Publications

  1. Foot Ankle Spec. 2016 Nov 10.

Comparison of Locking Plate with Interfragmentary Screw Versus Plantarly Applied Anatomic Locking Plate for Lapidus Arthrodesis: A Biomechanical Cadaveric Study.

Cottom JM1, Baker JS2.

Author information

  • 1Florida Orthopedic Foot & Ankle Center, Sarasota, Florida [email protected]
  • 2Florida Orthopedic Foot & Ankle Center, Sarasota, Florida.

Abstract

Arthrodesis of the first metatarsal cuneiform joint, or Lapidus procedure, is a widely accepted treatment for hallux valgus. Recent studies have focused on comparing various constructs for this procedure both in the laboratory and clinical settings. The current study compared in a cadaveric model the strength of 2 constructs. The first construct utilized a medially applied low-profile locking plate and an interfragmentary screw directed from plantar-distal to dorsal-proximal. The second construct consisted of a plantarly applied plate with a compression screw placed through the plate from plantar-distal to dorsal-proximal. The ultimate load to failure for the 2 groups tested was 255.38 ± 155.38 N and 197.48 ± 108.61 N, respectively (P = .402). There was no significant difference found between the 2 groups with respect to ultimate load to failure, stiffness of the construct, or moment at time of failure. In conclusion, the medially applied plate with plantar interfragmentary screw appears to be stronger than the plantar Lapidus plate tested for first metatarsal cuneiform arthrodesis, though this difference did not reach statistical significance.

LEVELS OF EVIDENCE: Level V: Biomechanical Study.

 

 

 

  1. J Foot Ankle Surg. 2016 Nov – Dec;55(6):1223-1228.

The “All-Inside” Arthroscopic Broström Procedure With Additional Suture Anchor Augmentation: A Prospective Study of 45 Consecutive Patients.

Cottom JM1, Baker JS2, Richardson PE2.

Author information

  • 1Fellowship Director, Attending Physician, Florida Orthopedic Foot and Ankle Center, Sarasota, FL. Electronic address: [email protected]
  • 2Fellow, Florida Orthopedic Foot and Ankle Center, Sarasota, FL.

Abstract

Lateral ankle sprains are a common injury that typically respond well to nonoperative therapy. When nonoperative therapy fails and patients develop chronic lateral ankle instability, they become candidates for surgical repair. The present study examined 45 consecutive patients (45 ankles) with chronic lateral ankle instability who underwent arthroscopic Broström repair using a double-row suture anchor construct. The 45 patients (27 females and 18 males) were followed up for a mean of 14 (range 12 to 20) months. The mean time to weightbearing with crutches was 3.3 (range 2 to 4) days, and full weightbearing was initiated at a mean of 14.4 (range 12 to 16) days. All patients participated in structured physical therapy, which was started at 21.6 (range 18 to 23) days. Patients were transitioned to regular shoe gear with a stirrup-style ankle brace at 28.7 (range 26 to 31) days. The American Orthopaedic Foot and Ankle Society scale scores improved from an average preoperative score of 48.7 (range 45 to 55) to 95.4 (range 90 to 100) postoperatively. The average visual analog scale decreased from 8 (range 6 to 10) preoperatively to 0.6 (range 0 to 5) postoperatively at the last follow-up visit. The Karlsson-Peterson score postoperatively was 87 of 100. We have shown that patients with this new arthroscopic Broström technique modified with a proximal suture anchor can begin weightbearing earlier than previously reported, without adverse effects in terms of pain, functional outcomes scores, and clinical outcomes.

Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  1. J Foot Ankle Surg. 2016 Nov – Dec;55(6):1229-1233.

A Biomechanical Comparison of 3 Different Arthroscopic Lateral Ankle Stabilization Techniques in 36 Cadaveric Ankles.

Cottom JM1, Baker JS2, Richardson PE2, Maker JM2.

Author information

  • 1Director, Florida Orthopedic Foot and Ankle Center Fellowship, Sarasota, FL. Electronic address: [email protected]
  • 2Fellow, Florida Orthopedic Foot and Ankle Center, Sarasota, FL.

