and each patient resumed essentially normal gait and activity. Addition of external-fixator stabilization aids greatly in wound care, as well as general ease of patient mobility and positioning. External fixation facilitates the use of cross-extremity flaps in pediatric patients in whom free tissue transfer may not be optimal.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |