Despite the lack of evidence-based standard guidelines to select the best surgical treatment option for end-stage ankle osteoarthritis, the rate of total ankle arthroplasty (TAA) is increasing rapidly relative to ankle arthrodesis (AA) with the development of implant designs and surgical techniques. Physicians and patients would benefit from a more comprehensive understanding of the differences in postoperative pain relief, functional improvement, the rates of complication or reoperation, and restoration of gait ability and sports activity. This paper overviews the current consensus on indications and contraindications for TAA and provides a literature review on a comparison of the clinical and functional results between TAA and AA.

Although total ankle arthroplasty (TAA) has increased considerably in the past ten years, reflecting improvements in implant design and survivorship, the clinical outcomes have been less satisfactory than total hip or total knee arthroplasties. Several issues under debate include postoperative management and rehabilitation in TAA. Especially, there is no consensus or evidence for the most appropriate postoperative management and rehabilitation for patients undergoing TAA. This study was therefore undertaken to suggest appropriate postoperative management and rehabilitation in TAA, after reviewing published articles and focusing on the following topics: prehabilitation, hospital stay, immobilization type and duration, weight-bearing management, pharmacological treatment, and adopted rehabilitation protocols. In previous studies, the postoperative management and rehabilitation proposed depended on the surgeon's preference, the patient's characteristics, and the associated surgical procedures performed after TAA. Nonetheless, our research indicates the best approach is to include a prehabilitation program, immobilization in the early postoperative stage (2~4 weeks), range of motion exercise with partial weight-bearing ambulation, followed by full weight-bearing ambulation after six weeks. Further studies are required to develop a standardized rehabilitation protocol and improve the overall quality of care after TAA.

Purpose: To evaluate the correlation between the fibrillar pattern of the Achilles tendon on ultrasonography (US) and functional outcomes in patients who underwent open tendon repair after Achilles tendon rupture. Materials and Methods: Data of 44 patients who had been subjected to US at least 6 months after repair, during the period between July 2012 and July 2019 were reviewed. Those with bilateral tendon rupture, re-rupture, open injury, and chronic or insertional rupture, were excluded from the review. We divided them into two groups, the homogenous group (HoP) and the heterogenous group (HeP) based on the fibrillar pattern on US. We also divided the HoP into linear and wavy subgroups, and the HeP into no hypoechoic lesion and hypoechoic lesion subgroups. The rupture type of the Achilles tendon, radiographic factors including US and magnetic resonance images, patient-related, surgical factors, and clinical results at the last visit after repair were assessed retrospectively. Results: The tendon thickness was 11.4±1.7 mm in the HoP, and 14.5±3.0 mm in the HeP (p<0.001). A shredded pattern was observed in 17 cases (65.4%) in the HoP, and in 17 cases (94.4%) in the HeP (p=0.031). The mean value of the number of sutures used was 8.9±3.05 in the HoP and 11.39±1.75 in the HeP (p=0.001). The mean value of the difference in calf circumference was 0.9±0.67 cm in the HoP and 1.36±0.71 cm in the HeP (p=0.037). There were no statistically significant differences in the fibrillar patterns and patient-related factors. Conclusion: The fibrillar pattern observed after repair was correlated with the functional outcome and showed a significant relationship with the rupture pattern and the number of sutures used. Therefore, we suggest a careful individualized postoperative rehabilitation protocol to maximize functional outcomes by referring to the fibrillar pattern in US, especially in shredded ruptures.

Purpose: Smart insoles are wearable devices that are inserted into shoes. Smart insoles with built-in pressure and acceleration sensors can measure the plantar pressure, stride length, and walking speed. This study evaluated the validity and reliability of the plantar pressure measurements of smart insoles during walking on flat ground. Materials and Methods: Twenty one subjects were included in this study. After wearing smart insoles, I-SOL^® (Gilon, Seongnam, Korea), the subjects walked a 10 m corridor six times at a rate of 100 steps/min, and the middle three steps, free from direction changes, were chosen for data analysis. The same protocol was repeated after wearing Pedar-X (Novel Corporation, Munich, Germany), an insoletype plantar pressure measurement equipment with proven validity. The average maximum pressure (P_peak, kPa) and the time at which P_peak appeared (P_time, %stride) were calculated for each device. The validity of smart insoles was evaluated by using the interclass correlation coefficient (ICC) of P_peak and P_time between the two instruments, and Cronbach's alpha was obtained from the P_peak values to evaluate the reliability. Results: The ICC of P_peak was 0.651 (good) in the hallux, 0.744 (good) in the medial forefoot, 0.839 (excellent) in the lateral forefoot, and 0.854 (excellent) in the hindfoot. The ICC of P_time showed 0.868 (excellent) in the hallux, 0.892 (excellent) in the medial forefoot, 0.721 (good) in the lateral forefoot, and 0.832 (excellent) in the hindfoot. All ICC values showed good or excellent results. The Cronbach's alpha of P_peak measured in the smart insoles was 0.990 in the hallux, 0.961 in the medial forefoot, 0.973 in the lateral forefoot, and 0.995 in the hindfoot; all indicated excellent reliability in all areas. Conclusion: The plantar pressure measurements of smart insoles during walking on a flat ground showed validity compared to Pedar-X, and high reliability after repeated measurements.

Lateral compartment syndrome of the lower leg is rarely observed. Hence, there may be difficulty in diagnosis as its clinical patterns are different and more complicated than usual. We report two rare cases of a 20-year-old and a 28-year-old diagnosed with isolated lateral compartment syndrome who had either a surgical or conservative treatment. The comparison was done by analyzing the progression of neurological manifestation, electromyography, and nerve conduction study for two years. In the final follow-up, the patient who underwent the surgical treatment showed a shorter recovery time. However, both patients showed a full recovery from neurologic deficits.

Past research has reported that the common causes of ankle arthritis include trauma, congenital deformity, and degeneration. Among them, fracture-induced post-traumatic arthritis is most common. For patients with ankle fractures, an anatomical reduction is performed through surgical treatment. However, insufficient reduction or malunion of the fracture site may change the alignment of the ankle joint, resulting in valgus or varus deformities. Currently, most operative options for valgus arthritis aim to either restore joint alignment and/or reduce the uneven load on the cartilage. In this report, we would like to share our clinical experience of a patient with posttraumatic valgus ankle arthritis caused by severely comminuted fracture and dislocation. A satisfactory outcome could be obtained with combined fibular lengthening osteotomy and medial displacement calcaneal osteotomy.

Myiasis is the parasitic infestation of the body of a live animal by fly larvae that grow inside the host while feeding on its tissue. Necrotic tissue is a favorable environment for larvae to thrive, which can be seen easily in patients with a diabetic foot. Myiasis in a diabetic foot is rare but is constantly being reported. The common larvae genera causing myiasis are Calliphoridae, Sarcophagidae, and Muscidae. This paper reports a rare case of sarcophaga myiasis in a diabetic foot. To the best of the author's knowledge, this is the first case report in Korea regarding human myiasis with the sarcophaga genus.