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Biomedical subjects

Sigvard T Hansen

Publications and source records attributed to Sigvard T Hansen.

16 recordsLinked to original sources
PubMed2005

Isolated medial column stabilization improves alignment in adult-acquired flatfoot.

UNLABELLED: In some patients with painful flatfoot, realignment and arthrodesis of the medial naviculocuneiform and first tarsometatarsal joints can be done to correct alignment and relieve symptoms. The primary purpose of this radiographic study was to assess the ability of isolated medial column arthrodesis to improve hindfoot alignment. We also assessed the ability of the procedure to correct radiographic parameters of overall foot structure in acquired flatfoot. Preoperative and postoperative radiographs of 19 patients who had naviculocuneiform and/or tarsometatarsal realignment and arthrodesis for adult-acquired flatfoot were examined by two reviewers. All parameters improved, with the lateral talometatarsal angle approaching normal. A decrease in talonavicular subluxation in the axial plane suggests passive improvement in hindfoot position without direct manipulation of any hindfoot bones or joints. These observations provide evidence for a link between stability of the midfoot and alignment of the hindfoot. In carefully selected patients, medial column realignment may restore normal anatomy without fusing essential joints. Modern clinical outcome studies are the next step in the objective evaluation of this procedure. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series-no, or historical, control group) See the Guidelines for Authors for a complete description of levels of evidence.

Adult↗
PubMed2005

Functional limitations of patients with end-stage ankle arthrosis.

BACKGROUND: Arthritis and other rheumatic conditions are the leading causes of disability among adults in the United States. The purpose of this report was to describe the self-reported functional limitations of a group of patients with end-stage ankle arthrosis. METHOD: Patients who presented for operative management of end-stage ankle arthrosis at the University of Minnesota and Harborview Medical Center completed a Musculoskeletal Functional Assessment (MFA) as part of their preoperative clinical evaluation. Data from patients evaluated during the time period April, 1995, through May, 2004, were used for this project. RESULTS: Four hundred and twenty-six patients with the diagnosis of end-stage ankle arthrosis completed baseline questionnaires. Six of the 426 patients received care on both ankles during the time of this project. The average age of patients at the time of completion of the questionnaire was 56.7 years. There were 241 men and 185 women. The primary underlying causes identified by the treating surgeon at the time of surgery were primary osteoarthritis with no known prior trauma (66), previous trauma (tibial fracture, foot fractures, or ankle ligamentous disruption) (296), rheumatoid arthritis (24), no known cause (21), and a variety of diseases or infections (19). In all domains, the patients with end-stage ankle arthrosis showed statistically significant differences from a general population sample. CONCLUSIONS: The effects of ankle arthritis as demonstrated by this data are severe. Most of these patients were severely limited in function. Without a data-driven understanding of the limitations the patients have, it is difficult to make an effective argument for focused research to solve the problems. Without understanding the patients' needs, it is impossible to assess the effect of treatment. The information in this paper provides a baseline understanding of effect of the current functional limitations of patients with end-stage ankle arthrosis.

Activities of Daily Living↗
PubMed2005

Alternative to the modified jones procedure: outcomes of the flexor hallucis longus (FHL) tendon transfer procedure for correction of clawed hallux.

BACKGROUND: The modified Jones procedure is the traditional operative procedure for correction of a clawed hallux, although the deformity may be caused by overpull of one of three different muscles. In this study we present the radiographic and functional outcomes of flexor hallucis longus (FHL) tendon transfer as treatment for clawed hallux. The transfer is performed by drawing two thirds of the FHL tendon up through a drill hole in the proximal phalanx and then suturing it medially back to the remaining third. METHODS: We retrospectively identified 19 patients (22 feet) who had FHL tendon transfer for correction of clawed hallux over a period of 5 years. Followup was an average of 51.0 (range 6 to 74; +/- 3.8) months after the procedure. Outcome and patient satisfaction were determined using the Long-Form Musculoskeletal Function Assessment (MFA) score. Patients were asked whether they were satisfied, somewhat satisfied, or dissatisfied with the overall outcome and were asked about shoewear limitations. Preoperative and postoperative radiographs were evaluated in 15 patients (17 feet). We measured the hallux valgus and interphalangeal (IP) angles on the anteroposterior (AP) radiographs. On the lateral view we measured the angle of the IP joint, the metatarsophalangeal (MTP) joint, and the talometatarsal angle. Statistical analysis was done using a repeated measures ANOVA (p < 0.05). RESULTS: On the lateral radiographs, the hallux IP joint angle (p < 0.0012; n = 15) and hallux MTP joint angle (p < 0.0265; n = 15) were significantly reduced postoperatively. On AP radiographs, the hallux valgus angle (p < 0.0334) was significantly reduced; however, the IP angle and the talometatarsal angle were not significantly different after surgery. Patients had an average MFA score of 14.6 (+/-3.8 standard error, range 1 to 35; n = 19). Thirteen patients were fully satisfied and six were somewhat satisfied with the overall result of the surgery. Four patients thought that their hallux limited the types of shoes they could wear, while 15 did not. CONCLUSION: It has been shown that clawed hallux can result from excessive motor function in one of three muscles: FHL tendon, peroneus longus (PL), and extensor hallucis longus (EHL). This study suggests that transfer of part of the tendon of the FHL is an effective alternative operative procedure for correction of clawed hallux.

