Introduction: Orthopaedic surgery ranks among the least racially and gender diverse medical/surgi... more Introduction: Orthopaedic surgery ranks among the least racially and gender diverse medical/surgical specialties. United States military surgeons train in military or military-funded residency positions to care for a markedly diverse population; however, the composition and diversity of these training programs have not been previously assessed. The purpose of this study was to analyze the trends of physician diversity in military orthopaedics in comparison with other surgical specialties over time. Methods: We performed a retrospective cohort study evaluating matriculation into first year of residency training in US military surgical training programs between 2002 and 2020. In total, 9,124 applicants were reviewed. We collected matriculant self-reported race/ethnicity and sex and the medical/specialty program. We considered under-represented minorities as those who reported their race as African American, Indian/Alaskan Native, and Native, other, or who reported ethnicity as Hispani...
Category: Sports; Trauma; Other Introduction/Purpose: Achilles tendon ruptures are common injurie... more Category: Sports; Trauma; Other Introduction/Purpose: Achilles tendon ruptures are common injuries in the active duty US military population. Timely rehabilitation has critical importance in force readiness. There remains debate about optimal treatment of Achilles tendon ruptures. Recent studies have found decreased risk of rerupture but increased complication rates with operative management, with similar times to full recovery. The development of a minimally invasive, percutaneous Achilles tendon technique has shown lower rates of wound complications than open management, with similar re-rupture rates. However, there exists no comparative studies between the percutaneous, minimally invasive Achilles tendon surgery and nonoperative management. This was a retrospective cohort study comparing the results of the Percutaneous Achilles Repair System (PARS) and nonoperative management in the active duty military population. Methods: All Achilles tendon injuries in active duty patients wer...
Background: The preferred patient-reported outcome measure for the assessment of shoulder conditi... more Background: The preferred patient-reported outcome measure for the assessment of shoulder conditions continues to evolve. Previous studies correlating the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive tests (CATs) to the American Shoulder and Elbow Surgeons (ASES) score have focused on a singular domain (pain or physical function) but have not evaluated the combined domains of pain and physical function that compose the ASES score. Additionally, previous studies have not provided a multivariable prediction tool to convert PROMIS scores to more familiar legacy scores. Purpose: To establish a valid predictive model of ASES scores using a nonlinear combination of PROMIS domains for physical function and pain. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: The Military Orthopaedics Tracking Injuries and Outcomes Network (MOTION) database is a prospectively collected repository of patient-reported outcomes and intraoperative v...
In recent years, there seems to be a trend toward performing large numbers of gastrocnemius reces... more In recent years, there seems to be a trend toward performing large numbers of gastrocnemius recessions for a variety of pathological conditions of the foot and ankle. Whether it be as part of a complex flat or cavus foot reconstruction or to improve dorsiflexion, to offload forefoot pressures when treating diabetic ulcers, or, in the case of this paper, to decrease tension across the Achilles to treat tendinopathy, there is no doubt that the gastrocnemius recession has emerged as a vital tool in the armamentarium of the foot and ankle surgeon. While there are several case series that demonstrate promising results with regard to pain relief after gastrocnemius recession for Achilles tendinopathy1,2, the literature has not been as defined regarding the effect on plantar-flexion strength postoperatively3,4. Some of these limitations include small sample size, retrospective study designs with no preoperative strength-testing for comparison, and gastrocnemius recession procedures perform...
The present study does an admirable job of quantifying the pain relief, strength, and function fo... more The present study does an admirable job of quantifying the pain relief, strength, and function following a gastrocnemius recession. The results are very encouraging with regard to reducing pain and improving patient-reported satisfaction. The results of strength-testing and self-reported sports function may be a little less promising; however, this comes as no surprise. We believe that this procedure is so effective because by lengthening the gastrocnemius, the muscle is weakened. In the case of tendinopathy, this muscle-weakening reduces the stress across the degenerative portion of the tendon, and with other pathological processes, it reduces the deforming force of the gastrocnemius-soleus complex. The decrease in calf circumference postoperatively seems to support this assumption. The authors also addressed the small sample size, but they did not separate the cases with insertional and midsubstance disease. We believe that it may be beneficial to look at these entities separately...
