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      Clinical Rating Systems for the Ankle-Hindfoot, Midfoot, Hallux, and Lesser Toes

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          Abstract

          Four rating systems were developed by the American Orthopaedic Foot and Ankle Society to provide a standard method of reporting clinical status of the ankle and foot. The systems incorporate both subjective and objective factors into numerical scales to describe function, alignment, and pain.

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          Most cited references 10

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          Ankle arthrodesis. Long-term follow-up with gait analysis.

          A functional assessment of twelve patients after ankle arthrodesis for post-traumatic arthritis was carried out by means of an extensive clinical evaluation and gait analysis after an average follow-up of eight years. A weighted point system was developed to grade ankle function clinically. The data on gait analysis were examined to determine the effect of arthrodesis of the ankle on the over-all pattern of walking. Under conditions of normal daily living while wearing shoes, all patients functioned well after arthrodesis. The gait-analysis data obtained with the patients wearing shoes showed excellent gait characteristics, and the ankle motion that had been lost was compensated for by: (1) motion of the small joints of the ipsilateral foot; (2) altered motion of the ankle in the contralateral limb; and (3) appropriate footwear. While the patients were walking barefooted, some adverse effects of fusion of the ankle were evident. Velocity of gait was slowed and the length of stride was shortened in all twelve patients. One patient whose ankle had been fused in an equinus position had a back-knee deformity during stance phase, and another walked only on his toes when he was without shoes. The gait patterns of all patients were markedly improved when they were wearing shoes with appropriate heel heights.
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            Plantar fasciotomy for intractable plantar fasciitis: clinical results and biomechanical evaluation.

            Thirteen consecutive patients underwent plantar fasciotomy in 16 feet for intractable plantar fasciitis and had follow-up from 4.5 to 15 years. Plantar fasciotomy was successful (good or excellent results) for 71% of the 14 feet operated on and for which follow-up data were available. However, time to full recovery was prolonged, additional treatment was frequently required, and abnormalities of foot function persisted. Flattening of the longitudinal arch occurred. Dynamic force-plate studies showed differences in peak vertical, fore-aft, and lateral-medial forces between patients and matched controls. More rapid progression of weightbearing along the longitudinal axis of the foot during stance phase in patients indicated avoidance of heel loading.
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              Revision of ankle arthrodesis with external fixation for non-union.

              We evaluated the cases of twenty-six patients (twenty-six ankles) who had had revision of an ankle arthrodesis with external fixation for a nonunion, to determine the reasons for the failure of the previous arthrodesis. Eighteen patients had had supplemental bone-grafting in addition to the external fixation. The failure of the previous arthrodesis was related to inadequate fixation technique in seven patients and to technical problems in two patients; in the other seventeen patients at least one risk factor was identified. We also determined the functional results of the revision operation with external fixation for all patients. The average duration of follow-up was five years (range, two to ten years) in the twenty-two patients who did not have a reoperation for a persistent nonunion. The results were excellent in eleven patients, good in five, fair in four, and poor in six. The over-all rate of union was twenty (77 per cent) of twenty-six, comparable with that after primary arthrodesis; however, supplemental bone-grafting is usually necessary. In the current series, rigid fixation, precise apposition of bone and alignment of the foot, and early treatment of perioperative infection gave satisfactory results.
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                Author and article information

                Journal
                Foot & Ankle International
                Foot Ankle Int.
                SAGE Publications
                1071-1007
                1944-7876
                July 1994
                July 1994
                July 1994
                July 1994
                : 15
                : 7
                : 349-353
                Affiliations
                [1 ]Department of Orthopedics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota.
                [2 ]Crystal Clinic, Akron, Ohio.
                [3 ]Private practice, Orthopaedic Surgery, Richmond, Virginia.
                [4 ]Duke University Medical Center, Durham, North Carolina.
                [5 ]Private practice, Baltimore, Maryland.
                [6 ]Private practice, Indianapolis, Indiana.
                Article
                10.1177/107110079401500701
                7951968
                © 1994

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