Foot and Ankle Clinics RSS feed: Current Issue. Foot and Ankle Clinics updates you on the latest trends in patient management; keeps you up to date on the newest advances; and provides a sound basis for choosing treatment options. Each issue focuses on a single topic in foot and ankle surgery and is presented under the direction of an experienced guest editor.http://www.foot.theclinics.com/?rss=yesElsevier Inc.en © 2009 Published by Elsevier Inc. All rights reserved. Foot and Ankle Clinics1083-7515144December 2009 © 2009 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.foot.theclinics.com/article/PIIS1083751509001004/abstract?rss=yesContents10.1016/S1083-7515(09)00100-4Foot and Ankle Clinics 14, 4 (2009)2009-12-01Foot and Ankle Clinics2009-12-01144S1083-7515(09)X0005-7vviiihttp://www.foot.theclinics.com/article/PIIS1083751509001016/abstract?rss=yesForthcoming Issues10.1016/S1083-7515(09)00101-6Foot and Ankle Clinics 14, 4 (2009)2009-12-01Foot and Ankle Clinics2009-12-01144S1083-7515(09)X0005-7ixixhttp://www.foot.theclinics.com/article/PIIS1083751509000886/abstract?rss=yes I am certain that the readers are all familiar with the eponymic origin of Achilles to describe the tendon we are so accustomed to treating. There are certainly eponymic uses of injuries, procedures, techniques, and tests, but there are no other anatomic parts of the lower limb that have such significance. Perhaps this is wrapped up in the mythology of the same, or the significance that we attach to this tendon (no pun intended). There are certain treatments of Achilles tendon pathology that I have not changed much in 25 years.ForewordMark S. Myerson10.1016/j.fcl.2009.08.009Foot and Ankle Clinics 14, 4 (2009)2009-12-01Foot and Ankle Clinics2009-12-01144S1083-7515(09)X0005-7xixiihttp://www.foot.theclinics.com/article/PIIS1083751509000898/abstract?rss=yes Despite the frequency with which they occur and the many articles written about them, disorders of the Achilles tendon continue to be the subject of controversy. Even the terminology to describe conditions affecting the Achilles tendon is controversial; tendinopathy, tendinosis, tendinitis, tenosynovitis, peritendinitis, and achillodynia, among others, have all been used. The etiology, pathogenesis, and natural history of Achilles disorders remain largely unknown, and there are no definitive criteria to differentiate acute from chronic conditions. Although most acute Achilles tendon injuries occur in athletes involved in sports that require repetitive impact loading, such as jumping or running, approximately 25% of patients with Achilles tendon injuries have no history of athletic involvement, resulting in a diverse patient group requiring individualized treatment considerations. Recommendations for a variety of operative and nonoperative treatment methods often are based on empiric evidence rather than scientific data, and new treatment protocols are continually being developed. There are few prospective, randomized, controlled trials available for a comparison of the different treatments. All of these factors make the treatment of Achilles tendon disorders, ranging from chronic overuse tendinopathy to acute tendon rupture, a challenging problem for orthopedists.PrefaceG. Andrew Murphy10.1016/j.fcl.2009.08.010Foot and Ankle Clinics 14, 4 (2009)2009-12-01Foot and Ankle Clinics2009-12-01144S1083-7515(09)X0005-7xiiixivhttp://www.foot.theclinics.com/article/PIIS1083751509000849/abstract?rss=yesThe complexity of its anatomy coupled with the biomechanics of the Achilles tendon may explain the frequency of injury to this structure. Its unique characteristic of the muscle crossing three joints (knee, ankle, and subtalar joints) makes it more susceptible to injury than muscles that span a single joint. A better understanding of the contributing pathologic conditions associated with functional shortening of the gastroc-soleus complex and its effects on the normal biomechanics of the foot and ankle may improve the treatment of the many and varied pathologies that occur within the tendon itself and the associated abnormalities that occur with a tight Achilles tendon.Anatomy and Biomechanical Aspects of the Gastrocsoleus ComplexJosé Carlos Cohen10.1016/j.fcl.2009.08.006Foot and Ankle Clinics 14, 4 (2009)2009-12-01Foot and Ankle Clinics2009-12-01144S1083-7515(09)X0005-7617626http://www.foot.theclinics.com/article/PIIS1083751509000801/abstract?rss=yesContracture of the gastrocnemius-soleus complex with equinus deformity is a common hindfoot condition. In children, it is frequently associated with neuromuscular conditions such as cerebral palsy. In the adult population, it is linked to numerous pathologies such as adult-acquired flatfoot, diabetic neuropathic ulcers, and plantar fasciitis. With the medial column reduced, failure to achieve 10° of passive ankle dorsiflexion with the knee flexed and extended suggests a contracture. This article reviews the anatomical and evolutionary basis for human foot structure, implications of tight gastrocnemius, and