The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons, Jan 2, 2018
Chronic plantar fasciitis is a common cause of foot pain, with conservative treatment providing r... more Chronic plantar fasciitis is a common cause of foot pain, with conservative treatment providing relief for most patients. However, because of the common occurrence of this pathology, this leaves many patients dissatisfied. The purpose of the present study was to determine the effectiveness of extracorporeal shock wave therapy (ESWT) to treat chronic plantar fasciitis (PF) in a largely active duty population. A review of 82 patients (115 heels) who had undergone ESWT for chronic PF was performed. Outcome data were obtained by patient telephone interviews. All ESWT was conducted at 24 kV for 2000 shocks. Of the 82 patients (115 heels), 76 (93%; 111 heels) agreed to participate. Their mean age was 42 ± 10 years, with 41 males (54%) and 35 females (46%). The mean follow-up period was 42 ± 22 months. Of the patients, 73.6% were active duty military personnel. The mean preoperative pain score of 7.8 ± 2 had improved to 2.5 ± 2 at the last follow-up visit (p <.0001). Active duty patient...
Page 1. ABSTRACT: Chemotherapy-induced cell death is linked to apoptosis, and there is increasing... more Page 1. ABSTRACT: Chemotherapy-induced cell death is linked to apoptosis, and there is increasing evidence that multidrug-resis-tance in cancer cells may be the result of a decrease in the ability of a cell to initiate apoptosis in response to cytotoxic agents. ...
Background: Displaced lateral malleolar fractures are often treated with reduction and surgical s... more Background: Displaced lateral malleolar fractures are often treated with reduction and surgical stabilization. However, there has not been a comprehensive laboratory comparison to determine the most appropriate device for treating these patients. This study subjected a range of contemporary lateral fibular plates to a series of mechanical tests designed to reveal performance differences. Methods: Forty fresh frozen lower extremities were divided into 4 groups. A Weber B distal fibula fracture was simulated with an osteotomy and stabilized using 1 of 4 plate systems: a standard Synthes one-third tubular plate with interfragmentary lag screw, a Synthes LCP locking plate with lag screw, an Orthohelix MaxLock Extreme low-profile locking plate with lag screw, or a TriMed Sidewinder nonlocking plate. Controlled monotonic bending and cyclic torsional loading were applied and bending stiffness, torsional stiffness, and fracture site motion were quantified. Resistance to cyclic torsional loa...
Category: Ankle; Sports Introduction/Purpose: The Modified Brostrom (MB) has become the gold stan... more Category: Ankle; Sports Introduction/Purpose: The Modified Brostrom (MB) has become the gold standard for operative management of chronic lateral ankle instability. Despite overall good clinical outcomes with this procedure, recent biomechanical data has called into question the strength and durability of this technique. Accordingly, the addition of suture tape to the MB construct has been described in an attempt to more closely recreate the natural biomechanical properties of the ankle lateral ligament complex. Despite its increasing popularity, the Modified Brostrom with suture tape augmentation (MBA) remains controversial due to a lack of clinical data. The purpose of this study is to determine the differences in clinical outcomes of MB compared to MBA. Methods: A systematic review of the literature was performed using PubMed, Embase, and CINAHL to identify English-language articles from 2009 - present discussing outcomes with the MBA technique. Total number of patients, patient ...
Introduction/Purpose: Studies investigating when patients can safely return to driving are becomi... more Introduction/Purpose: Studies investigating when patients can safely return to driving are becomingly increasingly numerous in the orthopedic literature because of the recognition of the importance of the activity to the lives of most adults. Previous systematic reviews have proven helpful by collecting and summarizing these studies to establish concise guidelines that can be presented to patients during the counseling surrounding a procedure. Having these guidelines can be even more crucial when discussing elective procedures. This systematic review summarizes the available studies investigating when it is safe to return to driving following elective foot and ankle procedures.
