Background: Neglected clubfoot in this series is defined as untreated equino-cavo-adducto-varus in older children or adults. Relapsed clubfoot is the residual deformity that remains after single or multiple surgical interventions. Severely neglected clubfoot rarely exists today in developed countries, except in some emigrants from low-and middle-income countries. Acute surgical management with corrective mid-foot osteotomy and elongation of the Achilles tendon has an excellent functional outcome. Objective: To assess the functional outcome of acute correction of neglected Talipes-quinoa-varus deformity in adults. Methods: This is a cross-sectional, hospital-based multi-centric study. Forty patients were included in this study. Midfoot osteotomy and elongation of the Achilles tendon were performed on all patients. Data was collected using a questionnaire and the functional outcome has been assessed using the American Orthopedic Foot and Ankle Society Score (AOFAS). This score was measured before surgery and one year after surgery. Results: the mean age was 19.9 ± 4.7 years. Males were 25 (62.5%) and females were 15 (37.5%). The mean preoperative AOFAS score was 37.7 ± 7.1 (poor). This score improved to 80.7 ± 13.7 (good to excellent), two years after surgery. However, this indicates a significant change in the functional outcome after the operation (p value < 0.05). Excellent postoperative functional outcome was found among patients aged 18 -23 years 18 (50%) p value: 0.021. The majority of patients 36 (90%) were fully satisfied with the operation, 2 (5%) partially satisfied and 2 (5%) were unsatisfied. Conclusion: acute correction of neglected and relapsed TEV with elongation of the Achilles tendon
Background: Charcot neuroarthropathy is a severe disease involving several joints but most commonly affecting the foot and ankle.Charcot arthropathy is a serious late complication of many pathologies like diabetes mellitus, syphilis, and meningiomyelocele. It may result in fractures, permanent deformity, and even limb loss. Ankle fusion with internal fixation has high morbidity and complications. External fixation can provide stability to the joint and correction of the deformity with less risk for surgical complications.Objectives: To assess the clinical and functional outcomes of ankle joint arthrodesis using external fixator in patients with severe Charcot ankle arthropathy. Materials and Method:This study is descriptive cross-sectional hospital-based study that involved an 18 patients with advanced Charcot arthropathy of the ankle joint. Ankle fusion with Ilizarov external fixation was done for all patients. The patients were followed, and the frame was removed after clinical and radiological evidence of union were obtained. The American Orthopedic Foot and ankle Society scale (AOFAS) was assessed before surgery and one year after surgery. The post-operative complications and patient satisfaction also evaluated. The Data was analyzed using IMP SPSS version26.Results: Number of patients was 18, 14 males and 4 females. The most frequent age group was more than 50 years (11 patients, 61.1%). Preoperative AOFAS score was poor for all of the patient (100%). The postoperative AOFAS score was improved, 6 patients (33.3%) obtained excellent result, 5 patients (27.8) good, 4 patients (22.2) fair, while 3 patients (16.7) remained poor. 13 patients (72.2%) were satisfied with the outcome while 5 of them (27.8%) were unsatisfied. The most frequent complication rate was for pin track infection which occurred in 6 patients (33.3%). Conclusion:Fusion of the ankle joint with ring external fixator is useful treatment option for Charcot-arthropathy instability and deformity, particularly in cases where internal fixation methods are ineffective. With an acceptable rate of complications, it can lead to a satisfactory outcome and an improved functional score.