Adolescent↗
PubMed2005

An association between functional second metatarsal length and midfoot arthrosis.

BACKGROUND: Primary tarsometatarsal arthrosis is relatively uncommon. The etiology of osteoarthritis in the foot is poorly understood, and it is possible that mechanical or anatomic factors play a role. METHODS: We compared the relative length of the metatarsals in patients with idiopathic arthrosis of the midfoot with that in a group of controls without arthrosis. We analyzed the radiographs of all patients who had had an arthrodesis of the first, second, and third tarsometatarsal joints to treat arthrosis during a three-year period at a tertiary teaching hospital. We excluded patients with a history of inflammatory arthritis, trauma, or Charcot arthropathy. Nine patients (fifteen feet), seven women and two men with an average age of 64.2 years, met the inclusion criteria. We compared them with a control group consisting of the uninjured feet of patients with an acute traumatic injury to the hindfoot and the feet of volunteers with no foot problems. We measured the first, second, and fourth metatarsal lengths and the intermetatarsal angles on weight-bearing anteroposterior radiographs. We also measured the length of the first metatarsal relative to the long axis of the second metatarsal to define the functional first metatarsal length. The ratios of metatarsal lengths and the ratios of functional lengths were used for analysis to minimize differences in foot size and differences caused by radiographic magnification. Statistical comparisons between groups were then carried out. RESULTS: In the study group, the length of the first metatarsal was, on the average, 77.0% of the length of the second metatarsal, whereas, in the control group, the first metatarsal length was an average of 82.0% of the second metatarsal length. The functional length of the second metatarsal was, on the average, 18.6% greater than that of the first metatarsal in the study group and only an average of 4.1% greater than that of the first metatarsal in the control group. Both differences were significant (p < 0.0004 and p < 0.0001, respectively). CONCLUSIONS: Patients with midfoot arthrosis had a different ratio of the first to the second metatarsal length than did a similarly aged cohort without midfoot arthrosis. The patients had a relatively short first metatarsal or a relatively long second metatarsal, or both. Midfoot arthrosis may have a mechanical etiology. Recognition of risk factors is the first step in developing prevention strategies.

Adult↗
PubMed2005

Adult cavovarus foot.

Cavovarus foot deformity, which often results from an imbalance of muscle forces, is commonly caused by hereditary motor sensory neuropathies. Other causes are cerebral palsy, cerebral injury (stroke), anterior horn cell disease (spinal root injury), talar neck injury, and residual clubfoot. In cavovarus foot deformity, the relatively strong peroneus longus and tibialis posterior muscles cause a hindfoot varus and forefoot valgus (pronated) position. Hindfoot varus causes overload of the lateral border of the foot, resulting in ankle instability, peroneal tendinitis, and stress fracture. Degenerative arthritic changes can develop in overloaded joints. Gait examination allows appropriate planning of tendon transfers to correct stance and swing-phase deficits. Inspection of the forefoot and hindfoot positions determines the need for soft-tissue release and osteotomy. The Coleman block test is invaluable for assessing the cause of hindfoot varus. Prolonged use of orthoses or supportive footwear can result in muscle imbalance, causing increasing deformity and irreversible damage to tendons and joints. Rebalancing tendons is an early priority to prevent unsalvageable deterioration of the foot. Muscle imbalance can be corrected by tendon transfer, corrective osteotomy, and fusion. Fixed bony deformity can be addressed by fusion and osteotomy.

