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In the evaluation of the distal articular orientation of the first metatarsal in hallux abducto valgus, one tool that can be employed is the radiographic measurement of the proximal articular set angle (PASA). Although it has been demonstrated that the inter-evaluator reliability of the measurement of PASA is suboptimal, the measurement may still retain usefulness. If intra-evaluator reliability is acceptable and the measurement is a valid predictor of the intraoperative condition, then the measurement retains clinical usefulness. The present study was designed to determine the intra-evaluator reliability of the measurement of PASA. Five evaluators were asked to make the measurement on five radiographs. Measurements were repeated approximately every 2 weeks until a total of 12 measurements on each radiograph were complied. A Chi-square distribution test of variance was utilized to analyze the data. The results demonstrated that the intra-evaluator reliability of the measurement of PASA was acceptable in three of the five evaluators, suggesting that some physicians can achieve satisfactory consistency in the measurement. It is unclear why the intra-evaluator reliability of the measurement of PASA is suboptimal for some physicians. Further study is required to address this issue, as well as the issue of the validity of the measurement.

Numerous procedures have evolved to operatively stabilize the ankle suffering from chronic inversion instability. The use of the plantaris tendon to anatomically reconstruct the lateral collateral ankle ligaments is among those that avoid the complication of restriction of subtalar joint range of motion. The authors present a modified technique of reconstructing the calcaneofibular and anterior talofibular ligaments using a plantaris tendon that maintains its insertion. A retrospective study of eight patients that elected the procedure for chronic ankle instability was conducted. The average follow-up was 12.7 months. Significant improvement in functional score (p less than 0.01) and talar tilt (p less than 0.05) was noted following the procedure. No restriction of subtalar joint motion was observed in any patient after the procedure. The advantages and disadvantages of the procedure are discussed. The authors conclude that the procedure appears to be a desirable alternative in achieving ankle stability while maintaining normal hindfoot function.

Changes have been proposed in the orientation of the first metatarsal base closing abductory wedge osteotomy based on sound theoretical reasoning. The newer proposed method, utilizing an orientation of the osteotomy perpendicular to the weight-bearing surface, produces only pure transverse plane motion and no loss of ground contact by hinge axis mechanisms. In contrast, the traditional orientation of the osteotomy, perpendicular to the long axis of the metatarsal, produces extraneous frontal plane motion that results in loss of ground contact as the osteotomy site is closed. The presented study formulates a mathematical model to calculate the amount of loss of ground contact produced by the traditional osteotomy orientation. The values obtained from 168 calculations suggest far less clinical significance to the change than has been implied or stated previously.

Dual calcaneonavicular and talocalcaneal coalitions are probably not rare. Given the possibility for failed calcaneonavicular bar resection if a concurrent talocalcaneal bar goes undetected, careful preoperative evaluation is suggested. A case presentation has been made to illustrate the clinical significance of this problem.

A review of the current medical literature concerning the use of various vasoconstrictive agents with local anesthetics is presented. These agents are employed in podiatry primarily for the purpose of prolonging the duration of anesthesia and surgical hemostasis. Epinephrine, phenylephrine, levonordefrin, felypressin, and norepinephrine have all been utilized in conjunction with the local anesthetics by the various medical professions. Although controversy surrounds the use of these agents, this article should assist the podiatric physician in making an informed decision.

Adhesive capsulitis is a rheumatologic complication that may be encountered in the ankle joint in posttraumatic situations. The condition presents with chronic ankle pain, stiffness, and swelling. The diagnosis can be confirmed arthrographically. A report is made of a severe case that was successfully treated with arthroscopic surgery. The shortcomings of the existing literature are discussed. The authors suggest that, where applicable, arthroscopy should be utilized in the diagnosis and treatment of this condition.

The proximal articular set angle (PASA) is used in the evaluation of hallux abducto valgus, as well as a criterial parameter for the selection or rejection of various hallux abducto valgus corrective procedures. The authors casually observed variability in the measurement of PASA in clinical situations, stimulating the development of the presented study to determine if, in fact, the measurement of PASA varies excessively from one physician to another. The results clearly indicate that the interevaluator measurement of PASA is excessive (p less than 0.001 in seven of eight x-ray series and p less than 0.01 in one of eight x-ray series). The authors discuss the clinical implications of the findings. Furthermore, the shortcomings of the study are discussed, specifically the inability to conclude about intraevaluator variability.