title: Anterior ankle impingement after tendo-Achilles lengthening for long-standing equinus deformity in residual poliomyelitis.
abstract: BACKGROUND
  This study was performed to investigate anterior ankle impingement after tendo-Achilles lengthening for long-standing equinus deformity in patients with residual poliomyelitis and to investigate whether the severity of preoperative equinus deformity affected the occurrence of symptomatic anterior impingement.
  
  
  METHODS
  Twenty-seven consecutive patients (mean age, 43.8 ± 9.4 years) with residual poliomyelitis who underwent tendo-Achilles lengthening for equinus foot deformity were included. On lateral foot-ankle weight-bearing radiographs, the tibiocalcaneal angle, plantigrade angle, and McDermott grade were measured and the presence of anterior blocking spur was evaluated.
  
  
  RESULTS
  Eleven patients (40.7%) had anterior ankle impingement on radiographic findings preoperatively and 24 patients (88.9%) at latest follow-up. There was a significant difference in McDermott grade between preoperative and latest follow-up (P < .001). There were significant differences in tibiocalcaneal angle and plantigrade angle between the patients with anterior ankle pain and without anterior ankle pain (P = .006 and .011, respectively) and between the patients with anterior blocking spur and without anterior blocking spur (P = .005 and .010, respectively).
  
  
  CONCLUSIONS
  Most patients with residual poliomyelitis had anterior ankle impingement after tendo-Achilles lengthening for long-standing equinus deformity, and the presence of symptomatic anterior ankle impingement was significantly associated with the severity of the equinus deformity. Therefore, for residual poliomyelitis patients with severe long-standing equinus deformity, surgeons should consider the possibility of a subsequent anterior procedure for anterior impingement after tendo-Achilles lengthening.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: Kwandong University Myongji Hospital, Kyungki, Goyang, Korea.
authors.forename: Ki Hyuk
authors.initials: KH
authors.lastname: Sung
authors.forename: Chin Youb
authors.initials: CY
authors.lastname: Chung
authors.forename: Kyoung Min
authors.initials: KM
authors.lastname: Lee
authors.forename: Seung Yeol
authors.initials: SY
authors.lastname: Lee
authors.forename: Moon Seok
authors.initials: MS
authors.lastname: Park
mesh_terms: D000125:Achilles Tendon / Q000601:surgery*; D000328:Adult; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000601:surgery; D004863:Equinus Deformity / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D011051:Poliomyelitis / Q000150:complications*; D011859:Radiography; D012189:Retrospective Studies; D055815:Young Adult
keywords: anterior ankle impingement; long-standing equinus deformity; residual poliomyelitis; tendo-Achilles lengthening