Abstract

Arthroscopic lateral ankle stabilization has become an increasingly popular option among foot and ankle surgeons to address lateral ankle instability, because it combines a modified Broström-Gould procedure with the ability to address any intra-articular pathologic findings at the same session. The present study evaluated 3 different constructs in a cadaveric model. Thirty-six fresh frozen cadaver limbs were used, and the anterior talofibular ligament was identified and sectioned. The specimens were then placed into 1 of 3 groups. Group 1 received a repair with a single-row, 2-suture anchor construct; group 2 received repair with a novel, double-row, 4-anchor knotless construct; and group 3 received repair with a double-row, 3-anchor construct. Specimens were then tested for stiffness and load to ultimate failure using a customized jig. Stiffness was measured in each of the groups and was 12.10 ± 5.43 (range 5.50 to 22.24) N/mm for group 1, 13.40 ± 7.98 (range 6.71 to 36.28) N/mm for group 2, and 12.55 ± 4.00 (range 6.48 to 22.14) N/mm for group 3. No significant differences were found among the 3 groups in terms of stiffness (p = .939, 1-way analysis of variance, ɑ = 0.05). The groups were tested to failure, with observed force measurements of 156.43 ± 30.39 (range 83.69 to 192.00) N for group 1, 206.62 ± 55.62 (range 141.37 to 300.29) N for group 2, and 246.82 ± 82.37 (range 164.26 to 384.93) N for group 3. Statistically significant differences were noted between groups 1 and 3 (p = .006, 1-way analysis of variance, ɑ = 0.05). The results of the present study have shown that a previously reported arthroscopic lateral ankle stabilization procedure, when modified with an additional proximal suture anchor into the fibula, results in a statistically significant increase in strength in terms of the maximum load to failure. Additionally, we have described a previously unreported, knotless technique for arthroscopic lateral ankle stabilization.

Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Clin Podiatr Med Surg. 2016 Oct;33(4):545-51.

Endoscopic Plantar Fascia Debridement for Chronic Plantar Fasciitis.

Cottom JM1, Baker JS2.

Author information

  • 1Florida Orthopedic Foot and Ankle Center, 2030 Bee Ridge Road, Suite C, Sarasota, FL 34239, USA. Electronic address: [email protected]
  • 2Florida Orthopedic Foot and Ankle Center, 2030 Bee Ridge Road, Suite C, Sarasota, FL 34239, USA.

Abstract

When conservative therapy fails for chronic plantar fasciitis, surgical intervention may be an option. Surgical techniques that maintain the integrity of the plantar fascia will have less risk of destabilizing the foot and will retain foot function. Endoscopic debridement of the plantar fascia can be performed reproducibly to reduce pain and maintain function of the foot.

Copyright © 2016 Elsevier Inc. All rights reserved.

 

5. J Foot Ankle Surg. 2016 Jul-Aug;55(4):748-52.

Endoscopic Debridement for Treatment of Chronic Plantar Fasciitis: An Innovative Technique and Prospective Study of 46 Consecutive Patients.

Cottom JM1, Maker JM2, Richardson P2, Baker JS2.

Author information

  • 1Fellowship Director and Attending Physician, Florida Orthopedic Foot and Ankle Center, Sarasota, FL. Electronic address: [email protected]
  • 2Fellow, Foot and Ankle Surgical Fellowship, Florida Orthopedic Foot and Ankle Center, Sarasota, FL.

Abstract

Plantar fasciitis is one the most common pathologies treated by foot and ankle surgeons. When nonoperative therapy fails, surgical intervention might be warranted. Various surgical procedures are available for the treatment of recalcitrant plantar fasciitis. The most common surgical management typically consists of open versus endoscopic plantar fascia release. Comorbidities associated with the release of the plantar fascia have been documented, including lateral column overload and metatarsalgia. We present an innovative technique for this painful condition that is minimally invasive, allows visualization of the plantar fascia, and maintains the integrity of the fascia. Our hypothesis was that the use of endoscopic debridement of the plantar fascia with or without heel spur resection would provide a minimally invasive technique with acceptable patient outcomes.

Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

 

6. J Foot Ankle Surg. 2016 May-Jun;55(3):655-8.

Endoscopic Debridement for Treatment of Chronic Plantar Fasciitis: An Innovative Surgical Technique.

Cottom JM1, Maker JM2.

Author information

  • 1Fellowship Director and Attending Physician, Florida Orthopedic Foot & Ankle Center, Sarasota, FL. Electronic address: [email protected]
  • 2Fellow, Foot and Ankle Surgical Fellowship, Florida Orthopedic Foot & Ankle Center, Sarasota, FL.