Background: Disorders of the Achilles tendon can occur in adolescents and adults and include both traumatic and non-traumatic problems such as insertional tendinitis, intra-substance tendinopathy, complete rupture. Insertional tendinitis radiographically present as Huglund's deformity, posterior calcaneal spur and retro-calcaneal calcification. Diagnosed based on history clinical examination to radiography.Objectives: to correlated between clinical and radiographically finding in patents with insertional Achilles tendonitis.Methodology: This study is a descriptive cross-sectional hospital-based study conducted in Khartoum state, Sudan. The study was total coverage, data collected questionnaire and patents' X-rays were studied.Results: A total of 25 patients and 30 feet was studied most of them were within age group (41-60) representing 53.3% and 14 were female representing 46.7%. concerning the severity 12 case were severe (40%), 13 were moderate (43.3%) and 5 cases were mild in their presentation with 16.7% of total cases.8 cases(mild) had posterior calcaneal spur (26.7%), 10 cases (4 mild, 4 moderate and 2 sever) had patchy calcification (33.3%), 8cases (severe disease) had both spur and Huglund's deformity and calcification. The relation between the severity of the Insertional Achilles Tendinitis and the radiographic finding was found to be statistically significant (p-value less than 0.05). Conclusion and Recommendations:Our study concluded that there is significant correlation between radiographic and clinical presentation but this correlation is weak. Based on this finding X-rays alone is not valid method for diagnosis and severity determination of Achilles tendonitis. Our study was done on a short period so a recommendation to be done over long duration, in order to involve more cases. Also we recommend that the size and the length of posterior calcaneal prominence taking in consideration over is presence or absence. And the study group must be matched to the control group for more accurate and reliable results.
Background: Disorders of the Achilles tendon can occur in adolescents and adults and include both traumatic and non-traumatic problems such as insertional tendinitis, intra-substance tendinopathy, complete rupture. Insertional tendinitis radiographically present as Huglund's deformity, posterior calcaneal spur and retro-calcaneal calcification. Diagnosed based on history clinical examination to radiography.Objectives: to correlated between clinical and radiographically finding in patents with insertional Achilles tendonitis.Methodology: This study is a descriptive cross-sectional hospital-based study conducted in Khartoum state, Sudan. The study was total coverage, data collected questionnaire and patents' X-rays were studied.Results: A total of 25 patients and 30 feet was studied most of them were within age group (41-60) representing 53.3% and 14 were female representing 46.7%. concerning the severity 12 case were severe (40%), 13 were moderate (43.3%) and 5 cases were mild in their presentation with 16.7% of total cases.8 cases(mild) had posterior calcaneal spur (26.7%), 10 cases (4 mild, 4 moderate and 2 sever) had patchy calcification (33.3%), 8cases (severe disease) had both spur and Huglund's deformity and calcification. The relation between the severity of the Insertional Achilles Tendinitis and the radiographic finding was found to be statistically significant (p-value less than 0.05). Conclusion and Recommendations:Our study concluded that there is significant correlation between radiographic and clinical presentation but this correlation is weak. Based on this finding X-rays alone is not valid method for diagnosis and severity determination of Achilles tendonitis. Our study was done on a short period so a recommendation to be done over long duration, in order to involve more cases. Also we recommend that the size and the length of posterior calcaneal prominence taking in consideration over is presence or absence. And the study group must be matched to the control group for more accurate and reliable results.
Normal alignment of the arches and adequate stability is essential for the foot to function correctly. Pes planus and pes cavus are fairly common foot deformities, but it is uncommon to see both in the same patient simultaneously. This study aimed to describe the clinical presentation and prognosis of an uncommon combination of bilateral foot abnormalities named “windswept heels” resembling windswept knees. A 43-year-old female employee experienced frequent pain in her right foot and swelling and pain in her left foot, mainly when walking barefoot. She had a severe cavovarus deformity of the right foot with pressure callosities on the lateral side, clawing of the toes, and a positive Coleman’s block test. With the loss of the medial arch, severe heel valgus, and forefoot abduction, the left foot developed a planovalgus deformity. The left foot’s talus-first metatarsal angle and the right foot’s calcaneal inclination angle increased on weight-bearing radiographs. The left foot underwent staged surgical treatments, including medial sliding calcaneal osteotomy, gastrocnemius recession, and cotton osteotomy. For the right foot, lateral sliding calcaneal osteotomy, plantar fasciotomy, and peroneus longus tendon transfer. The American Orthopaedics Foot and Ankle Society Score (AOFAS) was used to measure the clinical and functional outcomes. At 1 year, her AOFAS scale was 85 compared to 59 before surgery. Since this presentation resembles the windswept knee deformity, we propose calling this disorder windswept heel deformity.
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