The recent coronavirus disease of 2019 pandemic has resulted in unprecedented limitations in pers... more The recent coronavirus disease of 2019 pandemic has resulted in unprecedented limitations in person-to-person contact, elective surgeries, and even traumatic injuries, leaving potential gaps in training and skill development. Surgical programs have had to adapt with the rapid implementation of surgical simulation curricula, collaborative lecture series, and greater focus on online learning. Using models, simulation, and virtual learning, we have accommodated for restrictions and operative volume from coronavirus disease of 2019. The goal was to establish a durable system of extra-clinical training that would increase patient safety and collaborative knowledge sharing. From our simulated interventions, we noted maintenance of skills despite low operative volumes, low temporal or monetary commitment especially when compared with operating room time, and engagement from both learners (medical students and junior residents) and teachers (senior residents and staff physicians). Our experience with transition to a virtual curriculum with involvement of multiple institutions has also resulted in greater diversity of lectures, increased frequency of academics, and high levels of participation. In this article, we discuss our department’s experience with these alterations and the path for surgical training moving forward. We have seen multiple benefits to advancement of nonclinical specialty-specific simulation and virtual didactics. While some of these efforts may require some early expenditure, both monetary and temporal, to establish the program infrastructure, they are easy to apply, confer substantial added value, and appear durable.
The Modified Broström has become the gold standard for operative management of chronic lateral an... more The Modified Broström has become the gold standard for operative management of chronic lateral ankle instability. Despite overall good clinical outcomes with this procedure, recent biomechanical data have called into question the strength and durability of this technique. Accordingly, the addition of suture tape to the Modified Broström construct has been described in an attempt to more closely recreate the natural biomechanical properties of the ankle lateral ligament complex. We performed a systematic review of the literature was using PubMed, Embase, and CINAHL to identify English-language articles from 2009 to present discussing outcomes with the augmented Modified Broström technique. A total of 4 studies (2 retrospective cohort studies, 2 case series) involving 156 patients with Modified Broström with augmentation met inclusion criteria. Average follow-up time was 13.8 months. Of the 3 studies reporting patient-reported outcome measures both pre- and postoperatively, there was a significant improvement in all measures (p < .05). Two studies compared the Modified Broström directly with and without augmentation, one of which found a statistically significant difference in the Foot and Ankle Ability Measure in favor of the augmentation group (93.1 vs 90.5, p = .027), while American Orthopaedic Foot and Ankle Society score was not significantly different (p > .05) between the 2 procedures across studies. There were no significant differences in complications between techniques. Modified Broström with suture tape augmentation for chronic lateral ankle instability can produce good short-term clinical outcomes with few complications, comparable to the Modified Broström alone.
Abstract Injuries that occur to the military athlete are related to the tremendous stresses that ... more Abstract Injuries that occur to the military athlete are related to the tremendous stresses that are placed on the lower extremities during all phases of training. Many who join the military have not had athletic training prior to entering military service, and many injuries occur early on due to the new stresses placed on the feet and ankles of new recruits. Expectations persist during military service to maintain a high level of physical fitness. Exposure to traumatic injury is also elevated during a military career. Military personnel are at elevated risk of injury to the lower extremities throughout their career.
The authors' hypothesis was that weakening the gastrocnemius muscle at the time of tendon tra... more The authors' hypothesis was that weakening the gastrocnemius muscle at the time of tendon transfer will reduce the risk of rupture and facilitate faster rehabilitation with increased active dorsiflexion and improved overall outcome, because the transferred tendon is spared the antagonistic effect of the gastrocnemius during the early recovery period. A retrospective chart review identified 12 patients who underwent a tibialis posterior tendon (PTT) transfer with gastrocnemius Botox injection for foot drop. All statistical analyses were conducted using SAS version 9.2 (SAS Institute, Inc., Cary, North Carolina). There were no failures or tendon ruptures. All patients had zero dorsiflexion (DF) strength preoperatively, and those with DF strength documented postoperatively had a mean DF strength at final clinical evaluation of 3.9 (p < .001) with a mean active DF of 4°. It was concluded that gastrocnemius chemodenervation with Botox at the time of PTT transfer is a safe and effe...