Abstract

Plantar fasciitis is one the most common pathologies seen by foot and ankle surgeons. When nonoperative therapy fails, surgical intervention is warranted. Various surgical procedures are available for the treatment of recalcitrant plantar fasciitis. The most common surgical management typically consists of open versus endoscopic plantar fascia release. The documented comorbidities associated with the release of the plantar fascia include lateral column overload and metatarsalgia. We present a new technique for this painful condition that is minimally invasive, allows visualization of the plantar fascia, and maintains the integrity of this fascia. Our hypothesis was that the use of endoscopic debridement of the plantar fascia would provide a minimally invasive technique with acceptable patient outcomes.

Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

 

7. Clin Podiatr Med Surg. 2015 Jul;32(3):355-74.

Metatarsus Primus Varus Correction.

Sorensen MD1, Gradisek B2, Cottom JM3.

Author information

  • 1Weil Foot & Ankle Institute, Golf River Professional Building, 1455 East Golf Road, Des Plaines, IL 60016, USA. Electronic address: [email protected]
  • 2Weil Foot & Ankle Institute, Golf River Professional Building, 1455 East Golf Road, Des Plaines, IL 60016, USA.
  • 3Florida Orthopedic Foot & Ankle Center, 2030 Bee Ridge Rd, Sarasota, FL,34239, USA.

Abstract

We present a discussion on the use of proximal first-ray osteotomies in the surgical treatment for hallux valgus as a valid option compared with first-tarsometatarsal arthrodesis. Recent and historical literature tells us that stability of the first ray is a function of the alignment and reestablishment of retrograde stabilizing forces at the first tarsometatarsal joint. This realignment and stabilization may be accomplished with the use of distal soft tissue and proximal osteotomy procedures.

Copyright © 2015 Elsevier Inc. All rights reserved.

 

8. J Foot Ankle Surg. 2015 May-Jun;54(3):487-9.

Isolated calcaneofibular ligament injury: a report of two cases.

Rigby R1, Cottom JM2, Rozin R3.

Author information

  • 1Logan Regional Orthopedics, Logan, UT. Electronic address: [email protected]
  • 2Fellowship Director, Florida Orthopedic Foot & Ankle Center Sarasota, FL.
  • 3Partners Imaging, Sarasota, FL.

Abstract

Injury to the lateral ankle ligaments is very common among both athletes and nonathletes alike. Although anterior talofibular ligament injuries and combination anterior talofibular ligament and calcaneofibular ligament injuries are considerably common, an isolated injury to the calcaneofibular ligament has rarely been reported. We present the case reports of 2 patients, both of whom had sustained an isolated calcaneofibular ligament injury. In both patients, the diagnosis was obtained from the clinical examination and magnetic resonance imaging. Also, in 1 patient, formal open surgical inspection was performed. We advocate conservative treatment initially using the same protocols used for common lateral ankle ligament injuries and, if necessary, surgical intervention to address this unique and rare pathologic entity.

Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

9. See comment in PubMed Commons belowClin Podiatr Med Surg. 2015 Jan;32(1):93-8.

Cartilage allograft techniques and materials.

Cottom JM1, Maker JM2.

Author information

  • 1Fellowship Director, Attending Physician, Florida Orthopedic Foot and Ankle Center, Sarasota, FL. Electronic address: [email protected].
  • 2Florida Orthopedic Foot & Ankle Center, 2030 Bee Ridge Rd, Sarasota, FL,34239, USA.

 

Abstract

Hyaline cartilage is avascular in nature, relying on surrounding synovial fluid for its nutrient supply. Lacking an inflammatory response, hyaline cartilage is unable to be repaired itself after injury. BMS technique allows reparative cartilage to be produced, taking the form of fibrocartilage. Fibrocartilage is weaker than hyaline cartilage. Various cartilage allograft materials are available for reparative techniques. The cartilage allograft materials discussed herein include fresh allograft transplantation, ACEM, and particulated juvenile articular cartilage.

Copyright © 2015 Elsevier Inc. All rights reserved.

 

10. Clin Podiatr Med Surg. 2014 Jul;31(3):381-9.

Surgical management of stage 2 adult acquired flatfoot.

Maker JM, Cottom JM.

Author information

  • Florida Orthopedic Foot & Ankle Center, 2030 Bee Ridge Rd, Sarasota, FL,34239, USA.
  • Florida Orthopedic Foot & Ankle Center, 2030 Bee Ridge Rd, Sarasota, FL,34239, USA.

