RESUMEN
BACKGROUND: The Manchester-Oxford Foot Questionnaire (MOXFQ) has been validated in Spanish for use in patients undergoing foot and ankle surgery. METHODS: 120 patients completed the MOXFQ and the SF-36 before surgery and 6 and 12 months postoperative. Surgeons completed the American Orthopaedic Foot and Ankle Society (AOFAS) Clinical Rating System. Psychometric properties were assessed for all three MOXFQ dimensions, and for the MOXFQ Index. RESULTS: The Spanish MOXFQ demonstrated consistency with Cronbach's alpha values between 0.65 and 0.90, and reliability ([ICCs] >0.95). It shows a moderate to strong correlation between the Walking/standing dimension and the related domains of the SF-36 (|r|>0.6), the AOFAS Ankle-Hindfoot Scale (|r|>0.47) and Hallux-MTP-IP Scale (|r|>0.64). Responsiveness was excellent, (effect sizes >2.1). The respective minimal detectable change (MDC90) was 14.18 for the MOXFQ Index. CONCLUSIONS: The Spanish version of the MOXFQ showed good psychometric properties in patients with foot and ankle disorders.
Asunto(s)
Tobillo/cirugía , Pie/cirugía , Encuestas y Cuestionarios/normas , Adulto , Anciano , Comparación Transcultural , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación del Resultado de la Atención al Paciente , Reproducibilidad de los Resultados , Autoinforme , TraducciónRESUMEN
Early diagnosis and treatment of compartment syndrome of the leg or foot is invaluable in avoiding a chronic and often debilitating course. In cases where an ischemic contracture results in pain, disability or soft tissue compromise, surgical intervention is indicated. Thorough physical examination of patients and a thorough understanding of pathomechanics of the foot and ankle are paramount. These combined with a comprehensive preoperative plan and meticulous execution can often provide improved function and decrease pain in patients affected by this debilitating problem.
Asunto(s)
Síndromes Compartimentales/cirugía , Pie , Pierna , Recuperación del Miembro , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/etiología , HumanosRESUMEN
Contracture of the gastrocnemius musculature is a prevalent finding in the setting of foot and ankle pathology. Tightness of the posterior musculotendinous structures in the leg limits ankle range of motion and affects an equinus posture of the foot. Increased contact pressures are generated in the plantar foot with weightbearing. The resultant overload of the ligaments and the intrinsic muscles of the midfoot and forefoot is manifest in a variety of pathologic processes. The altered mechanics contributes to, among other conditions, ankle impingement, plantar fasciitis, midfoot arthritis, posterior tibial tendon dysfunction, forefoot overload, diabetic ulceration, and Charcot arthropathy. Effective management of these conditions includes addressing the underlying gastrocnemius contracture as well as the related foot and ankle pathology. Here we describe the underlying biomechanical abnormalities and radiographic findings in these pathological conditions of the foot and ankle associated with gastroequinus contracture. An awareness and understanding of the pathomechanics should enable the radiologist to better appreciate the form and function associated with the image.
Asunto(s)
Articulación del Tobillo , Contractura/fisiopatología , Enfermedades del Pie/etiología , Músculo Esquelético , Articulación del Tobillo/diagnóstico por imagen , Fenómenos Biomecánicos , Neuropatías Diabéticas/fisiopatología , Humanos , Artropatías/etiología , Artropatías/patología , RadiografíaRESUMEN
There is no standardized method reported in the literature to measure ROM of the ankle after a total ankle arthroplasty, which limits the possibility to compare results from the various ankle designs. It seems that most of the measurements are a combination of ankle and midfoot motion, not the tibiotalar joint. A protocol was developed to accurately measure the true tibiotalar and midfoot motion before and after an ankle replacement. Lateral radiographs were taken of the ankle with the patient in a weightbearing position, and measurements were done along fixed landmarks. In this study, the tibiotalar, midfoot, and combined ROM were measured preoperative and 1 year postoperative in a standardized, reproducible fashion. The preoperative tibiotalar ROM was 18.5 degrees and combined ankle and midfoot motion 25.1 degrees. The true tibiotalar motion after an Agility total ankle arthroplasty was 23.4 degrees, and the combined ankle and midfoot motion was 31.3 degrees. The average improvement in ROM in the tibiotalar joint was approximately 5 degrees, and combined ROM was 6.1 degrees. Preoperative ROM proved to be the main factor determining the eventual postoperative ROM. It is possible to accurately measure the true ankle and the midfoot motion and those measurements should be used when reporting on the results of ankle replacements. Total ankle arthroplasty resulted in a statistically significant, but clinically less than expected, increase in ROM.
Asunto(s)
Articulación del Tobillo/fisiología , Articulación del Tobillo/cirugía , Artroplastia de Reemplazo , Prótesis Articulares , Rango del Movimiento Articular , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los ResultadosRESUMEN
Isolated arthrodesis of the navicular complex is a means of restoring the integrity of the medial column. This facilitates pain relief and improved function. This option should be considered in the treatment of degenerative disease in these joints. Grade III PTTI may be managed with arthrodesis of the navicular complex , provided degenerative changes are limited to the talonavicular-naviculocuneiform joints. This procedure must include concomitant correction of the hindfoot. Osseous necrosis or bone loss that is due to severe degeneration may be managed successfully with cancellous or structural grafting that is sufficient to maintain the length of the medial column. If extensive grafting increases the risk of nonunion, the navicular or its remnants can be excised and a talocuneiform fusion may be performed. Successful management of conditions that affect the navicular complex requires meticulous attention to restoration of medical column. Optical results also demand consideration of overall alignment and condition of adjacent joints.
Asunto(s)
Artrodesis/métodos , Artropatías/cirugía , Articulaciones Tarsianas/cirugía , Artrodesis/efectos adversos , Pie/cirugía , Enfermedades del Pie/cirugía , HumanosRESUMEN
Several procedures are available for the treatment of posterior tibialis tendon dysfunction. The procedure that is chosen for a specific patient should address the patient's unique problem and make biomechanical sense. A fusion should be avoided, if possible; however, if a fusion is the appropriate solution, one should not hesitate to do it.
Asunto(s)
Calcáneo/cirugía , Pie Plano/cirugía , Deformidades Adquiridas del Pie/cirugía , Talón/cirugía , Disfunción del Tendón Tibial Posterior/cirugía , Artrodesis/efectos adversos , Artrodesis/métodos , Fenómenos Biomecánicos , Pie Plano/clasificación , Pie Plano/fisiopatología , Deformidades Adquiridas del Pie/fisiopatología , Talón/fisiopatología , Humanos , Osteotomía/efectos adversos , Disfunción del Tendón Tibial Posterior/clasificación , Disfunción del Tendón Tibial Posterior/fisiopatología , Articulación Talocalcánea/cirugíaRESUMEN
The developers of a successful prosthetic implant for ankle replacement must consider the biomechanical properties that are unique to this complex joint. The prosthesis needs to provide structural support while allowing for motion in the sagittal, transverse, and coronal planes. Although the design must conform to and function within the soft tissue constraints of the ankle, it is only a component of the overall success. Paying attention to leg alignment and meticulous soft tissue balancing is essential to a satisfactory outcome.