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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n\u003Cp id=\u0022p-1\u0022\u003EAs part of Specialty Day sponsored by the American Orthopaedic Foot \u0026amp; Ankle Society, 4 speakers reviewed contemporary issues in foot and ankle surgery. The topics included sesamoid excision in athletes, os trigonum syndrome in dancers, 2 types of neuroma surgery, and the effect of different surgical tools on heat production.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Esesamoids\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Esesamoidectomy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eos trigonum\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eathletes\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Edancers\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eneuroma\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Edrills\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eheat production\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Efoot \u0026amp; ankle conditions\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eorthopedic procedures\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n\n\u003Cp id=\u0022p-2\u0022\u003EIn collaboration with the American Orthopaedic Foot \u0026amp; Ankle Society, 4 presenters reviewed new data related to various aspects of foot and ankle surgery. The first 2 sessions focused on injuries sustained by athletes and dancers.\u003C\/p\u003E\n\u003Cp id=\u0022p-3\u0022\u003ESesamoiditis is a common overuse injury among athletes and dancers that is characterized by chronic inflammation of the sesamoid bones, which help elevate the bones of the great toe. Sesamoidectomy of the first metatarsophalangeal joint in athletically active patients may be indicated when nonsurgical care has failed. However, bilateral sesamoid excision can lead to alteration of joint mechanics or a cock-up deformity of the hallux [Cohen BE. \u003Cem\u003EFoot Ankle Clin.\u003C\/em\u003E 2009].\u003C\/p\u003E\n\u003Cp id=\u0022p-4\u0022\u003EJ. Chris Coetzee, MD, Twin Cities Orthopedics, Edina, Minnesota, USA, pointed out that elite athletes with sesamoiditis\u2014including dancers\u2014can successfully return to ballet following excision of either the medial or tibial sesamoid bones [Bichara DA et al. \u003Cem\u003EFoot Ankle Int.\u003C\/em\u003E 2012] and a short structured rehabilitation program. Dr Coetzee then discussed original findings from a retrospective review of 106 athletes in his practice who were dissatisfied with nonsurgical care and who subsequently underwent medial (n\u2005=\u200584), lateral (n\u2005=\u200522), or bilateral (n\u2005=\u20055) sesamoid excisions from 2006 to 2013 with a mean follow-up of 31 months. The mean age of the patients was 44 years, and 72% were women.\u003C\/p\u003E\n\u003Cp id=\u0022p-5\u0022\u003EAll patients were referred to physical therapy to complete a structured program of rehabilitation goals starting at 1 to 2 weeks postsurgery. Surgical complications included chronic pain and instability (n\u2005=\u20051) and symptomatic hallux valgus requiring surgical repair (n\u2005=\u20052). Seven patients were lost to follow-up.\u003C\/p\u003E\n\u003Cp id=\u0022p-6\u0022\u003EPreoperatively to 24 months, there was a significant improvement in the revised Foot Function Index (FFI-R); no significant change was noted from year 1 to year 2. At 2 years, \u0026gt;\u200585% of patients expressed satisfaction with their results, and 86% were able to return to their prior levels of sporting activity. Among these, 25% still reported pain in the metatarsophalangeal joint complex.\u003C\/p\u003E\n\u003Cp id=\u0022p-7\u0022\u003EBrad R. Moser, MD, Twin Cities Orthopedics, Edina, Minnesota, USA, then spoke about posterior ankle impingement syndrome secondary to os trigonum syndrome, another common injury in dancers. Typically, the dancer will complain of discomfort during movements that require plantar flexion, such as the relev\u00e9 or en pointe position. For these patients, open excision of the os trigonum may provide pain relief and a return to activity [Guo QW et al. \u003Cem\u003EArthroscopy\u003C\/em\u003E. 2010].\u003C\/p\u003E\n\u003Cp id=\u0022p-8\u0022\u003EDr Moser reviewed original outcomes data for 40 young dancers (35 women, 5 men) who underwent the procedure beginning in June 2006 and who were followed through January 2015. Mean age was 18.5 years, and mean follow-up time was 20.6 months. All patients also underwent specialized treatment with a team of dance physical therapists. The functional outcomes are presented in \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E.