 

Abstract

Adult acquired flatfoot deformity is a progressive disorder with multiple symptoms and degrees of deformity. Stage II adult acquired flatfoot can be divided into stage IIA and IIB based on severity of deformity. Surgical procedures should be chosen based on severity as well as location of the flatfoot deformity. Care must be taken not to overcorrect the flatfoot deformity so as to decrease the possibility of lateral column overload as well as stiffness.

Copyright © 2014 Elsevier Inc. All rights reserved.

 

11. J Foot Ankle Surg. 2013 Sep-Oct;52(5):563-7.

Does the Arthrex TightRope® provide maintenance of the distal tibiofibular syndesmosis? A 2-year follow-up of 64 TightRopes® in 37 patients.

Rigby RB2, Cottom JM1.

Author information

  • 1Fellowship Director, Attending Physician, Florida Orthopedic Foot and Ankle Center, Sarasota, FL. Electronic address: [email protected].
  • 2Fellow, Florida Orthopedic Foot & Ankle Center, Sarasota, FL

 

 

Abstract

Syndesmotic diastasis can occur as an isolated injury or with concomitant fractures. A review of 37 patients with 64 TightRopes® for syndesmotic repair was performed, with a mean follow-up of 23.6 ± 4.3 months, from 2007 to 2011. The patients’ mean age was 40.67 (range 14 to 87) years. The mean initial measurements were as follows: tibiofibular clear space (TFCS) = 4.1 ± 1.1 mm, tibiofibular overlap (TFO) = 7.2 ± 2.7 mm, and medial clear space (MCS) = 2.9 ± 0.5 mm. The mean final measurements were as follows: TFCS = 4.2 ± 1.3 mm, TFO = 7.4 2.8 mm, and MCS = 3.0 0.5 mm. The calculated measurable difference from the initial to final TFCS, TFO, and MCS was significantly less than the maximum threshold for allowable widening of the syndesmosis: TFCS, p < .001; TFO, p < .002; and MCS, p < .001. Complications occurred in 10 patients; 7 (19%) experienced knot irritation and 3 (8%) developed an infection. The mean interval to weightbearing was 33.2 ± 12.7 days. The mean postoperative American Orthopaedic Foot and Ankle Society score was 97 (range 90 to 100). Of 64 suture endobuttons, 4 (6.25%) required removal. The fracture types were as follows: 3 (8%) isolated syndesmotic injuries, 9 (24%) trimalleolar fractures, 10 (27%) bimalleolar fractures, 7 (18%) Weber B fractures, 3 (8%) Weber C fractures, 1 (3%) Salter Harris type 3 fracture, and 4 (11%) Maisonneuve fractures. TightRope® fixation was advantageous because it rarely required removal, allowed for physiologic motion of the syndesmosis, and resulted in an early return to weightbearing. In addition, we have concluded that the TightRope® provides long-term stability of the ankle mortise, which was confirmed by the radiographic criteria and excellent American Orthopaedic Foot and Ankle Society scores.

Copyright © 2013 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

 

12. J Foot Ankle Surg. 2013 Sep-Oct;52(5):575-9.

Early weightbearing using Achilles suture bridge technique for insertional Achilles tendinosis: a review of 43 patients.

Rigby RB2, Cottom JM1, Vora A3.

Author information

  • 1Fellowship Director, Attending Physician, Florida Orthopedic Foot and Ankle Center, Sarasota, FL. Electronic address: [email protected]
  • 2Fellow, Florida Orthopedic Foot & Ankle Center, Sarasota, FL
  • 3Illinois Bone and Joint Institute

Abstract

Posterior heel pain caused by insertional Achilles tendinosis can necessitate surgical intervention when recalcitrant to conservative care. Surgical treatment can necessitate near complete detachment of the Achilles tendon to fully eradicate the offending pathologic features and, consequently, result in long periods of non-weightbearing. A suture bridge technique using bone anchors is available for reattachment of the Achilles tendon. This provides restoration of the Achilles footprint on the calcaneus, including not only contact, but also actual pressure between the tendon and bone. We performed a review of 43 patients who underwent surgical treatment of insertional Achilles tendinosis with reattachment of the Achilles tendon using the suture bridge technique. The mean age was 53 (range 29 to 87) years. The mean follow-up period was 24 (range 13 to 52) months. The mean postoperative American Orthopaedic Foot and Ankle Society score was 90 (range 65 to 100). The mean preoperative visual analog scale pain score was 6.8 (range 2 to 10) and the mean postoperative visual analog scale pain score was 1.3 (range 0 to 6). The mean interval to weightbearing was 10 (range 0 to 28) days. No postoperative ruptures occurred. Of the 43 patients, 42 (97.6%) successfully performed the single heel rise test at the final postoperative visit. Concomitant procedures were performed in 35 patients, including 33 (77%) requiring open gastrocnemius recession and 2 (5%) requiring flexor hallucis longus tendon transfer. A total of 42 patients (97.6%) returned to regular shoe gear, and 42 (97.6%) returned to their activities of daily living, including running for 20 athletic patients (100%). Complications included postoperative wound dehiscense requiring surgical debridement in 2 patients (5%) and soft tissue infection requiring antibiotics and surgical debridement in 1 (2%) patient. Our findings support using the Achilles tendon suture bridge for reattachment of the Achilles tendon in the surgical treatment of insertional Achilles tendinosis.

