OKOJ, Volume 7, No. 2

Midfoot and Tarsometatarsal Arthritis

Midfoot arthritis can be the result of several problems, including trauma, inflammatory disease, neuropathic arthropathy, and primary (idiopathic) arthritis. The most common presenting complaint in patients with midfoot arthritis is pain along the dorsum of the foot with weight bearing. Patients with midfoot arthritis may also report pain from constrictive shoe wear secondary to osteophyte formation along the dorsum of the foot. Deformity associated with midfoot arthritis can lead to a significant amount of pain independent of the arthritic symptoms. Initial treatment should consist of nonsurgical measures focused at controlling the pain and deformity. If appropriate treatment fails after 6 months, consideration must be given to surgical intervention. The gold standard for surgical treatment of midfoot arthritis is arthrodesis. Interpositional tendon arthroplasty of the fourth and fifth tarsometatarsal joints may be an acceptable motion-sparing alternative to arthrodesis in patients with lateral column arthritis.

    • Keywords:
    • Lisfranc joint injury

    • midfoot injury

    • tarsometatarsal injury

    • midfoot arthrodesis

    • tarsometatarsal joint arthrodesis

    • rheumatoid arthritis

    • Subspecialty:
    • Foot and Ankle

Recognition and Treatment of Leg Pain in Athletes

Leg pain is a common complaint among athletes in running and jumping sports, and can be a significant, even career-ending, disability. Clinical conditions considered in the differential diagnosis of leg pain in an athlete include medial tibial stress syndrome, stress fracture, chronic exertional compartment syndrome, and popliteal artery entrapment syndrome. Although the sources of leg pain in the athlete are varied, a thorough history and physical examination can help define contributing factors, of which duration, location, and intensity of the pain and its pattern with respect to activity level are most important. Additional testing depends on the differential diagnosis, but includes radiography in most patients and selected use of other imaging modalities. Treatment for most conditions is conservative and involves rest or a change in training regimen.

    • Keywords:
    • overuse injury

    • compartment syndrome

    • CS

    • chronic exertional compartment syndrome

    • chronic exertional CS

    • exertional CS

    • medial tibial stress syndrome

    • stress fracture

    • fatigue fracture

    • insufficiency fracture

    • tibial stress fracture

    • popliteal artery entrapment syndrome

    • shin splints

    • intracompartmental pressure

    • fasciotomy

    • Subspecialty:
    • Sports Medicine

Posterior Wall Acetabular Fractures: Diagnosis, Treatment, and Results

Fractures of the posterior wall of the acetabulum are the most common type of acetabular fracture, accounting for approximately 25% of all acetabular fractures. The simple appearance of the posterior wall fracture on plain radiographs underestimates its potential complexity. Rather than having one simple fracture fragment, most posterior wall fractures are comminuted or have areas where the articular surface along the margin of the primary fracture line is impacted into the underlying cancellous bone. In general, posterior wall fractures are amenable to nonsurgical treatment if the remaining, intact part of the acetabulum is large enough to maintain hip joint stability and congruity; however, this situation is often difficult to determine. Clinical outcome has been shown to be directly related to the accuracy of reduction, but accurate repositioning of all of the small posterior wall fragments is frequently a challenging task. This article reviews the etiology, clinical presentation, and the technique and results of open reduction and internal fixation of posterior wall fractures of the acetabulum.

    • Keywords:
    • acetabulum trauma

    • acetabular trauma

    • intra-articular hip fracture

    • broken hip

    • dislocated hip

    • posterior fracture dislocation of the hip joint

    • acetabular posterior wall fracture

    • Subspecialty:
    • Trauma