\u003C\/p\u003E\n\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16270\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16270\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16270\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \u003Cp id=\u0022p-9\u0022 class=\u0022first-child\u0022\u003EFunctional Outcomes Following Open Excision of the Os Trigonum\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003Cp id=\u0022p-10\u0022\u003EThree dancers suffered transient damage to the sural nerve, and 1 developed complex regional pain syndrome that lasted for \u0026gt;\u20051 year. Only 2 patients did not return to their prior activity levels, although this was deemed unrelated to the procedure. Overall, the dancers were very satisfied with the results. Dr Moser emphasized that this procedure, when used alongside physical therapy, offers a low-risk, high-satisfaction option to young dancers who wish to return to their previous levels of activity.\u003C\/p\u003E\n\u003Cp id=\u0022p-11\u0022\u003EThe next presenter then turned to a surgical procedure for an injury more likely to occur among the general population\u2014interdigital neuroma. If conservative treatment produces no relief, the standard surgical procedure is a simple neurectomy. However, some data suggest that neurectomy with intramuscular implantation of the proximal nerve stump also offers pain improvement [Adams S et al. \u003Cem\u003EFoot Ankle Clin.\u003C\/em\u003E 2011].\u003C\/p\u003E\n\u003Cp id=\u0022p-12\u0022\u003EChamnanni Rungprai, MD, University of Iowa, Iowa City, Iowa, USA, reviewed original data from a chart review comparing outcomes among patients with interdigital neuroma who underwent either simple neurectomy or neurectomy with intramuscular implantation.\u003C\/p\u003E\n\u003Cp id=\u0022p-13\u0022\u003EThe chart review included 102 consecutive patients with 125 neuromas who had undergone surgery between 2000 and 2013 (\u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E). The same group of surgeons performed all of the procedures, and outcomes were evaluated using the FFI, the SF-36 Health Survey Update (SF-36), and the visual analog scale (VAS).\u003C\/p\u003E\n\u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16271\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16271\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16271\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \u003Cp id=\u0022p-14\u0022 class=\u0022first-child\u0022\u003EStudy Demographics\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003Cp id=\u0022p-15\u0022\u003EBoth surgical procedures produced significant improvements in the FFI, the SF-36, and the VAS from baseline (\u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.005, all). As expected, operating time was significantly longer in the implantation group (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.001). Limitations of the study included its retrospective study design and the fact that approximately 50% of patients were lost to follow-up.\u003C\/p\u003E\n\u003Cp id=\u0022p-16\u0022\u003EDr Rungprai emphasized that, to his knowledge, this was the largest comparative study to date comparing outcomes between the 2 different procedures using validated outcome measures.\u003C\/p\u003E\n\u003Cp id=\u0022p-17\u0022\u003EThe fourth paper of the session provided information regarding bone drilling, which is relevant to every surgical procedure. All surgical instruments provide heat, which can induce osteonecrosis at a threshold of 70\u00b0C. Andrew Palmisano, MD, University of Michigan Health System, Ann Arbor, Michigan, USA, reviewed the results of a study comparing the amount of heat produced by twist drills, Kirschner (K) wires, and cannulated drills of different sizes [Palmisano A et al. \u003Cem\u003EJ Orthop Trauma\u003C\/em\u003E. 2014].\u003C\/p\u003E\n\u003Cp id=\u0022p-18\u0022\u003EDr Palmisano explained that each piece of drilling equipment was driven into warmed human cadaveric tibia by a battery-powered hand drill, secured to provide a constant advancing speed (1 mm\/s) during drilling. Two thermocouples were placed 0.5 and 1.5 mm from the drill hole margin and 2 mm deep to the surface. Eight tests were performed for each tool.\u003C\/p\u003E\n\u003Cp id=\u0022p-19\u0022\u003EHeat production decreased as the diameter of the K wire increased. Conversely, heat production increased as the twist drill diameter increased. When all 3 tools were compared, the twist drill provided the least amount of heat; the cannulated twist drill produced the most. Differences in K wire size did not have much effect on heat production, suggesting that surgeons can be comfortable using whatever-size K wire will produce the stiffest construct.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/7\/23.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlqbq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzlqbq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}