Current literature consistently precludes the chevron osteotomy for bunion correction in patients older than age 50 years. We retrospectively reviewed 47 patients (73 bunions) with an average age of 62 years (range, 55–81 years old) who had a chevron-Akin double osteotomy. The mean follow-up was 4 years, 6 months (range, 2 years, 3 months to 8 years, 2 months). The overall satisfaction rate was 95%. No significant pain or stiffness in the first metatarsophalangeal joint occurred in comparison with other bunion procedures. Radiographic results were better for patients with a preoperative intermetatarsal angle of less than 15° and tibial sesamoid position of less than or equal to 2. We disagree with the current recommendation that age older than 50 years is a contraindication to a chevron procedure. The Akin osteotomy adds additional intraoperative correction of the hallux angulation and rotation; thus, the chevron-Akin double osteotomy is a useful combination procedure. We recommend this procedure for the mild to moderate bunion deformity even in elderly patients.

HISTORY - A 20-year-old Division 1 pole vaulter suffered medial foot and ankle pain when he landed off of the mat and hit the pole vaulting standard after vaulting 18 feet. He had acute onset of pain with an impact loading to the left medial ankle. Examination at that time revealed ecchymosis and swelling localized about the left medial heel and on the medial aspect of the foot. Plain x-rays at that time were thought to be negative. He was treated for a medial ankle sprain. He attempted to go back and do cross training but had a great deal of difficulty running and had difficulty getting up on his toes. He had continued swelling in the area of the medial heel and midfoot. X-rays of the foot at that time again were negative. At two months the patient was still unable to resume walking activities comfortably. He was unable to participate in any running or sprinting activities and his pain was more localized to the medial midfoot and arch area. PHYSICAL EXAMINATION - Examination 2 months showed residual fullness localized about the midfoot with a normal range of motion of the ankle subtalar midfoot and forefoot. There was good strength throughout the tendinous structures of the foot and pain was localized to the medial midfoot. He was unable to walk on his toes and had pain with single heel raise. DIFFERENTIAL DIAGNOSIS: Medial ankle sprain with deltoid ligament injury Posterior tibial tendon tear Talo-navicular and spring ligament complex injury Lis franc ligament injury TEST AND RESULTS: Standing x-ray examination of left foot: approx 6 mm subluxation of tarsal navicular joint with dorsal subluxation of navicular on talus MRI examination of left foot: diffuse edema pattern with mild flattening and peripheral fractures of minimally subluxed left navicular complete rupture of left spring ligament with anterior deltoid ligament injury. FINAL/WORKING DIAGNOSIS: Spring ligament complete rupture with acquired flat foot and anterior deltoid ligament tear. TREATMENT: 1. Surgical repair of spring and anterior deltoid ligament. 2. 2 weeks - ROM exercises with plantar flexion and inversion. 3. 6 weeks - cast brace, PWB. Progressed to FWB by 8 weeks. 4. 12 weeks - jogging with shoe orthosis. Jumping - 6 months. 6. 9 months - unrestricted activities. Set American record 18 months after surgery. Won USA Olympic trials in 1996.

Fifteen patients (19 feet) who underwent simultaneous surgical excision of two primary interdigital neuromas in adjacent web spaces of the foot were studied retrospectively. There were 11 female patients (73%), The average age of the patients was 54.4 years. Other causes of multiple web space tenderness were excluded prior to surgical resection of both neuromas. At an average follow-up of 68.6 months (range, 32-113 months), 10 feet (53%) had complete resolution of symptoms and six feet (31%) had minimal residual symptoms. Three feet in two patients (16%) continued to have significant pain after surgery,One sequela of the procedure was dense sensory loss of the plantar aspect of the third metatarsal head to the tip of the third toe. There was also proximal dorsal sensory loss to the second, third, and fourth toes which was a function of the type of incision used. The sensory loss did not cause disability in the patients, but did cause some awkwardness with nail care.Resection of adjacent interdigital neuromas, although rarely indicated, can be expected to provide significant pain relief in 84% of patients, which is similar to results reported for resection of a single neuroma.

We examined 16 feet, 33 to 133 months (mean 83) after simultaneous calcaneocuboid and talonavicular fusions performed for a variety of painful disorders of the hindfoot. Objectively, four feet were rated excellent, eight good, four fair and none poor. There was one asymptomatic nonunion of the talonavicular joint. Progressive degenerative arthritis of the ankle was seen in six patients and of the naviculocuneiform joint in seven.Biomechanically, simultaneous calcaneocuboid and talonavicular arthrodesis is better than an isolated talonavicular fusion and is a simple and effective alternative to triple arthrodesis.

Bunions occur in athletes. Often, the bunion is compensated and has a congruous joint, needing minimal treatment. If the bunion rapidly progresses, the sesamoids sublux, and the joint becomes incongruous; surgery becomes necessary. Surgery for decompensated bunions and secondary problems is discussed.

This article describes pain that occurs in both the posterior and inferior heels. Various examples of athletes with these kinds of pain are discussed. The different types of heel pain are explored, and the article stresses the need for conservative care.