Triple arthrodesis involves subtalar, talonavicular, and calcaneocuboid joint fusion and is perfo... more Triple arthrodesis involves subtalar, talonavicular, and calcaneocuboid joint fusion and is performed to relieve pain and correct deformity. Complications include malunion resulting in equinovarus and lateral column overload, which can lead to painful callosities and stress fractures. This study quantified the effectiveness of a closing-wedge calcaneal &amp;amp;amp;amp;amp;amp;amp;amp;quot;Z&amp;amp;amp;amp;amp;amp;amp;amp;quot; osteotomy for correction of the varus condition and reduction of abnormal loading of the lateral border of the foot. Ten fresh-frozen feet were used. Angle meters were attached to the calcaneus and second cuneiform to measure hindfoot and midfoot varus, and pressure sensors were placed under the first and fifth metatarsal heads to document loading of the borders of the foot. Tensile loads were applied to ten extrinsic tendons and the Achilles tendon while an 1187 N axial foot load was applied. Calcaneus and second cuneiform coronal plane angles and medial and lateral plantar pressures were measured initially, after triple fusion-induced varus, and after &amp;amp;amp;amp;amp;amp;amp;amp;quot;Z&amp;amp;amp;amp;amp;amp;amp;amp;quot; osteotomy. The calcaneal &amp;amp;amp;amp;amp;amp;amp;amp;quot;Z&amp;amp;amp;amp;amp;amp;amp;amp;quot; osteotomy had no significant corrective effect, with hindfoot alignment virtually identical before and after the procedure under the described foot loading conditions. Similarly, second cuneiform inclination, representative of midfoot alignment, showed no change from the osteotomy. Medial and lateral peak plantar pressures after calcaneal &amp;amp;amp;amp;amp;amp;amp;amp;quot;Z&amp;amp;amp;amp;amp;amp;amp;amp;quot; osteotomy did not differ from those measured after varus triple fusion. In this cadaver model of varus malunited triple arthrodesis, the closing-wedge calcaneal &amp;amp;amp;amp;amp;amp;amp;amp;quot;Z&amp;amp;amp;amp;amp;amp;amp;amp;quot; osteotomy was ineffective for correction of bone alignment and lateral forefoot overloading under the tested conditions. The results provide additional information on which to base treatment after triple arthrodesis with varus malunion.
Introduction: Orthopaedic surgery ranks among the least racially and gender diverse medical/surgi... more Introduction: Orthopaedic surgery ranks among the least racially and gender diverse medical/surgical specialties. United States military surgeons train in military or military-funded residency positions to care for a markedly diverse population; however, the composition and diversity of these training programs have not been previously assessed. The purpose of this study was to analyze the trends of physician diversity in military orthopaedics in comparison with other surgical specialties over time. Methods: We performed a retrospective cohort study evaluating matriculation into first year of residency training in US military surgical training programs between 2002 and 2020. In total, 9,124 applicants were reviewed. We collected matriculant self-reported race/ethnicity and sex and the medical/specialty program. We considered under-represented minorities as those who reported their race as African American, Indian/Alaskan Native, and Native, other, or who reported ethnicity as Hispani...
Category: Sports; Trauma; Other Introduction/Purpose: Achilles tendon ruptures are common injurie... more Category: Sports; Trauma; Other Introduction/Purpose: Achilles tendon ruptures are common injuries in the active duty US military population. Timely rehabilitation has critical importance in force readiness. There remains debate about optimal treatment of Achilles tendon ruptures. Recent studies have found decreased risk of rerupture but increased complication rates with operative management, with similar times to full recovery. The development of a minimally invasive, percutaneous Achilles tendon technique has shown lower rates of wound complications than open management, with similar re-rupture rates. However, there exists no comparative studies between the percutaneous, minimally invasive Achilles tendon surgery and nonoperative management. This was a retrospective cohort study comparing the results of the Percutaneous Achilles Repair System (PARS) and nonoperative management in the active duty military population. Methods: All Achilles tendon injuries in active duty patients wer...
Background: The preferred patient-reported outcome measure for the assessment of shoulder conditi... more Background: The preferred patient-reported outcome measure for the assessment of shoulder conditions continues to evolve. Previous studies correlating the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive tests (CATs) to the American Shoulder and Elbow Surgeons (ASES) score have focused on a singular domain (pain or physical function) but have not evaluated the combined domains of pain and physical function that compose the ASES score. Additionally, previous studies have not provided a multivariable prediction tool to convert PROMIS scores to more familiar legacy scores. Purpose: To establish a valid predictive model of ASES scores using a nonlinear combination of PROMIS domains for physical function and pain. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: The Military Orthopaedics Tracking Injuries and Outcomes Network (MOTION) database is a prospectively collected repository of patient-reported outcomes and intraoperative v...
