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The surgical treatment of diabetic patients can be challenging. The physiologic and metabolic abnormalities seen in diabetic patients can adversely affect healing and outcomes in even the simplest of procedures. This article examines some of the special considerations in the treatment of diabetic patients undergoing foot and ankle surgeries., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Cuneiform dislocation associated with Lisfranc injury is a very rare injury. Dislocation over the midfoot due to a seizure has not been previously reported in published studies. A 35-year-old female presented with an intercuneiform dislocation and Lisfranc fracture-dislocation after a generalized seizure. Immediate close reduction of the dorsally dislocated cuneiforms was performed, followed by definitive treatment to restore the foot arches. A proposed underlying pathophysiology of dislocation due to seizure in terms of the biomechanics is discussed. The purpose of our report was to present the unusual etiology of this form of cuneiform dislocation and Lisfranc joint complex injury., (Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Determining the status of bone healing after osteotomy can be challenging and has implications ranging from clinical decision-making to standardization of research outcomes without the use of computed tomography. To date, no method has been validated for determining osseous healing of an osteotomy site of the long bones of the foot. The purpose of the present study was to develop a radiographic union scoring system that would enhance the diagnostic healing assessment. We adapted existing orthopedic scales that had been validated for healing in the leg for application in the long bones of the foot. One hundred cases were evaluated by 6 blinded assessors to test the inter- and intrarater reliability of the subjective healing assessment compared with the proposed scoring system. The radiographs were classified by postoperative period: ≤4, 5 to 12, and >12 weeks. The proposed scale had a high interrater reliability but was burdensome. Using a priori item reduction protocols, the scale was limited to the 5 items with the best internal consistency, which significantly reduced the burden. The result was excellent interrater reliability (α = 0.87) among all assessors compared with acceptable reliability (α = 0.66) for the subjective osteotomy healing assessment. The intrarater reliability during the subsequent retest phase demonstrated similar relationships, with low agreement (r = 0.38) for subjective healing. Each of the items included in the final scoring scale had moderate to good agreement across all assessors (r = 0.51 to 0.63). The reliability of this system appeared superior to the subjective assessment of osseous healing alone, even in the absence of clinical correlates after an osteotomy in the foot., (Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Understanding the epidemiology of foot and ankle trauma could be useful in health services research and for policy makers. It can also define practice patterns. Using the National Trauma Data Bank data set from 2007 to 2011, we analyzed the frequency and proportion of each fracture in the foot and ankle in major trauma hospitals in the United States. A total of 280,933 foot and/or ankle fractures or dislocations were identified. Although oversampling of more severe trauma in younger patients might have occurred owing to the nature of the data set, we found that the most common fractures in the foot and ankle were ankle fractures. Midfoot fractures were the least common among all the foot and ankle fractures when categorized by anatomic location. Approximately 20% of all foot and ankle fractures were open., (Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

The results achieved with this technique after a mean follow-up of 8 years (85% excellent and good results) allow neoligamentplasty to be considered as a viable alternative to the classic procedures in the treatment of subtle intercuneiform and tarsometatarsal joint lesions., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Parkour is an extreme sport that has been popular in Europe for a few years. This sport has now made it across the Atlantic and is quickly gaining popularity in the United States. Participants of this activity, known as parkouristes, try to overcome obstacles in their environment in the most efficient manner possible. This can be accomplished by simply jumping or scaling an obstacle, but sometimes this is done in a very acrobatic manner. The sport had a longtime underground following but has now gained media exposure through various television advertisements, and it has even been featured in recent blockbuster films. As a result, many amateurs are attempting to recreate these dangerous stunts without proper protection or guidance. We will review the case of an 18-year-old male who sustained multiple fracture/dislocations of his left foot while practicing parkour. ACFAS Level of Clinical Evidence: 4.

Ten patients (11 feet) with severe, high-velocity, open injuries to the midfoot were treated with uniplanar external fixation. The mean patient age was 38 years. Five wounds measured >10 cm, and 3 had extensive degloving of the foot extending into the lower leg. All had grossly comminuted fractures of the tarsal and metatarsal bones: 9 patients had a fractured cuboid; 6 had a fractured navicular; 7 had a fractured cuneiform; and all had metatarsal fractures. Lisfranc joint dislocations were present in 7 feet, and intertarsal dislocations were seen in 3 cases. Six patients underwent split-thickness skin grafting, and 1 required a myocutaneous flap. The average duration of fixator use was 9 weeks (range, 6-15 weeks). Clinically, patients were evaluated 1 year after fixator removal for any residual pain in the foot, ability to stand on tiptoe, presence of a limp, deformity of an arch, and range of motion at the ankle, subtalar, and metatarsophalangeal joints. Each parameter was graded as good, fair, or poor. All patients had sensate plantigrade feet, with 2 patients who experienced pain on weight bearing, 5 who had difficulty standing comfortably on tiptoe, and 2 who limped because of pain. Three patients exhibited flatfoot deformity, whereas 4 had cavus deformity. All demonstrated stiffness at the midfoot and restriction of subtalar and forefoot motion, with 5 also having restricted ankle motion. Radiographically, all fractures were healed at the time of follow-up; 4 were malunited, with 1 demonstrating ankylosis across the tarsometatarsal joint. These results suggest that crush injuries to the midfoot often result in persistent morbidity despite early comprehensive management with external fixation.

