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To quantify the long-term prevalence of game-related Lisfranc trauma in college football on artificial turf and natural grass. 32 universities were evaluated over 10 competitive seasons across all Football Bowl Subdivision (FBS) conferences. Outcomes of interest included injury severity, injury category, primary type of injury, player and skill position, injury mechanism and situation, elective imaging and surgical procedures, and field conditions. Injury incidence rates (IIR) were calculated using injuries per 10 games = (number of injuries) number of games) × 10. Of the 1577 games documented, 783 games (49.7%) were played on a 3-layer artificial turf (≥9.0 lbs/ft2) infill system versus 794 games (50.3%) played on natural grass. In sum, 78 Lisfranc cases were documented with 34 (43.6%) occurring on artificial turf, and 44 (56.4%) on natural grass. MANOVAs indicated significant main effects by injury category (F3,74 = 6.439; P =.001), and injury mechanism (F5,72 = 3.372; P =.009) observed between surfaces, but not by injury severity (F2,75 = 0.720; P =.490), primary type of injury (F4,73 = 0.772; P =.547), overall player (F2,75 = 0.219; P =.804) and skill positions (F8,69 = 0.850; P =.563), injury situation (F10,67 = 1.030; P =.428), elective imaging and surgical procedures (F3,74 = 0.515; P =.673), or field conditions (F2,75 = 0.375; P =.688). Post hoc analyses indicated significantly greater incidences (P <.05) of Lisfranc trauma on natural grass attributed to shoe:surface interaction during noncontact play, and during no contact, foot rotation or planting. Ligament tears (n = 8; 57.1%), with minimal cases of subluxation/dislocations (n = 4; 28.6%) and fractures (n = 2; 14.3%) comprised grade 3 cases across both surfaces. In regards to Lisfranc trauma, a 3-layer, heavyweight artificial infill surface is as safe or safer than natural grass. The findings of this study may be generalizable only to this level of football competition. [ABSTRACT FROM AUTHOR]

Background: Recurrence is relatively common after surgical correction of hallux valgus. Multiple factors are discussed that could have an influence in the loss of correction. The aim of this study was to determine preoperative radiological factors with an influence on loss of correction after distal chevron osteotomy for hallux valgus. Methods: Five hundred twenty-four patients who underwent the correction of a hallux valgus by means of distal chevron osteotomy at our institution between 2002 and 2012 were included. We assessed weightbearing x-rays at 4 time points: preoperatively, postoperatively, and after 6 weeks and 3 months. We investigated the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), joint congruity, and the position of the sesamoids. Results: At all points of the survey, significant correction of the IMA and HVA was detected. The IMA improved from 12.9 (± 2.8) to 4.5 (± 2.4) degrees and the HVA from 27.5 (± 6.9) to 9.1 (± 5.3) degrees. Loss of correction was found in both HVA and IMA during follow-up with a mean of 4.5 and 1.9 degrees, respectively. Loss of correction showed a linear correlation with preoperative IMA and HVA, and a correlation between preoperative DMAA and sesamoid position. Conclusion: The chevron osteotomy showed significant correction for HVA, IMA, and DMAA. Preoperative deformity, in terms of IMA, HVA, DMAA, and sesamoid position, correlated with the loss of correction and could be assessed preoperatively for HVA and IMA. Loss of correction at 3 months persisted during the follow-up period. Level of Evidence: Level IV, retrospective case series. [ABSTRACT FROM AUTHOR]

An intermetatarsal coalition is an uncommon pathologic entity, previously reported in published studies as being primarily unilateral, most commonly between the first and second metatarsals and less so between the third and fourth metatarsals. We report an unusual case of a bilateral coalition of the third and fourth metatarsals in a 43-year-old male who presented with nonspecific dorsolateral foot pain. Conservative therapy initially failed, and resolution of pain was noted bilaterally after coalition resection. [ABSTRACT FROM AUTHOR]

The chevron osteotomy is a standard procedure by which bunions are corrected. One of us routinely performs a distal oblique osteotomy, which, to the best of our knowledge, has not been described for the correction of bunion deformities. The purpose of the present study was to compare the short- and medium-term results of the distal oblique and chevron osteotomies for bunion correction. We performed a retrospective clinical and radiographic comparison of patients who had undergone a distal oblique or chevron osteotomy for the correction of bunion deformity. In addition, a prospective patient satisfaction survey was undertaken. A total of 55 patients were included in the present study and were treated from January 2012 to November 2014. Of the 55 patients, 27 (49.2%) were in the chevron group and 28 (50.8%) in the distal oblique group. Radiographically, no statistically significant difference was found between the 2 groups with respect to postoperative first intermetatarsal angle ( p < .0001) and hallux valgus angle ( p < .0001), but a greater change was found in the intermetatarsal angle in the distal oblique group ( p = .467). Prospective patient satisfaction scores were available for 33 patients (60%), 16 (29%) in the chevron group and 17 (31%) in the distal oblique group. When converting the satisfaction score to a numerical score, the chevron group scored 3.3 ± 1.1 and the distal oblique group scored 3.2 ± 0.8 ( p = .812). We found that the distal oblique osteotomy used in the present study is simple and reliable and showed radiographic correction and patient satisfaction equivalent to those in the chevron osteotomy. [ABSTRACT FROM AUTHOR]

Hallux valgus is a common cause of foot pain and deformity in the adult and adolescent population, which often requires surgical treatment when nonsurgical treatments fail. When the condition is associated with an increased intermetatarsal angle, a surgical technique using a proximal first metatarsal osteotomy is often indicated. A proximal opening wedge osteotomy stabilized with a wedge and plate configuration offers a stable, reliable means to correct the increased intermetatarsal angle. This article describes a technique for surgical correction of hallux valgus with an increased metatarsal angle, using a 3-incision technique that includes: (1) a medial bunionectomy with capsular imbrication, (2) a lateral soft-tissue release, and (3) a proximal metatarsal osteotomy fixed with a 4-hole L-shaped plate with a wedge spacer. [Copyright &y& Elsevier]

The purpose of this investigation was to conduct a prospective trial to assess the effectiveness of a 4% sclerosing alcohol injection in a small group of patients with intermetatarsal neuromas who had failed previous conservative therapies including corticosteroid injections. Six patients with 8 neuromas were followed for a mean 346 days. A weekly series of 3–9 injections containing 1 mL of the 4% alcohol sclerosing solution were given based on patient response to treatment. Pre- and posttreatment surveys consisting of both objective and subjective findings including a visual analog pain scale were collected. The average pretreatment visual analog pain rating was 7.5 ± 1.14. The average posttreatment visual analog pain rating was 1.38 ± 2.39 with an average reduction of 6.13. The average reported improvement in symptoms was 73%. Five of the 6 patients would recommend the treatment to a friend or family member. No complications were encountered. Two neuromas in 2 patients failed the sclerosing injection course: 1 ultimately responded to antiinflammatory use and the other underwent excision. [Copyright &y& Elsevier]