We know that orthotic arch supports do not change the shape of the foot in either the growing or mature foot, but these have a role in management of symptoms. It is not understood however what the relationship is between the various types of arch supports and their impact on the radiographic changes to indicate changes in the configuration of the foot in the child and adult. We propose to use Weight Bearing CT (WBCT) to investigate the effect of orthotic arch support on the arch of the foot.
Subtalar arthritis is a common complication following arthrodesis of the ankle, but there is little increase in the incidence of arthritis following total ankle replacement. Radiographs have been used to attempt to classify subtalar arthritis extrapolating the Kellgren Lawrence scale for the knee weight to the subtalar joint but do not sufficiently indicate the load on the subtalar joint. We propose to use WBCT to evaluate the subtalar joint following ankle arthrodesis and total ankle replacement in a retrospective and prospective manner to accurately define changes in the subtalar joint.
The relationship between hallux rigidus, the plantar fascia and the gastrocnemius is not understood, although it is thought that many patients with this very common clinical problem have limited range of motion of the big toe, a tight plantar fascia as well as a contracted gastrocnemius muscle. We propose that these clinical correlates are causative and patients with hallux rigidus have not been ideally treated due to a lack of understanding of its etiology. We propose that patients with low grade hallux rigidus will have a positive plantar fascia tightness test, a positive Silversköld test, an elevated 1st metatarsal and a positive Jack test indicating limited range of motion of the hallux.
Post -traumatic arthritis has been associated with poorer outcomes than those of osteoarthritis in total ankle replacement, and stiffness is a more common feature of post-traumatic arthritis than osteoarthritis. Fibroblasts isolated from joints undergoing replacement which were associated with fibrosis express the IL-1 receptor and on exposure to IL-1α polarize to a highly inflammatory state that enables them to stimulate the recruitment of monocytes. We propose that the expression of the fibroblast is different in post-traumatic arthritis than those ankles with other etiologies and we aim to prospectively investigate patients with post-traumatic and other etiologies for ankle arthritis who are undergoing either arthrodesis or replacement. The cellular function of all ankles will be evaluated with the following cell markers: stromal cells such as fibroblasts, matrix metalloproteinases (MMPs) and cathepsins, and receptor activator of nuclear factor β (RANKL).
Metatarsalgia is a very common clinical problem and when it does not respond to shoe modifications, surgery with osteotomy is required. The incidence of complications of this osteotomy including floating toe, metatarsalgia, and persistent instability are however significant. In previously published studies on metatarsalgia and the lesser metatarsophalangeal joint Trnka, Myerson et al (Foot Ankle Int 22:47-50, 2001) and Bhatia, Myerson et al.( J Bone Joint Surg. 1994), the effect of an oblique metatarsal osteotomy (Weil) was evaluated. We hypothesize that in a cadaveric model, compared with an oblique osteotomy, the changes to the center of rotation of the metatarsal head will not occur with a shortening parallel diaphyseal osteotomy thereby decreasing the potential for complications following surgery.