The purpose of our study was to evaluate all contact pressures between the molded ankle-foot orthosis (MAFO) and the subject during activities of daily living. The MAFOs studied are used clinically to reduce plantar contact pressures associated with foot ulcers in adult neuropathic diabetic subjects, alleviating abnormal pressures by redistributing them to low-pressure plantar regions. While effective, MAFOs are often not used by the subject due to weight and comfort issues. An understanding of the contact pressures between the subject and the orthosis is a first step in improving basic MAFO design. Four nonimpaired, young adult males were tested in this study. A right-side MAFO was custom-molded and fitted for each subject by the same orthotist. Real-time pressures were obtained for the entire contact area using the F-Scan pressure measurement system. The data obtained demonstrated high contact pressures along the metatarsals of the foot, around the heel and ankle, and adjacent to the strap attachment sites. No contact pressures were noted along the posterior calf region during any of the activities performed. These data suggest the calf region would be a suitable site for material removal for weight reduction and increased comfort, especially in warm weather. In addition, these data may be useful to orthotists in improving the basic design and to researchers as a starting point for performing complex finite element analysis on the MAFO.

Real time contact pressure pads were used to evaluate calcaneal cuboid joint pressures as a result of lateral column lengthening. The Evan’s lateral column lengthening procedure has been used to restore the arch of the human foot after acquired adult flatfoot. There has been some question as to the consequences of this procedure with regards to calcanealcuboid arthrosis. This study evaluated the calcaneal cuboid contact pressure without lengthening, and after 5 and 10 mm lengthening. Each length was also evaluated with a compressive load of 350 N applied to the tibia. Total contact forces and pressures increased statistically as lengthening increased and after load application. Peak pressures also increased. Pressures exceeded 2.3 MPa in the loaded feet at 10 mm lengthening. Patients subjected to lateral column lengthening of 10 mm may be at increased risk for joint arthrosis.

From the Center for Orthopaedic Care, Inc. (G.J.S.), Cincinnati, Ohio; and Foot Ankle Services (P.S.C.), Department of Orthopaedics, University of Connecticut Health Center; Farmington, Connecticut; U.S.A.

Triple arthrodesis is the surgical fusion of the calcaneocuboid, talonavicular, and talocalcaneal joints of the foot. This is a palliative surgical procedure used to treat many painful hindfoot disorders (eg, clubfoot deformity, arthritis, Charcot's joint disease). Patient benefits include pain relief and improvement in foot function. Several anesthesia options are available for intraoperative and postoperative pain management. Perioperative nurses should be knowledgeable about foot anatomy, the sequence of surgical events, and possible postoperative complications from triple arthrodesis. A systems approach to patient care throughout the perioperative phase can ensure optimal patient outcomes.

Summary: Isolated flexor digitorum longus tendon transfers for reconstruction of stage II posterior tibial tendon insufficiency have limited effect on restoring the longitudinal arch. Use of ancillary os calcis osteotomies has recently gained popularity for both maintaining a weightbearing arch and for improving survivorship of soft tissue tendon procedures. A modification of the Evan's lateral column lengthening procedure, which consists of distraction arthrodesis of the calcaneocuboid joint, can restore the geometry of the foot while preserving hindfoot mobility.

Clinical Assistant Professor of Anesthesiology Thomas Jefferson University Jefferson Medical College 10th and Walnut Streets Philadelphia, Pennsylvania 19107Medical Student Thomas Jefferson University Jefferson Medical College 10th and Walnut Streets Philadelphia, Pennsylvania 19107Fellow in Cardiovascular Anesthesiology Thomas Jefferson University Jefferson Medical College 10th and Walnut Streets Philadelphia, Pennsylvania 19107