specific disease states. Operative releases for lengthening, including proximal gastrocnemius recession, tendo-Achilles lengthening, and endoscopic recession, are detailed.Achilles Lengthening ProceduresLan Chen, Justin Greisberg10.1016/j.fcl.2009.08.002Foot and Ankle Clinics 14, 4 (2009)2009-12-01Foot and Ankle Clinics2009-12-01144S1083-7515(09)X0005-7627637http://www.foot.theclinics.com/article/PIIS1083751509000837/abstract?rss=yesInsertional Achilles tendinopathy can be a painful debilitating condition that should initially be treated non-operatively. If pain becomes chronic and debilitating, despite appropriate conservative treatment, debridement of the diseased portion of the Achilles tendon and removal of the impinging calcaneal prominence and transfer of the flexor hallucis longus through a single incision can be a reliable pain relieving procedure with relatively high patient satisfaction.Insertional Achilles Tendinosis: Pathogenesis and TreatmentBryan D. Den Hartog10.1016/j.fcl.2009.08.005Foot and Ankle Clinics 14, 4 (2009)2009-12-01Foot and Ankle Clinics2009-12-01144S1083-7515(09)X0005-7639650http://www.foot.theclinics.com/article/PIIS1083751509000874/abstract?rss=yesNoninsertional Achilles tendinitis is a distinct clinical entity, frequently characterized by swelling, pain, and lower limb dysfunction. This condition can be frustrating to treat, for the patient and the physician alike, as reflected in the various treatments, both conservative and surgical, that have been described. Although many patients with Achilles tendinitis can be successfully treated with nonoperative methods, persistent symptoms require surgical treatment, such as tenotomy, debridement, or repair.Surgical Treatment of Non-Insertional Achilles TendinitisG. Andrew Murphy10.1016/j.fcl.2009.08.008Foot and Ankle Clinics 14, 4 (2009)2009-12-01Foot and Ankle Clinics2009-12-01144S1083-7515(09)X0005-7651661http://www.foot.theclinics.com/article/PIIS1083751509000746/abstract?rss=yesAchilles tendinopathy is a painful condition that occurs commonly in both active and inactive individuals. It seems that this condition is painful as a result of ingrowth of neural structures and neovessels leading to poor healing, rather than from inflammatory mediators. Traditional conservative measures are often successful. There is a subset of patients who fail to respond to these measures, however, and this has led to the investigation of newer conservative techniques. This article provides a review of many of the emerging techniques in the treatment of Achilles tendinopathy.Conservative Treatment of Achilles Tendinopathy: Emerging TechniquesJason E. Lake, Susan N. Ishikawa10.1016/j.fcl.2009.07.003Foot and Ankle Clinics 14, 4 (2009)2009-12-01Foot and Ankle Clinics2009-12-01144S1083-7515(09)X0005-7663674http://www.foot.theclinics.com/article/PIIS1083751509000825/abstract?rss=yesIncidence of Achilles tendon injury has increased as people continue to be active in their later years. Although acute rupture of the Achilles tendon is most commonly diagnosed using history and physical examination, improvements in magnetic resonance and ultrasound imaging have led to their routine use in evaluating these injuries. Non-operative versus operative management of acute Achilles tendon ruptures has been the subject of much controversy in the current literature, especially in light of non-operative treatment with functional bracing. This article highlights the current controversy and outlines the rationale for nonsurgical treatment of acute Achilles tendon ruptures.Non-Surgical Management of Achilles RupturesGiselle Tan, Brian Sabb, Anish R. Kadakia10.1016/j.fcl.2009.08.004Foot and Ankle Clinics 14, 4 (2009)2009-12-01Foot and Ankle Clinics2009-12-01144S1083-7515(09)X0005-7675684http://www.foot.theclinics.com/article/PIIS108375150900076X/abstract?rss=yesThis article reviews minimal incision techniques in the treatment of acutely ruptured Achilles tendon and the results that can be anticipated from these methods. However, lack of robust prospective randomized studies on the treatment of Achilles tendon rupture makes it impossible to draw conclusions on optimal treatment strategies. The bulk of the evidence available suggests that surgical repair reduces rerupture rates compared with non-operatively treated tendon ruptures. Surgery does have potential complications, but as outlined in the article, using a mini-open or percutaneous technique of repair might result in highly satisfactory outcomes with acceptably low complication rates.Minimal Incision Techniques for Acute Achilles RepairMark S. Davies, Matthew Solan10.1016/j.fcl.2009.07.006Foot and Ankle Clinics 14, 4 (2009)2009-12-01Foot and Ankle Clinics2009-12-01144S1083-7515(09)X0005-7685697http://www.foot.theclinics.com/article/PIIS1083751509000758/abstract?rss=yesAlthough the Achilles tendon is the strongest in the body, it also is the most often ruptured. Achilles tendon rupture most often occurs during sports activities in middle-aged men. Operative