Copyright © 2013 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

 

13. J Foot Ankle Surg. 2013 Sep-Oct;52(5):568-74.

The “all inside” arthroscopic Broström procedure: a prospective study of 40 consecutive patients.

Cottom JM1, Rigby RB.

Author information

  • 1Fellowship Director, Attending Physician, Florida Orthopedic Foot and Ankle Center, Sarasota, FL. Electronic address: [email protected]

Abstract

Lateral ankle sprains are the most common injury in sports. Nonoperative therapy is recommended initially, including functional rehabilitation. Surgery might be an option for those patients in whom nonoperative attempts fail. Various surgical approaches have been described in published studies for treating chronic lateral ankle instability. The procedures are typically grouped into 2 main categories: anatomic and nonanatomic repair of the lateral ligament complex. The open modified Broström-Gould anatomic repair technique is widely accepted as the reference standard for lateral ankle stabilization. In the present study, we used an arthroscopic approach to treat chronic anterior talofibular ligament tears without the extensive open incisions common in the traditional modified Broström-Gould procedure. Our hypothesis was that the use of an all-inside arthroscopic Broström procedure would provide a minimally invasive technique with acceptable patient outcomes. We also wished to explore the complication rates and interval to return to weightbearing activity. A total of 40 ankles in 40 consecutive patients were included in the cohort.

 

14. J Foot Ankle Surg. 2013 May-Jun;52(3):339-42.

Biomechanical comparison of a locking plate with intraplate compression screw versus locking plate with plantar interfragmentary screw for Lapidus arthrodesis: a cadaveric study.

Cottom JM1, Rigby RB.

Author information

  • 1Fellowship Director, Attending Physician, Florida Orthopedic Foot and Ankle Center, Sarasota, FL. Electronic address: [email protected]

Abstract

Lapidus arthrodesis (first metatarsal cuneiform arthrodesis) has become an accepted procedure for hallux abducto valgus. Several variations of fixation have been described. Earlier weightbearing postoperatively has been one reported benefit of using locking plates for fixation. Additionally, studies have demonstrated that fixation placed on the plantar or tension side of the arthrodesis increases the biomechanical advantage. We performed a biomechanical cadaveric study of the Lapidus procedure, comparing a previously reported technique using a low profile locking plate with an intraplate compression screw versus the same locking plate with a plantar interfragmentary screw (PIFS) placed on the tension side of the arthrodesis in 10 fresh, paired, cadaver limbs. The mean ultimate load of the plate with a PIFS was 383.2 ± 211.5 N, and the mean ultimate load of the plate with an intraplate compression screw was 205.5 ± 97.2 N. The mean ultimate load of the LPS Lapidus plate with a PIFS was statistically greater (p = .027) than that with the plate intraplate compression screw. Our results indicated that changing the orientation of the compression screw to a PIFS significantly increased the stability of the Lapidus arthrodesis fixation construct. The modified construct with the PIFS might decrease the incidence of nonunion and, ultimately, allow patients to bear weight faster postoperatively.

Copyright © 2013 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved

 

15. J Foot Ankle Surg. 2013 Jul-Aug;52(4):465-9.

Fixation of lapidus arthrodesis with a plantar interfragmentary screw and medial locking plate: a report of 88 cases.

Cottom JM1, Vora AM2.

Author information

  • 1Fellowship Director, Attending Physician, Florida Orthopedic Foot and Ankle Center, Sarasota, 2FL. Electronic address: [email protected]
  • Illinois Bone and Joint Institute. Chicago, IL, USA.

