February 2014

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Online Poll: Half Of DPMs Choose Austin As Their Most Common Bunionectomy Procedure

By Brian McCurdy, Senior Editor

When performing a bunionectomy, surgeons have a variety of techniques at their disposal. A Podiatry Today online poll reveals that half of the respondents use the Austin procedure as their most common bunionectomy procedure.

   Fifty percent of the 225 respondents voted for the Austin procedure as this issue went to press. Fourteen percent chose the Austin/Akin, 10 percent chose the distal metaphyseal osteotomy of the first metatarsal, 10 percent perform the Lapidus, 5 percent chose the base wedge osteotomy, 5 percent voted for the scarf and 4 percent perform the Reverdin procedure.

   Why is the Austin bunionectomy a popular choice? John Grady, DPM, cites the technique’s versatility in that one can use it to correct the proximal articular set angle (PASA), variable intermetatarsal angles, elevation/plantarflexion issues, and shorten or slightly lengthen metatarsals. He also notes surgeons can easily fixate Austin bunionectomies with screws or K-wires, and they have relatively few complications.

   “These results don’t surprise me that much,” says Christopher Hyer, DPM. “The Austin or chevron osteotomy has been very popular for decades. It is highly versatile and intrinsically stable.” He does note incidental reports of first metatarsal head avascular necrosis after the Austin, suggesting surgeons take care not to compromise the blood flow.

   Dr. Hyer, a Fellow and member of the Board of Directors of the American College of Foot and Ankle Surgeons, expresses some surprise that so many podiatrists are still performing base wedge procedures. He calls those procedures unstable, difficult to perform and says they have high complication rates.

   A scarf bunionectomy is the go-to choice for Dr. Grady, a Fellow of the American Society of Podiatric Surgeons and the Director of The Foot and Ankle Institute of Illinois.

   Dr. Hyer’s favorite bunion procedure is a Lapidus first tarsometatarsal joint fusion with a possible Akin osteotomy.

   “It is powerful, reproducible and can correct severe deformity when needed,” says Dr. Hyer, the Fellowship Director and an attending physician at the Orthopedic Foot and Ankle Center in Westerville, Ohio.

Does Running In Minimalist Shoes Increase Injury Risk?

By Brian McCurdy, Senior Editor

A recent study in the British Journal of Sports Medicine maintains that running in minimalist footwear appears to increase the chance of injury.

   Researchers focused on 99 runners with neutral or mild pronation, randomly assigning them to wear a neutral shoe (Nike Pegasus 28), a partial minimalist shoe (Nike Free 3.0 V2) or a full minimalist shoe (Vibram 5-Finger Bikila). Researchers employed baseline testing to record training and injury history as well as selected anthropometric measurements before the runners started a 12-week training program to prepare for a 10 km event, according to the study.

   The study notes there were a total of 23 injuries with four injuries in runners with neutral shoes and 12 injuries in runners with partial minimalist shoes. The authors say those who wore partial minimalist shoes reported a significantly higher rate of injury incidence throughout the 12-week period while runners in the full minimalist shoe group reported more shin and calf pain. The authors suggested caution when recommending minimalist footwear to runners who are new to barefoot running and preparing for a 10 km event.

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