Level II, prospective comparative study.

Clinical and pedobarograph evaluation was performed on 16 patients following flexor hallucis longus (FHL) tendon transfers to determine the resulting morbidity due to the loss of FHL function. All patients underwent FHL tendon transfer for either chronic tendon Achilles rupture or chronic Achilles tendinosis. Clinical evaluation of hallux function was performed using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale, the SF-36 score, and a clinical questionnaire to assess alteration in the clinical function of the hallux during activities of daily living. Pedobarography was carried out using the Musgrave pedobarograph system to detect changes in forefoot loading in comparison to the contralateral normal foot. Fourteen of the 16 patients scored maximally on the hallux metatarsophalangeal-interphalangeal scale and none of the patients noticed functional weakness of the hallux during activities of daily living at a mean follow-up of 43.6 months (range, 5-120 months). Pedobarograph readings showed a trend toward reduction in peak pressure loading on the distal phalanx, but this was not significant for the numbers of patients studied. There was no significant increase in loading of the first or second metatarsophalangeal joints to suggest that transfer metatarsalgia may complicate FHL tendon transfer. According to the results of the study morbidity from FHL transfer should be clinically insignificant.

The combination of the LPCT plate and a ball-and-socket bone-end preparation has both operative and biomechanical advantages over other fixation techniques. This combination ensures that the anatomical length of the first ray is only minimally shortened and the angle of plantarflexion of the first metatarsal is maintained, resulting in preservation of medial column stability and a better functional result.

Background:Health literacy is defined as the ability to understand basic health information with such competence as to be able to use this information to enhance health. Lower health literacy is associated with increased post-operative complications, reduced satisfaction and compliance. To ensure accessibility and comprehension by the general public, many international health organisations suggest that health literature has a reading grade level equivalent to the American sixth grade. However, previous studies show that this rarely occurs.Total ankle replacement (TAR) technology has rapidly progressed with new prosthesis showing increasingly improving outcomes. However, TAR remains a complex procedure which may be challenging to explain to the patient. Thus, many patients will turn to the internet for more information and as a ‘quasi-second opinion’. If the health education materials provided on the internet is not accessible to patients, it can leave them overwhelmed and confused. The aim of the study is to evaluate the readability of information on the internet with regards to Total Ankle ReplacementMethods: 110 websites from the two main search engines (Google and Bing) were assessed using the terms ‘total ankle replacement’ and ‘total ankle arthroplasty’. Once duplicates had been removed and exclusion criteria were applied, 36 unique websites were categorised and underwent analysis using readability software (WEB FX readability tool). The websites were assessed for readability using the Fleisch Reading Ease Score (FRES) and the Reading Grade Level (RGL). A score of greater than 65 for FRES and an RGL of six or less were considered acceptable. Differential and Inferential statistical analysis was performed using SPSS.Results:The mean FRES score was 54.95 (SD: ± 13.2); this was significantly below the recognised acceptable standard score of 65 (P<.0001). An ANOVA conducted showed significant difference between FRES scores based on categories (P=.041) with post-hoc testing showing that the difference between commercial and non-physician scores was the most significant (P=.016; CI:3.84-61.66).The mean RGL was 8.31 (SD: ± 1.95). One-way t-tests showed that these scores were significantly higher than the acceptable standard (P<.0001; CI: 1.64-2.97). ANOVA testing showed a significant difference based on category (P=.028) with post hoc testing showing significant difference between non physician and commercial scores (P=.012, CI: 0.71-9.33).Conclusion:The majority of the websites pertaining to total ankle replacement are significantly beyond the comprehension levels of the general public. This will affect the patient’s ability to discern the complexities and potential complications of total ankle arthroplasty, with serious ramifications for consent as well as post-operative rehabilitation and compliance.Level of Evidence: not applicable

Hallux rigidus was first described in 1887. Many aetiological factors have been postulated, but none has been supported by scientific evidence. We have examined the static and dynamic imbalances in the first metatarsophalangeal joint which we postulated could be the cause of this condition. We performed a finite-element analysis study on a male subject and calculated a mathematical model of the joint when subjected to both normal and abnormal physiological loads. The results gave statistically significant evidence for an increase in tension of the plantar fascia as the cause of abnormal stress on the articular cartilage rather than mismatch of the articular surfaces or subclinical muscle contractures. Our study indicated a clinical potential cause of hallux rigidus and challenged the many aetiological theories. It could influence the choice of surgical procedure for the treatment of early grades of hallux rigidus.