One hundred five patients (70% female and 30% male; average age, 48 years) with 132 symptomatic heels were treated according to a standard nonoperative protocol and then reviewed at an average follow-up of 29 months. The treatment protocol consisted of nonsteroidal anti-inflammatory medications, relative rest, viscoelastic polymer heel cushions, Achilles tendon stretching exercises, and, occasionally, injections. Obesity, lifestyle (athletic versus sedentary), sex, and presence or size of heel spur did not influence the treatment outcome. Ninety-four patients (89.5%) had resolution of heel pain within 10.9 months. Six patients (5.7%) continued to have significant pain, but did not elect to have operative treatment, and five patients (4.8%) elected to have surgical intervention. Despite attention to the outcome of surgical treatment for heel pain in the current literature, initial treatment for heel pain is nonoperative. The treatment protocol used in this study was successful for 89.5% of the patients.

In brief "Shin splints" is a catchall term for any kind persistent exercise-related lower leg pain with no obvious cause. Such pain can originate from a number of conditions, such as medial tibial stress syndrome, stress fracture, compartment syndrome, vascular pathology, nerve entrapment, and others. A methodical work-up designed to detect problems in all anatomic structures from bone to skin will narrow the possibilities and lay the basis for appropriate treatment.

Sixty-nine heels (53 patients) with chronic heel pain had a surgical release of the first branch of the lateral plantar nerve. The average duration of heel-pain symptoms was 23 months (range, six months to eight years). No patient had less than six months of conservative treatment before surgery. The average duration of preoperative conservative treatment was 14 months. Forty-four patients (83%) had taken nonsteroidal antiinflammatory agents. Sixty-three heels (91%) had used heel cups and/or orthoses. Fifty-nine heels (86%) had received one or more injections of a steroid preparation. Thirty-four heels had developed pain initially during a sports activity. Postoperatively, 61 heels (89%) had excellent or good results; 57 heels (83%) had complete resolution of pain. The average follow-up period was 49 months. In general, heel pain resolves with conservative treatment. In recalcitrant cases, however, entrapment of the first branch lateral plantar nerve should be suspected. Surgical release of this nerve can be expected to provide excellent relief of pain and facilitate return to normal activity.

Regional anesthesia provides significant advantages for the patient and practitioner involved in ambulatory foot and ankle surgery. Reliable techniques for administering regional ankle blocks emphasizing their importance in the practice of ambulatory surgery are presented.

Forefoot injuries constitute a significant portion of the problems that affect runners. With the increasing popularity of recreational running, more emphasis on the treatment of specific running injuries has surfaced. For the orthopaedic surgeon interested in treating runners, a thorough understanding of foot anatomy, biomechanics, shoes, orthotics, running surfaces, and conservative and surgical treatment options is mandatory. Runners place high demands on their feet and therefore require careful evaluation prior to embarking on a specific treatment course. This article represents a current overview of common problems affecting the forefoot of recreational and world-class runners. Treatment plans are based on the senior author's experience in the care of runners over the past 14 years.

When contemplating bunion surgery in the elite athlete, serious consideration should be given to its effects on the overall function and biomechanics of the forefoot. Many surgical treatment options are available, but their use in the high performance athlete has not previously been reported in the literature. In this paper we report on the successful use of the chevron bunionectomy procedure and related surgery in two world class female middle-distance and marathon runners.

ADVERTISEMENT RETURN TO ISSUEPREVArticleNEXTInitiation of methyl acetate pyrolysis in argon-diluted mixtures behind reflected shock wavesK. G. P. Sulzmann, D. E. Baxter, M. Khazra, and T. S. LundCite this: J. Phys. Chem. 1985, 89, 16, 3561–3566Publication Date (Print):August 1, 1985Publication History Published online1 May 2002Published inissue 1 August 1985https://pubs.acs.org/doi/10.1021/j100262a027https://doi.org/10.1021/j100262a027research-articleACS PublicationsRequest reuse permissionsArticle Views111Altmetric-Citations15LEARN ABOUT THESE METRICSArticle Views are the COUNTER-compliant sum of full text article downloads since November 2008 (both PDF and HTML) across all institutions and individuals. These metrics are regularly updated to reflect usage leading up to the last few days.Citations are the number of other articles citing this article, calculated by Crossref and updated daily. Find more information about Crossref citation counts.The Altmetric Attention Score is a quantitative measure of the attention that a research article has received online. Clicking on the donut icon will load a page at altmetric.com with additional details about the score and the social media presence for the given article. Find more information on the Altmetric Attention Score and how the score is calculated. Share Add toView InAdd Full Text with ReferenceAdd Description ExportRISCitationCitation and abstractCitation and referencesMore Options Share onFacebookTwitterWechatLinked InRedditEmail Other access options Get e-Alerts

In the 10 years 1972 through 1982, the senior author performed 21 operations on 15 runners with persistent foot and ankle pain. The operative procedures involved decompression of peripheral nerves in the foot and ankle, consisting of release of soft tissues in the tarsal tunnel and foot or removal of abnormal bony excrescences that were irritating these nerves. All 15 runners had good to excellent results and all returned to their preinjury running status, including the competitive athletes. Foot and ankle pain is best treated conservatively, but when signs and symptoms culled from a careful history and physical examination reflect a nerve entrapment syndrome, surgical intervention has its place in the armamentarium of the surgeon.