Articles & Videos


Minimally Invasive Achilles: Haglund’s Syndrome and Endoscopic Calcaneoplasty

Haglund’s syndrome is a condition where an enlargement of the heel bone causes irritation and inflammation. Just as nose sizes and shapes vary, so there can be variations in the size and shape of these bone variations…

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Great Toe Arthritis: Synthetic Cartilage Replacement (Cartiva)

Arthritis is a degenerative disease of cartilage (smooth lining of the joint surfaces). Arthritis in the big toe is the most common arthritic condition in the foot (1 in 40 people over the age of 50). Most patients complain of pain in the big toe joint, especially when pushing off to walk. Patients notice stiffness and swelling in the big toe, and a large bump on the top part of the toe…

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Minimally Invasive Achilles Tendon Repair

The Achilles tendon is the largest and strongest tendon in the body. As the tendon moves toward the heel, the fibers rotate, giving it greater mechanical resistance, but creating an area with poor blood supply which may makes the Achilles prone to tearing in this area….

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Minimally Invasive Os Trigonum Excision

What is Posterior Impingement? Posterior ankle impingement syndrome causes pain in the back of ankle. It typically occurs in a position of forced plantar flexion (foot pointing downwards). Push-off maneuvers, particularly with the ankle in plantarflexion, are typical of this disorder, as well as increased pain going down stairs. This occurs with less frequency than other ankle conditions, and thus there is often a delay to diagnosis and treatment, especially when initial presentation is not to a foot and ankle orthopedic surgeon who is aware of the condition…

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Arthritis of the Big Toe (Hallux Rigidus): What Are My Treatment Options?

What is it? Arthritis is a degenerative disease of cartilage (smooth lining of the joint surfaces). Arthritis in the big toe is the most common arthritic condition in the foot, affecting 1 in 40 people over the age of 50. Females are more commonly affected, and the condition typically develops between the ages of 30 and 60 years.

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Using Arthroscopic Techniques for Achilles Pathology

Endoscopic procedures around the foot and ankle provide the surgeon with the techniques to treat a variety of pathology with a minimally invasive approach. These lessinvasive approaches can diminish scar tissue and result in less perioperative pain, fewer wound complications, and quicker recovery.

Special focus has been placed on the Achilles tendon complex, where these techniques have been used to address acute and chronic ruptures, equinus contractures, and both insertional and noninsertional tendinopathies. Although high-level evidence-based literature for Achilles tendoscopy is somewhat lacking, the literature available does report consistently good outcomes with few complications, making them appealing for surgeons to adopt.

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Passport for the Orthopedic Boards and FRCS Examination

Co-authored by Dr. Paul J. Switaj

A biomechanical comparison study of a modern fibular nail and distal fibular locking plate in AO/OTA 44C2 ankle fractures

A lateral approach with open reduction and internal fixation with a plate is a very effective technique for the majority of distal fibular fractures. However, this open approach for ankle fixation may be complicated by wound dehiscence and infection, especially in high-risk patients. An alternative to plating is an intramedullary implant, which allows maintenance of length, alignment, and rotation and which allows for decreased soft tissue dissection. While there has been clinical data suggesting favorable short-term outcomes with these implants, there is no current biomechanical literature investigating this technology in this particular fracture pattern. This study sought to biomechanically compare an emerging technology with an established method of fixation for distal fibular fractures that traditionally require an extensive exposure.

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A comparison of 30-day complications following plate fixation versus intramedullary nailing of closed extra-articular tibia fractures

Tibial shaft fractures are the most common long bone fracture, frequently requiring surgical intervention. Plate fixation and intramedullary nailing (IMN) are two surgical techniques employed to provide bony fixation of these fractures. Although plate fixation offers the ability to ensure accurate alignment under direct visualization, it often requires increased surgical exposure when a minimally invasive plate osteosynthesis (MIPO) approach is not used.

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Acute and Chronic Injuries to the Syndesmosis

Stable syndesmotic injuries do not require surgical stabilization and can be treated with protected weight bearing. Advanced imaging demonstrating an intact deltoid ligament with preservation of the interosseous ligament and posterior inferior tibiofibular ligament is associated with a stable injury.

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Comparison of modern locked plating and antiglide plating for fixation of osteoporotic distal fibular fractures

An unstable ankle fracture has been shown to be an indication for open reduction and internal fixation in order to lower the risk of posttraumatic arthritis secondary to abnormal loading. Overall, this has been associated with good surgical outcomes. When occurring in osteoporotic bone, these fractures can be difficult to treat because of poor bone quality and inability to gain screw purchase.

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Evaluation of Posterior Malleolar Fractures and the Posterior Pilon Variant in Operatively Treated Ankle Fractures

Ankle fractures are a common orthopaedic injury that occur at a rate of 187 per 100 000 person-years and are the fourth most common fracture to require operative repair. Substantial attention has recently been placed on fractures that involve the posterior malleolus. There is a wide range in the reported prevalence of posterior malleolar involvement in ankle fractures, varying from 7% to 44%. The relevance and operative management of posterior malleolar fractures continues to be a source of controversy.

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Radiographic Study of the Fifth Metatarsal for Optimal Intramedullary Screw Fixation of Jones Fracture

Fracture of the proximal fifth metatarsal is a common injury, and its treatment is largely determined by the anatomic location of the fracture. Zone 1 includes the proximal cancellous tuberosity with an abundant blood supply, and fractures in this region reliably heal with nonoperative treatment. Zone 2 represents the metadiaphyseal region and is the location of the fracture first described by Sir Robert Jones in 1902. This region has a relatively poor blood supply and as a result is at increased risk of delayed union or nonunion. Zone 3 represents the proximal diaphysis and fractures in this region are commonly diaphyseal stress fractures.

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Treatment of peroneal nerve injuries with simultaneous tendon transfer and nerve exploration

Common peroneal nerve palsy is the most common mononeuropathy of the lower extremity and may resolve spontaneously. However, irreversible nerve damage can occur, with historically poor outcomes. Patients present with dorsal foot sensory loss, as well as loss of ankle dorsiflexion from the tibialis anterior and loss of foot eversion from the peroneus longus and brevis. The unopposed pull of the tibialis posterior and Achilles results in an equinovarus foot deformity, while the loss of the foot dorsiflexors results in a foot drop, with characteristic foot slap during heel strike and a steppage gait.

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