Abstract

Lapidus arthrodesis is a powerful procedure that can be used to correct pathologic features within the forefoot or midfoot. Many different methods of fixation for this procedure have been reported. The use of plating constructs has been shown to provide increased stability compared with screw-only constructs. The technique we have described consists of a plantar to dorsal retrograde lag screw across the arthrodesis site, coupled with a low-profile medial locking plate. A total of 88 consecutive patients were treated with this modification of the Lapidus procedure by 2 surgeons and were retrospectively evaluated. All patients followed an early postoperative weightbearing protocol. Patient age, gender, follow-up duration, interval to weightbearing and radiographic fusion, preoperative and postoperative intermetatarsal angle, hardware removal, preoperative and postoperative American Orthopaedic Foot and Ankle Society midfoot scores, and adjunct procedures were analyzed. The mean follow-up period was 16.76 ± 5.9 (range 12 to 36) months, and all healed fusions demonstrated radiographic union at a mean of 51 ± 19.1 (range 40 to 89) days. The patients were treated with weightbearing starting a mean of 10.90 ± 4.1 (range 5 to 28) days postoperatively. Complications included 15 patients (17%) requiring hardware removal, 2 cases (2%) of hallux varus, 6 cases (7%) of radiographic recurrent hallux valgus, and 2 patients (2%) with first metatarsocuneiform nonunion. The results of the present study have demonstrated that plantar lag screw fixation with medial locking plate augmentation for Lapidus arthrodesis allows for early weightbearing with satisfactory outcomes, improved clinical and radiographic alignment, and improved American Orthopaedic Foot and Ankle Society scores.

Copyright © 2013 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

 

16. Foot Ankle Spec. 2013 Feb;6(1):45-9.

Lateral simultaneous reaming technique with femoral head allograft implantation for tibiocalcaneal arthrodesis: a case report.

Rigby RB1, Cottom JM.

Author information

  • 1Fellowship Director, Attending Physician, Florida Orthopedic Foot and Ankle Center, Sarasota, FL. Electronic address: [email protected]

 

Abstract

Femoral head allograft is an accepted alternative for significant bone loss in severe hindfoot reconstruction. This is primarily because the size and shape of the graft provides not only structural support but additionally prevents significant loss of limb length. We present a case using a technique from a directly lateral approach and simultaneous preparation of the tibia and calcaneus for tibiocalcaneal arthrodesis. Acetabular resurfacing reamers were used to prepare the joint for grafting as well as sculpt the graft itself for near press fit between the tibia and calcaneus. Fixation with a lateral locking plate avoids the unnecessary decompression reaming of the graft core itself, ultimately sparing the valuable poles of the graft for increased likelihood of incorporation.

 

17. J Foot Ankle Surg. 2012 Jul-Aug;51(4):517-22.

Fixation of the Lapidus arthrodesis with a plantar interfragmentary screw and medial low profile locking plate.

Cottom JM1.

Author information

1Fellowship Director, Attending Physician, Florida Orthopedic Foot and Ankle Center, Sarasota, FL. Electronic address: [email protected]

 

Abstract

The Lapidus arthrodesis can be used to correct pathology within the forefoot or midfoot, and severe hallux valgus deformities as well as hypermobility of the medial column may be amenable to correction with this procedure. Many different skeletal fixation methods have been described for this procedure, and one form that appears to provide enough construct stability to allow patients to bear weight early in the postoperative period is described herein. This construct consists of an interfragmental compression screw oriented from the plantar aspect of the first metatarsal to the superior aspect of the medial cuneiform, with medial locking plate augmentation.

Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

18. J Foot Ankle Surg. 2011 Mar-Apr;50(2):135-40.

Early clinical and radiographic outcomes after treatment of displaced intra-articular calcaneal fractures using delta-frame external fixator construct.

Kissel CG1, Husain ZS, Cottom JM2, Scott RT, Vest J.