In recent years, there seems to be a trend toward performing large numbers of gastrocnemius reces... more In recent years, there seems to be a trend toward performing large numbers of gastrocnemius recessions for a variety of pathological conditions of the foot and ankle. Whether it be as part of a complex flat or cavus foot reconstruction or to improve dorsiflexion, to offload forefoot pressures when treating diabetic ulcers, or, in the case of this paper, to decrease tension across the Achilles to treat tendinopathy, there is no doubt that the gastrocnemius recession has emerged as a vital tool in the armamentarium of the foot and ankle surgeon. While there are several case series that demonstrate promising results with regard to pain relief after gastrocnemius recession for Achilles tendinopathy1,2, the literature has not been as defined regarding the effect on plantar-flexion strength postoperatively3,4. Some of these limitations include small sample size, retrospective study designs with no preoperative strength-testing for comparison, and gastrocnemius recession procedures perform...
The present study does an admirable job of quantifying the pain relief, strength, and function fo... more The present study does an admirable job of quantifying the pain relief, strength, and function following a gastrocnemius recession. The results are very encouraging with regard to reducing pain and improving patient-reported satisfaction. The results of strength-testing and self-reported sports function may be a little less promising; however, this comes as no surprise. We believe that this procedure is so effective because by lengthening the gastrocnemius, the muscle is weakened. In the case of tendinopathy, this muscle-weakening reduces the stress across the degenerative portion of the tendon, and with other pathological processes, it reduces the deforming force of the gastrocnemius-soleus complex. The decrease in calf circumference postoperatively seems to support this assumption. The authors also addressed the small sample size, but they did not separate the cases with insertional and midsubstance disease. We believe that it may be beneficial to look at these entities separately...
The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons, Jan 2, 2018
Chronic plantar fasciitis is a common cause of foot pain, with conservative treatment providing r... more Chronic plantar fasciitis is a common cause of foot pain, with conservative treatment providing relief for most patients. However, because of the common occurrence of this pathology, this leaves many patients dissatisfied. The purpose of the present study was to determine the effectiveness of extracorporeal shock wave therapy (ESWT) to treat chronic plantar fasciitis (PF) in a largely active duty population. A review of 82 patients (115 heels) who had undergone ESWT for chronic PF was performed. Outcome data were obtained by patient telephone interviews. All ESWT was conducted at 24 kV for 2000 shocks. Of the 82 patients (115 heels), 76 (93%; 111 heels) agreed to participate. Their mean age was 42 ± 10 years, with 41 males (54%) and 35 females (46%). The mean follow-up period was 42 ± 22 months. Of the patients, 73.6% were active duty military personnel. The mean preoperative pain score of 7.8 ± 2 had improved to 2.5 ± 2 at the last follow-up visit (p <.0001). Active duty patient...
Page 1. ABSTRACT: Chemotherapy-induced cell death is linked to apoptosis, and there is increasing... more Page 1. ABSTRACT: Chemotherapy-induced cell death is linked to apoptosis, and there is increasing evidence that multidrug-resis-tance in cancer cells may be the result of a decrease in the ability of a cell to initiate apoptosis in response to cytotoxic agents. ...
Background: Displaced lateral malleolar fractures are often treated with reduction and surgical s... more Background: Displaced lateral malleolar fractures are often treated with reduction and surgical stabilization. However, there has not been a comprehensive laboratory comparison to determine the most appropriate device for treating these patients. This study subjected a range of contemporary lateral fibular plates to a series of mechanical tests designed to reveal performance differences. Methods: Forty fresh frozen lower extremities were divided into 4 groups. A Weber B distal fibula fracture was simulated with an osteotomy and stabilized using 1 of 4 plate systems: a standard Synthes one-third tubular plate with interfragmentary lag screw, a Synthes LCP locking plate with lag screw, an Orthohelix MaxLock Extreme low-profile locking plate with lag screw, or a TriMed Sidewinder nonlocking plate. Controlled monotonic bending and cyclic torsional loading were applied and bending stiffness, torsional stiffness, and fracture site motion were quantified. Resistance to cyclic torsional loa...
