Utilizing an apparatus for separately testing the status of the anterior talofibular and the calaneofibular ligaments of the ankle in 25 healthy, 15- to 30-year-old adults, it became apparent that the stability of the ankle depends primarily upon the integrity of the anterior talofibular ligament. When the "fore n' aft" stress measurement exceeds 4 mm, a positive anterior drawer test is elicited, and the ankle ligament needs surgical repair. Tibial talar tilt normals ranged up to 18 degrees. Repair (early and late) is accomplished by suturing what one finds (there is always some ligament present) and reinforcing the anterior talofibular ligament repair with overlap of the nearby lateral talocalcaneal ligament plus the marginal ankle retinaculum. Four weeks in a plaster of paris walking cast are followed by use of Ace bandages of 2 weeks. Light activity is begun 6 weeks after repair, and activity of choice is begun 8 weeks after repair. Repeat stress testing is performed at 3 months postsurgery, and a questionnaire is completed at the same time. On a point system (1 to 10) reviewing pain, stability, and swelling, the results in 50 cases rate from 8 to 10, with a lower rating improving with more time. Surgical time is approximately 30 minutes. There seems to be no need for more radical surgery utilizing other muscles. The senior author has employed this surgery for the past 19 years with approximately 165 cases. Only 50 patients with proper 3-month postoperative stress testing and questionnaire follow-up, who were operated upon 1 or more years ago, area recorded here.

A retrospective study of 22 ankles in 22 patients with osteochondral talar dome lesions between 1975 and 1983 has indicated that surgical treatment yields superior results to conservative therapy. Thirteen male and 9 female patients, ages 9 to 72 years, average age 28 years, showed 10 medical lesions (Berndt and Harty classification (stage I (one); stage II/III (nine)) and 12 lateral lesions (stage II/III (5), stage IV (7)). Examination follow-up on 19 patients (86%) has averaged 24 months. The initial diagnosis seen retrospectively on x-rays was missed 43% of the time by emergency room physicians. A history of trauma was verified in 100% of the lateral lesions and 80% of the medial talar dome lesions. Of the 22 ankles, 14 lesions were isolated injuries, while 8 had concomitant fractures, lateral ligament, or peroneal tendon damage. Surgical treatment consisted of removal of the osteochondral fragment, curettage, and drilling of its bed. Two distinct surgical approaches were utilized. Lateral dome lesions were approached through the standard anterolateral incision, while medial dome lesions were approached through the anterior tibial tendon sheath with grooving of the anteromedial distal tibia articular surface. The medial approach allowed the somewhat posteriorly placed medial lesions to be reached, negating the need for a medial malleolar osteotomy and postoperative immobilization. On follow-up, no untoward ankle arthrosis was noted as a result of the grooving of the anteromedial distal tibia. Nineteen of the 22 patients had surgical therapy with 79% excellent or good, 21% fair, and no poor results. Five of the eight patients who elected prolonged conservative therapy finally had surgery. Of the three remaining patients conservatively treated, there were two fair results and one poor result.

The purposes of the project were to monitor the development of the lower extremities and the longitudinal arch of the foot and to determine whether or not arch support footwear (three types) affected development of a neutral arch in toddlers 11 to 14 months of age until age 5 years. A total of 125 beginner walkers were recruited through the pediatrics department during a period of 1 1/2 years and divided by lot into four different footwear groups (one nonarch supportive). The group was studied for 4 years by physical examinations, x-ray films, and pedotopography (a Moire fringe technique of photography). At initial examination all of the apparently normal toddlers had pes planus by all clinical, roentgenographic, and photographic measurements. There were no cavus feet at that time or at 5 years of age. Arches developed regardless of the footwear worn but development was faster during the first 2 years (until age 3 years) with arch support footwear. The rapidity of arch development until 5 years of age continued in those children who wore longitudinal arch cookies. Ossification of the sustentaculum tali begins at approximately 5 years of age but is not complete for at least another 1 to 2 years. Hyperpronation was present in 77.9% and genu valgum in 92.3% of the 5-year-old children. These conditions are apparently the norm at this age in both boys and girls.

Questionnaire cards were sent to 45,000 family shoe store customers; 15,000 cards were completed and returned, thereby permitting a broad statistical base in respect to the incidence and types of foot problems encountered in the United States. The incidence of corns, calluses, warts, ingrown toenails, bunions, hallux rigidus, hammer toes, cavus, and pes planus were correlated with age, sex, race, and demographic background, along with the incidence of surgery, conservative treatment, or no treatment. The extrapolated data indicated that 40% of the population have foot problems, of which 12% had surgery and 7% have been untreated.

When the patient appears in your office with foot and/or ankle complaints, what will be your standard routine X-rays for those areas and what information can you glean from your careful study of these films? What views portray the areas in question and what are suggestive pathognomonic signs? The author has attempted to outline some of the roentgenological approaches to diagnosis of ailments of the foot and ankle and to point out some of the clues that can be found with their interpretations. Many of the signs have, hitherto, not been recognized or are buried in the voluminous orthopaedic literature.