Author information

  • 1Detroit Medical Center PM&S-36 Residency Program, Detroit, MI, USA. [email protected]
  • 2Fellowship Director, Attending Physician, Florida Orthopedic Foot and Ankle Center, Sarasota, FL. Electronic address. [email protected]

Abstract

Intra-articular calcaneal fractures are associated with high morbidity, persistent pain, and long-term disability. This retrospective study assesses early clinical and radiographic postoperative findings of intra-articular calcaneal fractures following treatment by ligamentotaxis using a delta frame construct with a large fragment external fixator. Minimally invasive percutaneous reduction of calcaneal fractures is an alternative treatment for Sanders type II, III, and IV fractures. Ten patients from the Detroit Medical Center were followed between January 2002 and December 2004 for follow-up over a mean of 353.5 ± 85.45 days postoperatively. The mean age of the patients was 45.8 ± 12.3 years. There were 2 patients with Sanders type IIA, 3 patients with type IIIAB, 1 patient with type IIIAC, and 4 patients with type IV fracture patterns. The results demonstrated that the mean calcaneal width decreased, the calcaneal height increased, and the calcaneal length increased when comparing preoperative to postoperative measurements. Böhler’s angle increased from 20.8 ± 8.27° preoperatively to 25.7 ± 5.21° postoperatively, and Gissane’s angle decreased from 127.4 ± 45.22° preoperatively to 111.2 ± 39.38° postoperatively. The posterior facet step-off on CT examination reduced from 2.6 ± 0.82 mm preoperatively to 0.4 ± 0.26 mm postoperatively. The mean postoperative total subtalar joint range of motion was 19.0 ± 4.5° on the affected side and 34.4 ± 4.58° on the contralateral foot. The mean Maryland Foot score was 85.8 ± 6.41 in the 10 patients. With the exception of the change from preoperative to postoperative Böhler’s angle, and the comparison of the ipsilateral (side of the fracture) to contralateral resting calcaneal stance position, all of the comparisons revealed statistically significant (P ≤ .05) differences. The authors conclude that the delta frame construct is a viable alternative method to open reduction and internal fixation for treating intra-articular calcaneal fractures.

 

19. J Foot Ankle Surg. 2009 Nov-Dec;48(6):620-30.

Transosseous fixation of the distal tibiofibular syndesmosis: comparison of an interosseous suture and endobutton to traditional screw fixation in 50 cases.

Cottom JM1, Hyer CF, Philbin TM, Berlet GC.

Author information

  • 1Fellowship Director, Attending Physician, Florida Orthopedic Foot and Ankle Center, Sarasota, FL. Electronic address: [email protected]

 

Abstract

In this prospective cohort study, we compared screw fixation to interosseous suture with endobutton repair of the syndesmosis. Outcomes of interest included preoperative and postoperative modified American Orthopedic Foot and Ankle Society (AOFAS) hindfoot and ankle scores, and Short Form-12 health status scores, as well as radiographic measurements and the time to full weight bearing. Mean averages and ranges were calculated for numeric variables, and outcomes for each fixation group were compared statistically with Student t test. The cohort consisted of 50 patients; 25 in the screw fixation group and 25 in the interosseous wire with endobuttons group. The mean patient age was 34.68 (15 to 55) years in the interosseous suture endobutton group and 36.68 (17 to 74) years in the screw group, and the mean follow-up was 10.78 (range 6 to 12) months in the interosseous suture endobutton group, and 8.20 (range 4 to 24) months in the screw group. No statistically significant differences (P < or = .05) were noted in regard to age, follow-up duration, time to postoperative weight bearing, or subjective outcome scores between the fixation groups; although statistically significant improvements were noted in the subjective scores for each fixation group between the preoperative and postoperative measurements. The results of this study indicate that the interosseous suture with endobuttons is a reasonable option for repair of ankle syndesmotic injuries, and may be as effective as traditional internal screw fixation.

LEVEL OF CLINICAL EVIDENCE: 2.

 

20. See comment in PubMed Commons belowFoot Ankle Spec. 2008 Oct;1(5):280-7.

Flexor hallucis tendon transfer with an interference screw for chronic Achilles tendinosis: a report of 62 cases.

Cottom JM1, Hyer CF, Berlet GC, Lee TH.

Author information

  • 1Fellowship Director, Attending Physician, Florida Orthopedic Foot and Ankle Center, Sarasota, FL. Electronic address: [email protected]

 

Abstract

Chronic disorders of the Achilles tendon are frequently treated by foot and ankle surgeons. A number of surgical techniques have been described for treating chronic degenerative Achilles tendinosis. This is the largest reported series evaluating a method of transferring the flexor hallucis longus (FHL) tendon and securing it with an Arthrex interference screw into the calcaneus. Sixty-two patients with Achilles tendinosis underwent Achilles debridement and transfer of the FHL tendon for chronic conditions when greater than 50% of the tendon was involved. All 62 patients were followed for an average of 26.97 months. A modified American Orthopaedic Foot and Ankle Society score was evaluated both preoperatively and postoperatively and demonstrated significant improvement. Because of the anatomical relationship of the FHL tendon to the Achilles tendon and the fact that both tendons act in the same phase, transfer of this tendon in chronic Achilles tendinosis or rupture is a reasonable option. The described technique is advantageous in that it is simple to perform and is less time-consuming than other reported methods. The authors have had no revisions to date.

