We reviewed 17 patients after arthroscopic resection for anterior impingement in the ankle. All had had painful limitation of dorsiflexion which had failed to respond to conservative treatment. Review at an average of 39 months showed very significant improvements in levels of pain, swelling, stiffness, limping and activity. There was a significant improvement in the range of dorsiflexion but not of plantar flexion. One poor result was due to a superficial infection, and two other patients had residual numbness of the foot which persisted for several months

An alternative to Syme's amputation for congenital absence of the fibula is described in this paper. Nine children have had the ankle reconstructed using the Gruca technique with a very satisfactory result in eight. This procedure is not suitable for every patient and in most unilateral cases the operation can only be regarded as an interim procedure because of progressive leg-length inequality. The decision to remove the foot may be delayed and it allows childhood to be spent without resort to prostheses. However, the procedure can be considered as the definitive operation in cases of bilateral deformity

There are few reports on the tarsal tunnel syndrome in children. This paper concerns 10 such children. In adults the syndrome is equally distributed among the sexes but all these children were girls. Trauma preceded the symptoms in only two cases. The symptoms differed in some aspects from those usually seen in adults. Six of the children walked with the affected foot in supination. Three of the six, and one other, used crutches at intervals. All were operated on and at follow-up nine were symptom-free and the tenth had improved

1. Talipes equinovarus is a specific type of club foot which has a genetic basis. Its occurrence along with certain neurological disorders has been noted. 2. An investigation of its incidence in 1,447 mental defectives, excluding those with cerebral palsy, revealed an incidence of 228 per 1,000, which is about ten times that for the general population. 3. There may be an upset early in embryonic development to account for the co-existence of both mental deficiency and talipes equinovarus

1. It is possible that neonatal sciatic palsy occurs more often than is suggested by perusal of the literature: paralysis of a foot may easily be overlooked in the new-born infant; it may be regarded as a temporary paresis due to mild birth trauma; or in later months it may be attributed to poliomyelitis. 2. Eleven cases of neonatal sciatic palsy are reported. Autopsy in one suggested that the paralysis was due to direct pressure on the sciatic nerve before birth. 3. A hypothesis is advanced by which to explain how pressure on the nerve trunk may arise in utero

Primary subacute haematogenous osteomyelitis (PSHO) of the small bones of the foot is a rare and infrequently considered cause of a limp in children. We describe 11 patients with PSHO, of whom nine were under three years of age, who had a limp with few symptoms. The talus was involved in 36%. Bone scans were positive in all patients and led to localisation of the lesion in two. The radiological features included soft-tissue swelling, an osteolytic lesion in the talus and the calcaneus and a sclerotic appearance of the cuboid and the navicular bones. All patients except one were cured with antibiotics

We compared the chevron and the Wilson metatarsal osteotomy for hallux valgus in a prospective randomised trial on 87 feet in 51 patients, reviewed at averages of 5.5 and 38 months after operation. The patients in the chevron group returned to work earlier and mobilised faster, but, at the later review, those in the Wilson group had better functional results and were more satisfied with the appearance of the foot. Correction of the hallux valgus angle was better maintained in patients in the Wilson group and they had a better range of motion at the metatarsophalangeal joint; fewer complained of metatarsalgia

We report the results of a new surgical procedure for spastic equinovarus deformity due to cerebral palsy. This is the transfer of the anterior half of the split tibialis posterior to the dorsum of the foot through the interosseous membrane. We performed the operation on 23 feet in 18 children. All patients were assessed before operation and at follow-up at a mean of 8.4 years postoperatively. Using the criteria of Kling et al (1985), excellent results were obtained in 14 feet, good results in eight, and a poor result in only one

We report the case of a 59-year-old man with severe knee pain and inability to flex his toes or invert his plantar flexed foot after an external rotation injury to his knee. MRI showed rupture of the popliteus with a haematoma compressing the neurovascular bundle in the proximal calf, and electromyography demonstrated signs of an axonotmesis of the posterior tibial nerve. There was progressive nerve recovery over 24 weeks. Isolated rupture of the popliteus should be considered in any patient with an acute haemarthrosis, lateral tenderness and a stable knee, especially after an external rotation injury

Aims

The aim of this randomized trial was to compare the functional outcome of two different surgical approaches to the hip in patients with a femoral neck fracture treated with a hemiarthroplasty.