Adult↗
PubMed2004

Takedown of ankle fusion and conversion to total ankle replacement.

The painful ankle arthrodesis is an unsolved clinical problem. In many cases, transtibial amputation may be the best option for functional recovery. Recent reports of early success with second generation ankle implants show takedown of the problematic ankle fusion and conversion to total ankle arthroplasty may be an alternative to amputation. This study is a retrospective review of 23 ankles in 22 patients scheduled to have this procedure. Four patients were lost to followup, leaving 19 ankles in 18 patients at an average followup of 39 months. Three patients chose to have an amputation because of continued pain. In the remaining 16 ankles, the mean AOFAS ankle-hind foot outcome score improved from 42-68. Patients who had a clear source of pain with the ankle arthrodesis (such as subtalar arthrosis) had a better result than patients without a clear source of pain. All the patients who had the lateral malleolus resected during previous arthrodesis had complicated courses after arthroplasty. For patients with a definable source of pain and who have not had previous malleolar resection, conversion of a failed ankle arthrodesis to total ankle arthroplasty may be a viable alternative to amputation.

Adult↗
PubMed2004

Surgical anatomy of the gastrocnemius recession (Strayer procedure).

BACKGROUND: The Strayer procedure (gastrocnemius recession) is a treatment option for patients with clinically relevant gastrocnemius equinus contracture. The purpose of this study was to review the surgical anatomy of the Strayer procedure with specific reference to 1) the location of the sural nerve, and 2) the gastrocnemius tendon release point. METHODS: Forty consecutive Strayer procedures in 33 patients (15 males, 18 females) served as the study group. Recorded measurements included: 1) the location of the sural nerve relative to the deep fascia, 2) the distance from the medial border of the gastrocnemius tendon to the sural nerve, and 3) the distance from the distal end of the gastrocnemius muscle belly (identified by surface landmarks) to the actual release site. RESULTS: At the point of the gastrocnemius release, the sural nerve was located superficial to the fascia in 17/40 legs (42.5%) and deep to the fascia in 23/40 legs (57.5%). In five legs (12.5%), the nerve was directly applied to the gastrocnemius tendon and needed to be gently dissected off the tendon. The gastrocnemius release point was located an average of 18 mm distal (range, 20 mm proximal to 57 mm distal) to the surface landmark created by the distal extent of the gastrocnemius muscle belly. CONCLUSION: Knowledge of the relevant anatomy associated with the gastrocnemius recession should allow surgeons to minimize the rate of sural nerve injuries and improve cosmesis by decreasing the length of the surgical incision. A posteromedial incision that begins 2 cm distal to the gastrocnemius indentation and extends proximally will minimize the length of the incision required.

Achilles Tendon↗
PubMed2004

Complications and failure after total ankle arthroplasty.

BACKGROUND: Second-generation total ankle arthroplasty has been reported to have good intermediate-term results. The purpose of the present study was to report on the cause and frequency of reoperation and failure after total ankle arthroplasty and to determine demographic and clinical predictors of reoperation and failure. METHODS: Three hundred and six consecutive primary total ankle arthroplasties were performed with use of the DePuy Agility Total Ankle System between 1995 and 2001. At a mean of thirty-three months after the arthroplasty, we retrospectively reviewed the records with regard to patient age, gender, the indications for the index procedure, adjuvant procedures, the timing and frequency of reoperation, and the indications for and the type of reoperations performed. Kaplan-Meier analysis was performed to determine the rate of prosthetic survival, and Cox regression analysis was performed to determine predictors of reoperation and failure. RESULTS: Eighty-five patients (28%) underwent 127 reoperations (involving 168 procedures) after primary total ankle arthroplasty. The most common procedures at the time of reoperation were débridement of heterotopic bone (fifty-eight), correction of axial malalignment (forty), and component replacement (thirty-one). Eight patients underwent below-the-knee amputation. Age was found to be the only significant predictor of reoperation and failure after total ankle arthroplasty. The five-year survival rate with reoperation as the end point was 54%. The five-year survival rate with failure as the end point was 80% for all patients and 89% for patients who were more than fifty-four years of age. The prosthesis could not be salvaged in nine ankles (2.9%); the inability to salvage the prosthesis was most often due to loosening or infection. CONCLUSIONS: We noted a relatively high rate of reoperation after total ankle arthroplasty with this second-generation device. Younger age was found to have a negative effect on the rates of reoperation and failure. Most prostheses could be salvaged; however, the functional outcome of this procedure is uncertain.

