BackgroundPigmented villonodular synovitis (PVNS) is a rare benign neoplastic disease of the synovium of joints and tendon sheaths, which may be locally aggressive. It can be broadly classified into localised disease or more diffuse forms, with the latter more prone to recurrence after surgical excision. We describe our experience in the management of foot and ankle PVNS, focusing on the diffuse type.MethodsPatients with PVNS were identified from a histology database from 2000 to 2010 at the University Hospitals of Leicester. The primary aim was to determine oncological outcomes and evaluate clinical outcomes with the Toronto Extremity Salvage Score (TESS) and the American Academy of Foot and Ankle Surgeons (AOFAS) scores.Results30 patients, 16 males and 14 females with a mean age of 37±15 years, who underwent surgery, were identified. There were 22 nodular PVNS and 8 diffuse PVNS. The diffuse PVNS was more likely to be in the hindfoot (75%, 6/8), of which 50% (3/6) had osteoarthritis at presentation. The localised PVNS was mostly located in the forefoot (91%, 20/22). None of the localised PVNS had a recurrence. The surgical recurrence rate in this series was similar to the pooled recurrence rate from the literature [12.5% (1/8) compared to 12.2% (6/49)]. The mean TESS and AOFAS scores were 86 and 78, respectively.ConclusionsDiffuse PVNS is more likely to occur in the hindfoot and nodular PVNS is more common in the forefoot. Aggressive synovectomy alone is an effective treatment for diffuse PVNS, with good oncological and clinical outcomes.

Background: The purpose of this study was to investigate the influence of joint configuration and preparation on first metatarsophalangeal (MTPJ) union rates.Methods: We performed a retrospective analysis of first MTPJ arthrodeses undertaken in our institution. Clinical notes, radiographs and postal questionnaires were used to determine outcome.Results: Two hundred first MTPJ arthrodeses (172 patients) were included in the analysis (34 male: 138 female; mean age 62 yr). The overall union rate was 93.5%. Union was achieved in 109/118 MTPJs (92.4%) prepared in the flat-on-flat configuration and in 78/82 (95%) prepared in the ball-and-socket configuration (p = 0.438). Higher union rates favoured low-velocity joint preparation [using rongeur only 21/21 (100%), rongeur and burr 26/27 (96.3%) and conical reamer 31/34 (91.2%)] but this did not reach statistical significance (p = 0.317). There was a 95% satisfaction rate with surgery but male patients were less satisfied (p = 0.031).Conclusion: Union rates were not influenced by joint configuration or preparation techniques. (C) 2014 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

BACKGROUND:The insertion of peroneus longus is traditionally described to the plantar surface of the 1st cuneiform and 1st metatarsal. It is thought to be the main contributor to the plantarflexed first ray seen in cavus feet. METHODS:We studied the insertion of peroneus longus in 26 feet from 14 adult cadavers. The insertional points, presence of sesamoid bone and variations in insertion were noted. RESULTS:The main insertion was to the base of the 1st metatarsal and the medial cuneiform in the majority of feet but variations were observed. A sesamoid bone was present within the tendon under the cuboid in 16 feet, 12 of which had additional lateral insertion bands. CONCLUSIONS:Variations in the insertion of peroneus longus were found and we have described two new lateral bands.

The long-term outcome of primary talectomy for trauma without tibiocalcaneal fusion has not been reported in the literature. We report a case of a primary talectomy for trauma in a 10-year-old patient with 60-year follow-up. The patient had minimal symptoms during this period which suggests that this procedure can have the desired effect in providing good long-term quality of life.