We have reviewed 10 patients treated for anterior tarsal tunnel syndrome produced by compression of the deep peroneal nerve or its branches, and we have studied the anatomy of the tunnel in 25 adult feet. The causes of onset of the syndrome included contusion of the dorsum of the foot, tight shoe laces, talonavicular osteophytosis, ganglion, and pes cavus. The clinical signs were often diagnostic but electromyography was helpful. Operative decompression in nine feet of eight patients gave successful results at 1.5 to 4 years follow-up

1. Attention is drawn to a type of foot in which painful plantar callosities form under one or more metatarsal heads. The affected metatarsal heads are shown to be depressed, or dropped, and this dropping is not caused by toe deformities. 2. An operation is described which elevates a dropped metatarsal head by a wedge osteotomy through the base of the metatarsal. 3. The various deformities of the tread are described, and the possible causes of this condition are discussed. 4. It is stressed that corrective metatarsal osteotomy is not appropriate for patients with deformities of their toes, who require correction of the toe deformity

1. A series of 226 upper tibial osteotomies is reviewed with special reference to the complications occurring in each of the six different operative techniques that have been used. 2 Wedge osteotomy above the tuberosity is the safest operation, but care must be taken to avoid a fracture into the joint. 3. Wedge osteotomy through the lowest part of the tuberosity may be indicated in the presence of large subarticular cysts or collapse of a tibial condyle. 4. The significance of weakness of dorsiflexion of the foot and the dangers of injury to the anterior tibial artery in osteotomies below the tuberosity are discussed

In the 1950s Frederick Dwyer evolved the concept of treating resistant and relapsed clubfoot by osteotomy of the calcaneum. He published the results of his medial opening wedge procedure in 1963 with a mean follow-up of five years. We present the structured, radiographic and functional results at a mean elapsed time of 27 years of 36 feet (26 patients) all operated on by Dwyer. Their mean Laaveg and Ponseti (1980) grading was 83.7%. In 94% the heel was in neutral or valgus and 86% of the feet were plantigrade. A good range of movement was present in the ankle and subtalar joints in 83%

Aims

The aim of this study was to determine whether closed suction drain (CSD) use influences recovery of quadriceps strength and to examine the effects of drain use on secondary outcomes: quadriceps activation, intra-articular effusion, bioelectrical measure of swelling, range of movement (ROM), pain, and wound healing complications.

1. A large Caucasian kindred in South Africa are affected by a previously undescribed inherited deformity of the hands and feet called digito-talar dysmorphism. 2. The principal features of digito-talar dysmorphism are flexion deformities, narrowing and ulnar deviation of the fingers. The thumb may be held in an abnormal position by a soft-tissue web. Rocker-bottom foot may develop, due to vertical talus. The facies is normal and the mentality is unimpaired. 3. The general health is good but orthopaedic measures may be needed for function and cosmesis. 4. The condition is transmitted as an autosomal dominant trait, with varying clinical expression of the abnormal gene

Congenital or acquired shortness of a metatarsal may cause pain in adjacent metatarsals. From 1983 to 1990, we performed nine metatarsal lengthenings in seven adolescent patients by metaphyseal osteotomy followed by gradual distraction of callus (callotasis). Two patients required bone grafts after the lengthening. We used a rigid, unilateral external fixator designed for use in the hand and foot. At follow-up, from three to ten years later, healing had been achieved in all with an average healing index of 50 days/cm, and metatarsalgia had been relieved by the restoration of correct metatarsal length

1 . The principles and technique of flexor-extensor tendon transfers for claw toes are described. The operation is tedious, but it is effective in selected cases. 2. Sixty-eight patients have been operated upon and followed up; good results were obtained in fifty, fair results in eleven, and poor in seven. More careful selection and better operative technique might have avoided some of the failures. 3. The operation restores useful function to the toes at the cost of their prehensile action, diminishes any cavus deformity of the foot, and, by lessening the prominence of the metatarsal heads in the sole, avoids callosities and discomfort

We reviewed retrospectively 11 patients who had been treated surgically by open autologous osteochondral grafting for symptomatic chondral or osteochondral defects of the dome of the talus between 1996 and 1999. The mean ages of the eight men and three women were 34.2 and 25.9 years, respectively, with a mean time to follow-up of 24 months. The results of functional outcome were prospectively obtained using the MODEMS AAOS foot and ankle follow-up questionnaire, the AOFAS ankle-hindfoot scale and the Hannover scores for the ankle. The grafts were harvested from the ipsilateral knee. Good to excellent results were obtained for the ankle without adverse effects on the knee. We believe that autologous osteochondral grafting should be considered for the patient with a symptomatic osteochondral defect of the talus