Background: Weightbearing restrictions following foot and ankle surgery require the use of appropriate assistive devices for nonweightbearing ambulation during the recovery period. Selecting an appropriate assistive device that safely optimizes mobility and participation in daily activities is important to patient compliance and satisfaction. The purpose of this study was to compare physiologic demand, perceived exertion, and patient preference between a hands-free single crutch (HFSC) and standard axillary crutches (SACs) in foot and ankle patients. Methods: Using 44 preoperative orthopedic foot and ankle patients who had a mean age of 32 (19-51) years, a prospective, randomized, crossover study was performed. The sample consisted of 35 males and 9 females. The mean body mass index (BMI) was 26 (19-36), the mean height was 1.7 m, and the mean weight was 82 kg. Patient data and preactivity heart rate were recorded for all patients, who were then randomized to either an HFSC or SACs. Each patient was randomly assigned to the device they would utilize first using a random number generator. They then crossed over to the other device after vitals returned to within 10% of their baseline heart rate. Every subject completed a 6-minute walk test (6MWT) using both assistive devices in a crossover manner. Immediately following each 6MWT, postactivity heart rate, self-selected walking velocity (SSWV), perceived exertion using the OMNI Rating of Perceived Exertion (OMNI-RPE), and perceived dyspnea using the Modified Borg Dyspnea Scale were obtained. After completing both 6MWTs, patients were asked which assistive device they preferred the most. Results: The HFSC was preferred by 86% of patients. Significantly lower dyspnea scores (2.8 vs 5.3; P < .001), fatigue scores (2.4 vs 5.5; P < .001), preactivity and postactivity change in heart rate (28 vs 46 bpm; P < .001), and mean postactivity heart rate (107 vs 122 bpm; P < .001) were found using the HFSC compared with the SACs. The SAC group trended toward a higher SSWV (0.8 vs 0.77 m/s; P = .08). Those with a BMI greater than 25 also preferred iWALK over SACs ( P < .05). Neither group had any falls. Sixty-eight percent of patients complained of axillary/hand pain with the SACs, while 7% complained of proximal leg strap discomfort with the HFSC. Conclusion: The results of the current study in our relatively healthy cohort found that foot and ankle patients who were nonweightbearing preferred the HFSC over SACs. They experienced less physiologic demand as well as discomfort and perceived less exertion when using the HFSC compared with SACs. Level of Evidence: Level II, prospective comparative study.

Ankle arthroscopy has emerged as a viable treatment option for multiple ankle pathologies and continues to have expanding indications as technology and techniques improve. Historically, ankle arthroscopy used skeletal traction, and it has transitioned to noninvasive soft-tissue distraction because of high rates of iatrogenic complications. Although soft-tissue distraction has decreased complications, it continues to be both cumbersome and time-consuming. Thus we propose a 1-step simple ankle arthroscopy distraction technique that uses an external positioning arm to allow the surgeon to apply manual traction in multiple positions without the use of any reprocessed sterile equipment.

Background: Malreduction after syndesmotic stabilization occurs in as many as 52% of cases and has been shown to detrimentally affect clinical outcomes. We propose that the modified Glide Path technique reduces the occurrence of syndesmotic malreduction. Methods: This study is a prospective series comparing 16 patients reduced with the modified Glide Path technique with a retrospectively reviewed series of 25 patients reduced with a traditional technique using fluoroscopy and a clamp. The modified Glide Path technique consists of manual reduction of the fibula and placement of a Kirschner wire through the fibula and tibia along the transmalleolar axis. The syndesmosis can then be reduced along the glide path created by the Kirschner wire to prevent posterior or anterior malreduction. Computed tomographic scans of the repaired and contralateral ankles were obtained postoperatively to assess reduction. Results: We found a statistically significant decrease of syndesmotic malreductions using the modified Glide Path technique when compared with technique that did not use a glide path. In our study, 2 of 16 patients (12.5%) had syndesmotic malreductions using the modified Glide Path technique, compared with 11 of 25 patients (44%) with syndesmotic malreductions in the historical cohort. Conclusion: The modified Glide Path technique is a simple method for ankle syndesmotic reduction. The technique has lower rates of malreduction compared with historical methods and may be useful for most operative syndesmotic injuries. Level of Evidence: Level II, prospective cohort study.

Toe arthroscopy has historically had limited applications but is beginning to emerge as a viable treatment option for select toe pathologies, and continues to have expanding indications as technology and techniques improve. Toe arthroscopy has used a multitude of distraction techniques to perform the procedures but all have had limited success. Thus, we propose a simple toe arthroscopy distraction technique that uses an external positioning arm to allow the surgeon to apply manual traction in multiple positions without the use of an assistant, external weights, or any reprocessed sterile equipment.