Category: Ankle; Sports Introduction/Purpose: The Modified Brostrom (MB) has become the gold stan... more Category: Ankle; Sports Introduction/Purpose: The Modified Brostrom (MB) has become the gold standard for operative management of chronic lateral ankle instability. Despite overall good clinical outcomes with this procedure, recent biomechanical data has called into question the strength and durability of this technique. Accordingly, the addition of suture tape to the MB construct has been described in an attempt to more closely recreate the natural biomechanical properties of the ankle lateral ligament complex. Despite its increasing popularity, the Modified Brostrom with suture tape augmentation (MBA) remains controversial due to a lack of clinical data. The purpose of this study is to determine the differences in clinical outcomes of MB compared to MBA. Methods: A systematic review of the literature was performed using PubMed, Embase, and CINAHL to identify English-language articles from 2009 - present discussing outcomes with the MBA technique. Total number of patients, patient ...
Introduction/Purpose: Studies investigating when patients can safely return to driving are becomi... more Introduction/Purpose: Studies investigating when patients can safely return to driving are becomingly increasingly numerous in the orthopedic literature because of the recognition of the importance of the activity to the lives of most adults. Previous systematic reviews have proven helpful by collecting and summarizing these studies to establish concise guidelines that can be presented to patients during the counseling surrounding a procedure. Having these guidelines can be even more crucial when discussing elective procedures. This systematic review summarizes the available studies investigating when it is safe to return to driving following elective foot and ankle procedures.
The recent coronavirus disease of 2019 pandemic has resulted in unprecedented limitations in pers... more The recent coronavirus disease of 2019 pandemic has resulted in unprecedented limitations in person-to-person contact, elective surgeries, and even traumatic injuries, leaving potential gaps in training and skill development. Surgical programs have had to adapt with the rapid implementation of surgical simulation curricula, collaborative lecture series, and greater focus on online learning. Using models, simulation, and virtual learning, we have accommodated for restrictions and operative volume from coronavirus disease of 2019. The goal was to establish a durable system of extra-clinical training that would increase patient safety and collaborative knowledge sharing. From our simulated interventions, we noted maintenance of skills despite low operative volumes, low temporal or monetary commitment especially when compared with operating room time, and engagement from both learners (medical students and junior residents) and teachers (senior residents and staff physicians). Our experience with transition to a virtual curriculum with involvement of multiple institutions has also resulted in greater diversity of lectures, increased frequency of academics, and high levels of participation. In this article, we discuss our department’s experience with these alterations and the path for surgical training moving forward. We have seen multiple benefits to advancement of nonclinical specialty-specific simulation and virtual didactics. While some of these efforts may require some early expenditure, both monetary and temporal, to establish the program infrastructure, they are easy to apply, confer substantial added value, and appear durable.
The Modified Broström has become the gold standard for operative management of chronic lateral an... more The Modified Broström has become the gold standard for operative management of chronic lateral ankle instability. Despite overall good clinical outcomes with this procedure, recent biomechanical data have called into question the strength and durability of this technique. Accordingly, the addition of suture tape to the Modified Broström construct has been described in an attempt to more closely recreate the natural biomechanical properties of the ankle lateral ligament complex. We performed a systematic review of the literature was using PubMed, Embase, and CINAHL to identify English-language articles from 2009 to present discussing outcomes with the augmented Modified Broström technique. A total of 4 studies (2 retrospective cohort studies, 2 case series) involving 156 patients with Modified Broström with augmentation met inclusion criteria. Average follow-up time was 13.8 months. Of the 3 studies reporting patient-reported outcome measures both pre- and postoperatively, there was a significant improvement in all measures (p < .05). Two studies compared the Modified Broström directly with and without augmentation, one of which found a statistically significant difference in the Foot and Ankle Ability Measure in favor of the augmentation group (93.1 vs 90.5, p = .027), while American Orthopaedic Foot and Ankle Society score was not significantly different (p > .05) between the 2 procedures across studies. There were no significant differences in complications between techniques. Modified Broström with suture tape augmentation for chronic lateral ankle instability can produce good short-term clinical outcomes with few complications, comparable to the Modified Broström alone.