Age Factors↗
PubMed2003

Deformity and degeneration in the hindfoot and midfoot joints of the adult acquired flatfoot.

Adult acquired flatfoot is generally characterized by loss of the longitudinal arch, hindfoot valgus, and forefoot abduction, but the precise deformity has not been adequately described at the level of individual joints. Simulated weightbearing CT scans and plain radiographs of 37 symptomatic flat feet were examined in this study. The degree of arthritic degeneration was assessed in the major hindfoot and midfoot joints, and the location of deformity was studied along the medial column of the arch. Moderate to severe degeneration was seen in about one-third of talonavicular, subtalar, and calcaneocuboid joints. The medial column of the arch collapsed through the talonavicular joint in some feet, through the medial naviculocuneiform joint in others, but rarely through both. First tarsometatarsal joint subluxation was a frequent finding as well. In this small series, neither the degree of degenerative arthritis nor the amount of joint deformity was seen to correlate with patient age. Furthermore, no correlation was observed between foot deformity and joint degeneration.

Adolescent↗
PubMed2003

Fracture of the polyethylene component in an ankle arthroplasty: a case report.

A 57-year-old female underwent total ankle arthroplasty for post-traumatic arthrosis using the Agility Total Ankle System. The talar component was placed in varus malalignment. Her postoperative course was remarkable for 19 months of satisfactory function followed by the acute onset of intense pain and decreased range of motion. There was no history of trauma. After failing a short course of observation, revision surgery of the arthroplasty was performed. Operative findings revealed a complete fracture of the polyethylene. This report details the first case of such a complication and discusses the importance of component alignment in the prevention of polyethylene insert failure.

Acute Disease↗
PubMed2002

Ankle replacement: management of associated deformities.

Ankle arthroplasty is emerging as an alternative to arthrodesis. Restoring and maintaining proper bony alignment and muscle balance in the limb is essential if there is to be any chance for long-term survival. Deformity can arise above the ankle, in the joint itself, or in the foot. Secondary procedures in the foot and leg, including osteotomies, fusions and muscle balancing, are performed either before or simultaneously with ankle replacement.

Ankle Joint↗
PubMed2002

The effect on ankle dorsiflexion of gastrocnemius recession.

UNLABELLED: Gastrocnemius equinus contracture has been suggested as an etiologic factor in mechanical diseases of the foot and ankle and in ulcer formation in the foot. The purpose of this study is to assess the correction in ankle dorsiflexion that can be achieved with a gastrocnemius recession. An isolated gastrocnemius release (Strayer procedure) was performed on 26 legs, in 20 consecutive patients, for clinically significant gastrocnemius equinus contracture. Ankle dorsiflexion was assessed using a validated electrogoniometer. Ankle dorsiflexion was recorded with the knee straight and with the knee bent. Measurements were recorded preoperatively, and immediately postoperatively. Measurements at an average of 55.0 days postsurgery (range, 37 to 128 days) were performed on 20 legs (15 patients). RESULTS: Average preoperative ankle dorsiflexion with the knee straight was 5.1 degrees. Average preoperative ankle dorsiflexion with the knee bent was 22.8 degrees. Immediately following surgery the average ankle dorsiflexion with the knee straight was 23.2 degrees. The average correction was 18.1 degrees and this increase was significant (p < 0.0001.) In the 15 patients (20 legs) available for follow-up, the increase in ankle dorsiflexion with the knee straight was maintained (average: 24.9 degrees). Patients with gastrocnemius contracture who underwent an isolated gastrocnemius release increased their ankle dorsiflexion (knee straight) by an average of 18.1 degrees with postoperative ankle dorsiflexion (knee straight) being equivalent (23.2 and 22.8 degrees) to preoperative ankle dorsiflexion (knee bent). This correction appears to be maintained (23.2 vs. 24.9 degrees) at short-term follow-up.

Adult↗
PubMed2002

Isolated gastrocnemius tightness.