 

21. Foot Ankle Int. 2008 Aug;29(8):773-80.

Treatment of syndesmotic disruptions with the Arthrex Tightrope: a report of 25 cases.

Cottom JM1, Hyer CF, Philbin TM, Berlet GC.

Author information1Fellowship Director, Attending Physician, Florida Orthopedic Foot and Ankle Center, Sarasota, FL. Electronic address: [email protected]

 

 

Abstract:

BACKGROUND:

The complexity of syndesmotic injuries, often with both bone and soft tissue injury mandates an expeditious diagnosis and treatment to avoid unfavorable long term outcomes. Various methods of fixation of the syndesmosis have been reported. We present the largest series evaluating the Arthrex Tightrope for management of syndesmotic injuries.

 

MATERIALS AND METHODS:

Twenty-five patients with disruption of the distal tibiofibular articulation underwent treatment with an Arthrex Tightrope. In 21 cases, a single tightrope was placed, and in four cases, two tightropes were utilized. Associated ankle fractures were treated using proper AO technique. Those patients with diabetes and/or neuroarthropathic changes foot or ankle were not included in this study. Postoperative evaluation parameters included radiographic measurements, a modified AOFAS scoring system and SF-12.

RESULTS:

Average followup was 10.8 months. The mean time to full weightbearing was 5.5 (range, 2 to 8) weeks. Postoperative radiographic analysis of the mean distance from the tibial plafond to the placement of the tightrope(s), medial clear space, average postoperative tibiofibular overlap and the mean tibiofibular clear space demonstrated no evidence of re-displacement of the syndesmotic complex at an average of 10.8 (range, 6 to 12) months. The modified AOFAS hindfoot scoring scale and SF-12 both demonstrated significant improvements; preoperative values were assessed in the office with the first patient visit as they are incorporated into the patient intake form that each patient fills out at the initial visit.

CONCLUSION:

Utilization of the tightrope in diastasis of the syndesmosis should be considered as a good option. The method of placement is quick, can be minimally invasive, and obviates the need for hardware removal. In this series, it maintained excellent reduction of the syndesmosis.

 

22. J Foot Ankle Surg. 2008 May-Jun;47(3):250-8.

Treatment of Lisfranc fracture dislocations with an interosseous suture button technique: a review of 3 cases.

Cottom JM1, Hyer CF, Berlet GC.

Author information

  • 1Orthopedic Foot and Ankle Center, Columbus, OH, USA.

Abstract

Lisfranc fracture dislocations are complex and difficult to treat. Making the correct diagnosis and achieving an anatomical reduction are important factors in regard to achieving a favorable outcome with this injury. We describe a new technique that we have found to be useful for stabilizing Lisfranc fracture dislocations. This method is relatively fast, minimally invasive, and effective, and it eliminates the need for implant removal. To date, we have achieved predictable results for stabilizing and treating these difficult injuries with the use of a suture endobutton, instead of traditional interfragmental screw fixation. In this report, we describe 3 cases in which this method was used with satisfactory short-term results.

LEVEL OF CLINICAL EVIDENCE: 4

 

23. Foot Ankle Surg. 2008 Jan-Feb;47(1):51-5.

Dermatobia hominis (botfly) infestation of the lower extremity: a case report.

Cottom JM1, Hyer CF, Lee TH.

Author information

  • 1Orthopedic Foot and Ankle Center, 6200 Cleveland Avenue, Suite 100, Columbus, OH 43231, USA. [email protected]

Abstract

We present a report of myiasis, which is the infestation of the body by the larva of flies. In this particular case the patient traveled to Belize and was infested in her foot and leg by Dermatobia hominis or the human botfly. Treatment was initiated once she returned to the United States. She ultimately underwent surgical excision of the larva, which was noted to be alive and moving upon removal. This is a rare larval infestation in humans, but is frequently seen in domestic and livestock animals in Central and South America. With increased international travel, the foot and ankle surgeon should be aware of this parasitic infection in recent travelers to Central and South American countries.

ACFAS Level of Clinical Evidence: 4.