repair of a ruptured Achilles tendon can be accomplished with a variety of techniques, ranging from open repair, to minimally invasive technique, to endoscopic-assisted repair. This article focuses on open repair of acute Achilles tendon rupture. Surgical techniques, rehabilitation protocol, and the authors' preferred method are described.Open Repair of Acute Achilles Tendon RupturesSeth Rosenzweig, Frederick M. Azar10.1016/j.fcl.2009.07.002Foot and Ankle Clinics 14, 4 (2009)2009-12-01Foot and Ankle Clinics2009-12-01144S1083-7515(09)X0005-7699709http://www.foot.theclinics.com/article/PIIS1083751509000813/abstract?rss=yesChronic Achilles ruptures present a significant challenge for the treating physician. These patients often have marked impairment of functional activities and usually require surgical treatment to optimize outcome. This article reviews some of the methods that have been described to treat the chronic or neglected Achilles tendon rupture. The methods that have been used include gastrocnemius advancement, fascial turndown flaps, local tendon transfers, free tissue transfer, and use of synthetic grafts. There are no comparative data to guide evidence-based decision making in regard to choosing between treatment options.Chronic Achilles Tendon RupturesThomas G. Padanilam10.1016/j.fcl.2009.08.001Foot and Ankle Clinics 14, 4 (2009)2009-12-01Foot and Ankle Clinics2009-12-01144S1083-7515(09)X0005-7711728http://www.foot.theclinics.com/article/PIIS1083751509000850/abstract?rss=yesTendon transfers are commonly used in the foot and ankle to restore function in neglected ruptures, reconstruct degenerated tendons, and correct deformity. The Achilles tendon is commonly afflicted by these problems because of the dominant role it plays in the mechanics of gait and running and its inherently poor blood supply. This article discusses the general principles of tendon transfers with regard to Achilles tendon function, the surgical techniques involved, and published results using these techniques. The goal is to provide the orthopedic foot and ankle surgeon with a wide variety of techniques to solve both the straightforward Achilles tendon problem as well as the difficult revision case.Tendon Transfers for Achilles ReconstructionJohnny L. Lin10.1016/j.fcl.2009.08.007Foot and Ankle Clinics 14, 4 (2009)2009-12-01Foot and Ankle Clinics2009-12-01144S1083-7515(09)X0005-7729744http://www.foot.theclinics.com/article/PIIS1083751509000783/abstract?rss=yesSince the first reports in the medical literature of treatment of the Achilles tendon, complications have been recognized from both non-operative and operative techniques. These include tendon rerupture, sural nerve morbidity, wound healing problems, changes in tendon morphology, venous thromboembolism, elongation of the tendon, complex regional pain syndrome, and compartment syndrome. This article delineates the incidence for each of these complications, with differing techniques, methods of avoiding these complications and treatment methods if they occur.Complications of the Treatment of Achilles Tendon RupturesAndy Molloy, Edward V. Wood10.1016/j.fcl.2009.07.004Foot and Ankle Clinics 14, 4 (2009)2009-12-01Foot and Ankle Clinics2009-12-01144S1083-7515(09)X0005-7745759http://www.foot.theclinics.com/article/PIIS1083751509000771/abstract?rss=yesAcute injuries of the Achilles tendon are common among athletes and non-athletes alike. Injuries of other posterior calf muscles are far less common but should be considered in the differential, to ensure proper diagnosis and treatment of patients with calf injuries. This article focuses on these calf injuries, including injuries of the gastrocnemius, plantaris, soleus, and flexor hallucis longus, which may occasionally be mistaken for Achilles tendon disorders.Posterior Calf InjuryJohn T. Campbell10.1016/j.fcl.2009.07.005Foot and Ankle Clinics 14, 4 (2009)2009-12-01Foot and Ankle Clinics2009-12-01144S1083-7515(09)X0005-7761771http://www.foot.theclinics.com/article/PIIS1083751509000795/abstract?rss=yesThe operative management of acute Achilles tendon rupture marks the beginning of a comprehensive rehabilitation program. The goals of the rehabilitation program start with the reduction of pain and swelling and the recovery of ankle motion and power. They conclude with the restoration of coordinated activity and safe return to athletic activity. The rehabilitation protocol is directed by the injury and the quality of the repair, along with the patient's age, medical and social history, and athletic inclination. The protocol is dynamic and responsive to changing clinical findings.Achilles Tendon RehabilitationAdam C. Strom, Mark M. Casillas10.1016/j.fcl.2009.08.003Foot and Ankle Clinics 14, 4 (2009)2009-12-01Foot and Ankle Clinics2009-12-01144S1083-7515(09)X0005-7773782http://www.foot.theclinics.com/article/PIIS1083751509000904/abstract?rss=yesIndex10.1016/S1083-7515(09)00090-4Foot and Ankle Clinics 14, 4 (2009)2009-12-01Foot and Ankle Clinics2009-12-01144S1083-7515(09)X0005-7783804