This study evaluates the validity of the AOFAS Clinical Rating Systems by examining their level of correlation to the Medical Outcomes Study Short Form-36 (SF-36) in patients with foot and ankle complaints. The SF-36 is an extensively validated outcomes tool that has been used as a benchmark in examining the validity of outcomes instruments designed for the upper extremity, knee, shoulder, and general orthopaedic conditions. The study sample was 91 patients seen at the foot and ankle clinic of a university-based orthopaedic practice. Patients were administered both the AOFAS Clinical Rating Systems and SF-36 instruments. Pearson correlation coefficients of the AOFAS scores to the SF-36 sub-scales ranged from 0.02 to 0.36 in the overall study population. Correlation was higher for the sub-set of patients with ankle-hindfoot disorders (0.11 to 0.53) than patients with forefoot disorders (-0.05 to 0.25). The low levels of correlation seen in this study suggest poor construct validity of the AOFAS Clinical Rating Systems.

We carried out an experiment to measure the relationship between tensile force in the tendoachilles and plantar fascia strain, and how this relationship is affected by the metatarsophalangeal joint dorsiflexion angle. Eight cadaver lower extremity specimens underwent biomechanical testing. Using a servo-hydraulic testing machine, a tensile force up to 500 N was applied to the tendoachilles while the strain on the plantar fascia was measured using an extensometer. The experiment was repeated at four different metatarsophalangeal joint dorsiflexion angles (0 degrees, 5 degrees, 30 degrees, and 45 degrees). Measurements and calculations showed that dorsiflexion of the toes tightens the plantar fascia (the windlass effect) and increases the effect that a tensile force in the tendoachilles has on the tensile strain and tensile force in the plantar fascia.

One hundred fifty patients were enrolled in a multicenter, randomized, placebo-controlled, prospective, double-blind study to assess the clinical safety and effectiveness of extracorporeal shock wave therapy (ESWT) using the Dornier Epos Ultra for the treatment of plantar fasciitis. The Active Group was treated with electromagnetically generated shocks using ultrasound guidance during a single therapy session. The Control Group received a sham treatment under similar clinical conditions. The groups were demographically similar with respect to age, height, and weight. The average duration of symptoms was nearly 2 years in both groups. All patients were evaluated by the visual analog scale for pain, American Orthopaedic Foot and Ankle Society scores, Roles and Maudsley Score, SF-12 health status questionnaire, and physical examination. The Active Group reported 56% success at 3 months and 94% success at 12 months posttreatment. The Control Group reported 47% success at 3 months posttreatment. Twelve-month data were not collected for the Control Group as they were unblinded at 3 months and offered treatment. ESWT represents a safe treatment option for chronic proximal plantar fasciitis.

Traumatic dislocation of the peroneal tendons is an often unrecognized injury which has been reported to occur most commonly during snow skiing. The strength of the peroneal retinaculum is exceeded during resistance to violent passive dorsiflexion or to inversion stress. Pain, swelling, and ecchymosis may hinder early diagnosis; however, intense retromalleolar pain on active eversion is a specific, highly suggestive finding. Fracture of a thin shell of the lateral malleolar cortex is diagnostic. In chronic cases, marked dislocation of the tendons is frequently demonstrable, with more than the usual degree of snapping. Surgical repair is advocated, using one of several procedures available. Most acute cases can be treated by simple repair of the torn or fractured structures. In chronic cases, or in acute cases with deficient structures predisposing to dislocation, it is necessary to reconstruct the peroneal retinaculum and/or deepen the peroneal groove. Longitudinal splitting of the peroneus brevis tendon was a new finding in this series.

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