Abstract Injuries that occur to the military athlete are related to the tremendous stresses that ... more Abstract Injuries that occur to the military athlete are related to the tremendous stresses that are placed on the lower extremities during all phases of training. Many who join the military have not had athletic training prior to entering military service, and many injuries occur early on due to the new stresses placed on the feet and ankles of new recruits. Expectations persist during military service to maintain a high level of physical fitness. Exposure to traumatic injury is also elevated during a military career. Military personnel are at elevated risk of injury to the lower extremities throughout their career.
The authors' hypothesis was that weakening the gastrocnemius muscle at the time of tendon tra... more The authors' hypothesis was that weakening the gastrocnemius muscle at the time of tendon transfer will reduce the risk of rupture and facilitate faster rehabilitation with increased active dorsiflexion and improved overall outcome, because the transferred tendon is spared the antagonistic effect of the gastrocnemius during the early recovery period. A retrospective chart review identified 12 patients who underwent a tibialis posterior tendon (PTT) transfer with gastrocnemius Botox injection for foot drop. All statistical analyses were conducted using SAS version 9.2 (SAS Institute, Inc., Cary, North Carolina). There were no failures or tendon ruptures. All patients had zero dorsiflexion (DF) strength preoperatively, and those with DF strength documented postoperatively had a mean DF strength at final clinical evaluation of 3.9 (p < .001) with a mean active DF of 4°. It was concluded that gastrocnemius chemodenervation with Botox at the time of PTT transfer is a safe and effe...
Triple arthrodesis involves subtalar, talonavicular, and calcaneocuboid joint fusion and is perfo... more Triple arthrodesis involves subtalar, talonavicular, and calcaneocuboid joint fusion and is performed to relieve pain and correct deformity. Complications include malunion resulting in equinovarus and lateral column overload, which can lead to painful callosities and stress fractures. This study quantified the effectiveness of a closing-wedge calcaneal &amp;amp;amp;amp;amp;amp;amp;amp;quot;Z&amp;amp;amp;amp;amp;amp;amp;amp;quot; osteotomy for correction of the varus condition and reduction of abnormal loading of the lateral border of the foot. Ten fresh-frozen feet were used. Angle meters were attached to the calcaneus and second cuneiform to measure hindfoot and midfoot varus, and pressure sensors were placed under the first and fifth metatarsal heads to document loading of the borders of the foot. Tensile loads were applied to ten extrinsic tendons and the Achilles tendon while an 1187 N axial foot load was applied. Calcaneus and second cuneiform coronal plane angles and medial and lateral plantar pressures were measured initially, after triple fusion-induced varus, and after &amp;amp;amp;amp;amp;amp;amp;amp;quot;Z&amp;amp;amp;amp;amp;amp;amp;amp;quot; osteotomy. The calcaneal &amp;amp;amp;amp;amp;amp;amp;amp;quot;Z&amp;amp;amp;amp;amp;amp;amp;amp;quot; osteotomy had no significant corrective effect, with hindfoot alignment virtually identical before and after the procedure under the described foot loading conditions. Similarly, second cuneiform inclination, representative of midfoot alignment, showed no change from the osteotomy. Medial and lateral peak plantar pressures after calcaneal &amp;amp;amp;amp;amp;amp;amp;amp;quot;Z&amp;amp;amp;amp;amp;amp;amp;amp;quot; osteotomy did not differ from those measured after varus triple fusion. In this cadaver model of varus malunited triple arthrodesis, the closing-wedge calcaneal &amp;amp;amp;amp;amp;amp;amp;amp;quot;Z&amp;amp;amp;amp;amp;amp;amp;amp;quot; osteotomy was ineffective for correction of bone alignment and lateral forefoot overloading under the tested conditions. The results provide additional information on which to base treatment after triple arthrodesis with varus malunion.
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Papers by T. Eckel