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Diagnosis and Operation Results for Chronic Lateral Ankle Instability with Subtle Cavovarus Deformity and a Peek-A-Boo Heel Sign

 Dong Woo Shim  ;  Jae Wan Suh  ;  Kwang Hwan Park  ;  Jin Woo Lee  ;  Junwoo Byun  ;  Seung Hwan Han 
 YONSEI MEDICAL JOURNAL, Vol.61(7) : 635-639, 2020-07 
Journal Title
Issue Date
Adult ; Ankle / diagnostic imaging ; Ankle / physiopathology ; Ankle Joint / diagnostic imaging ; Ankle Joint / surgery* ; Female ; Foot ; Heel / diagnostic imaging ; Heel / physiopathology ; Humans ; Joint Instability / diagnosis ; Joint Instability / diagnostic imaging ; Joint Instability / surgery* ; Male ; Metatarsal Bones ; Metatarsus / diagnostic imaging ; Metatarsus / surgery ; Middle Aged ; Osteotomy / methods* ; Radiography ; Reconstructive Surgical Procedures ; Recovery of Function ; Talipes Cavus / diagnostic imaging ; Talipes Cavus / surgery ; Treatment Outcome ; Visual Analog Scale
Ankle ; foot deformities ; joint instability ; osteotomy ; reconstructive surgical procedures
Cavovarus deformity is considered an anatomical risk factor for chronic lateral ankle instability (CLAI). However, subtle deformity can be difficult to detect, and its correction is controversial. The current study aimed to evaluate clinical and radiographic outcomes of a modified Broström procedure (MBP) with additional procedures for CLAI with subtle cavovarus deformity and a positive peek-a-boo heel sign. We reviewed the records of 15 patients who underwent MBP with additional procedures for CLAI with a positive peek-a-boo heel sign between August 2009 and April 2015. Consecutive physical and radiographic examinations were performed. The visual analog scale (VAS) for pain, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and the Karlsson-Peterson (KP) ankle score were applied to assess clinical outcomes. Weight bearing radiographs, hindfoot alignment view, and ankle stress radiographs were also examined. The mean follow-up period was 58.5 months. Calcaneal lateral closing wedge osteotomy was performed in seven patients to correct fixed hindfoot varus, and first metatarsal dorsiflexion osteotomy was performed in 11 patients to correct plantarflexion of the first ray. Three patients underwent both procedures. Mean VAS, AOFAS, and KP ankle scores improved significantly (p=0.001), and instability did not recur. Radiographically, all stress parameters improved significantly (p=0.007). Simultaneous correction of a positive peek-a-boo heel sign and cavovarus deformity with MBP for CLAI improves clinical outcomes and prevents recurrent instability. A comprehensive evaluation and cautious approach for subtle cavovarus deformity should be followed when treating patients with CLAI. This trial is registered on Clinical Research Information Service (CRiS, KCT0003287).
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1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Park, Kwang Hwan(박광환) ORCID logo https://orcid.org/0000-0002-2110-0559
Lee, Jin Woo(이진우) ORCID logo https://orcid.org/0000-0002-0293-9017
Han, Seung Hwan(한승환) ORCID logo https://orcid.org/0000-0002-7975-6067
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