BACKGROUND: Contracture of the gastrocnemius-soleus complex has well-documented deleterious effects on lower-limb function in spastic or neurologically impaired individuals. There is scarce literature, however, on the existence of isolated gastrocnemius contracture or its impact in otherwise normal patients. We hypothesized that an inability to dorsiflex the ankle due to equinus contracture leads to increased pain in the forefoot and/or midfoot and therefore a population with such pain will have less maximum ankle dorsiflexion than controls. We further postulated that the difference would be present whether the knee was extended or flexed. METHODS: This investigation was a prospective comparison of maximal ankle dorsiflexion, as a proxy for gastrocnemius tension, in response to a load applied to the undersurface of the foot in two healthy age, weight, and sex-matched groups. The patient group comprised thirty-four consecutive patients with a diagnosis of metatarsalgia or related midfoot and/or forefoot symptoms. The control group consisted of thirty-four individuals without foot or ankle symptoms. The participants were clinically examined for gastrocnemius and soleus contracture and were subsequently assessed for tightness with use of a specially designed electrogoniometer. Measurements were made both with the knee extended (the gastrocnemius under tension) and with the knee flexed (the gastrocnemius relaxed). RESULTS: With the knee fully extended, the average maximal ankle dorsiflexion was 4.5 degrees in the patient group and 13.1 degrees in the control group (p < 0.001). With the knee flexed 90 degrees, the average was 17.9 degrees in the patient group and 22.3 degrees in the control population (p = 0.09). When gastrocnemius contracture was defined as dorsiflexion of < or = 5 degrees during knee extension, it was identified in 65% of the patients compared with 24% of the control population. However, when gastrocnemius contracture was defined as dorsiflexion of < or = 10 degrees, it was present in 88% and 44%, respectively. When gastrocnemius-soleus contracture was defined as dorsiflexion of < or = 10 degrees with the knee in 90 degrees of flexion, it was identified in 29% of the patient group and 15% of the control group. CONCLUSIONS: On the average, patients with forefoot and/or midfoot symptoms had less maximum ankle dorsiflexion with the knee extended than did a control population without foot or ankle symptoms. When the knee was flexed 90 degrees to relax the gastrocnemius, this difference was no longer present. CLINICAL RELEVANCE: These findings support the existence of isolated gastrocnemius contracture in the development of forefoot and/or midfoot pathology in otherwise healthy people. These data may have implications for preventative and therapeutic care of patients with chronic foot problems.

Adult↗
PubMed2002

Talocalcaneal and subfibular impingement in symptomatic flatfoot in adults.

BACKGROUND: Patients with symptomatic flatfoot deformity often present with pain in the lateral part of the hindfoot. The cause of this pain has not been clearly established. Impingement between the talus and the calcaneus or between the calcaneus and the fibula has been suggested as a cause but has not been documented. METHODS: We examined the computed tomographic scans, performed with simulated weight-bearing, of nineteen adult patients with symptomatic flatfoot to determine the potential causes of pain in the lateral aspect of the foot. The scans were performed with use of a custom loading frame designed to simulate weight-bearing with the foot in a neutral position while a 75-N axial compressive load was applied. Four examiners independently examined the coronal images as well as sagittal plane reconstructions for direct (bone-on-bone contact) and indirect (subchondral sclerosis or cysts) evidence of (1) extra-articular contact between the talus and the calcaneus in the sinus tarsi and (2) contact between the calcaneus and the fibula. The data were compared with those from five scans of normal feet in neutral alignment. RESULTS: Overall, the prevalence of sinus tarsi impingement was 92% and the prevalence of calcaneofibular impingement was 66% in the flatfoot group versus 0% and 5%, respectively, in the control group. The study patients who had calcaneofibular impingement also had sinus tarsi impingement. There was substantial agreement among the examiners as to whether impingement was present. CONCLUSIONS: There appear to be two frequently occurring extra-articular sources of bone impingement in the lateral aspect of the hindfoot in adults with symptomatic severe flatfoot deformity. The impingement in the lateral aspect of the hindfoot may first occur within the sinus tarsi and then involve the calcaneofibular region. Cyst formation and/or sclerosis in this region that is visible on plain radiographs or on computed tomographic scans performed without weight-bearing should create suspicion of impingement.

Adult↗