External fixation is a useful tool for treating severe traumatic injuries to the foot and ankle. External fixation, however, does have associated complications, such as inadequate fixation and pin tract infections. Temporary bridge plating of the medial, lateral, or both columns is a useful alternative to external fixation for treating multilevel foot injuries. This article describes the technique of temporary bridge plating which may be used as an alternative to external fixation.

Over the years patients with relatively minor compressive injuries seem to have a different morbidity, largely because of a constellation of neurologic findings, including dysesthesia and hyperesthesias. These are usually multifocal, and often extend far beyond the point of impact of the crushing force. Neuroischemia may play a role in the development of chronic pain after crush injuries to the foot, either through direct trauma to the peripheral nerves or by intraneural or extraneural fibrosis. This direct trauma to the nerve may cause chronic neuritis, which then triggers a sympathetically mediated pain syndrome. For the injured worker, these problems seem to be magnified. Early recognition of the extent of injury, the zone of injury, and the need for early soft tissue coverage is essential. With expeditious treatment, wound coverage, treatment of compartment syndromes, and early aggressive rehabilitation, many of the complications of these injuries, including chronic pain syndromes, can be minimized.

Enchondroma is a common bone tumor of the foot. It is often reported in the phalanges and distal metatarsals. The authors, however, present a rare case study of two patients with enchodromas as the cause of midfoot pain. One case presented in the lateral cuneiform which to the authors' knowledge is the first reported case in the literature. Two cases are presented with their surgical management including autogenous calcaneal graft and follow-up.

There are various osseous pathologies that afflict the tarsal navicular. These range from stress fractures and coalitions to overt fractures. In certain instances there is an interruption of its vascular supply. If this occurs in childhood, it is called Koehler's disease. Spontaneous osteonecrosis of the navicular in the adult is a rare entity and is known as Mueller-Weiss syndrome. There is little English literature available on the latter. A review of the literature and a case report are presented here.

Lateral subtalar joint dislocations are rare injuries which are usually the result of a violent eversional force, driving the talar head medially and displacing the rest of the foot laterally. Associated fractures and obstruction to closed reduction are more common with lateral than medial dislocations. Avascular necrosis of the talus and navicular as well as subtalar instability may result from these injuries. Severe post-traumatic subtalar arthritis may warrant triple arthrodesis. Prompt closed reduction of lateral subtalar dislocation is recommended to avoid soft-tissue or neurovascular compromise. A short period of immobilization limits loss of subtalar range of motion. Open reduction may be required, particularly with entrapment of the posterior tibial tendon or obstructing fracture fragments. A case of lateral subtalar joint dislocation is presented.

The purpose of this project was to study the epidemiology of pedal fractures among diabetic athletes and to determine whether diabetic athletes have a higher prevalence of pedal fractures than athletes from the general population. Questionnaire results were obtained from 120 athletes, 60 with diabetes mellitus and 60 without the disease. Subjects answered questions regarding gender, age, duration of disease (if present), presence of Type I or Type II diabetes, daily activity level, types of physical activity, and the admission or denial of athletically induced pedal fracture, including which bones were affected. Statistical significance was achieved with the following parameters: the presence of diabetes and increased prevalence of fracture (p < 0.025) maleness and diabetes and increased prevalence of fracture (p < 0.05), duration of diabetes greater than 25 years and increased prevalence of fracture (p < 0.005), control subjects greater than 30 years of age and increased prevalence of fracture (p = 0.007), moderate correlation between diabetes and prevalence of multiple fractures (r = 0.55, p < 0.025), and moderate correlation between daily activity level and prevalence of fracture among control subjects (r = 0.73, p < 0.05). The most frequently fractured bone was the fifth metatarsal. Until now the literature available on the topic has been sparse, confusing and inconclusive; the results of this study was enable individuals with diabetes to be informed of the risks of pedal fracture associated with active lifestyles.