No abstract

Background The Evans osteotomy is a widely used procedure for the correction of adult and pediatric flexible flatfoot deformity. Locking plates are commonly used to stabilize the osteotomy and the allograft. However, there have been incidences of soft-tissue irritation caused by the hardware, requiring subsequent hardware removal. Therefore, we sought to review whether age, sex, or laterality of the procedure had any correlation with the rate of hardware removal. Methods A retrospective review was performed of 47 consecutive patients who underwent an Evans calcaneal osteotomy between October 1, 2013, and October 1, 2016. Data were collected and analyzed based on age, sex, laterality, and the need for hardware removal. Results All of the 47 patients met the inclusion criteria. Seventy procedures were performed, and hardware removal was required in 16 patients and 21 feet (30%). The only statistically significant finding was that 11 females and only five males required either unilateral or bilateral hardware removal (P = .039). All 16 patients reported complete pain relief after hardware removal. Conclusions Females are twice as likely as males to develop symptoms after locking plate application over an Evans osteotomy and may require hardware removal. Despite the low-profile nature of the locking plate to fixate the Evans osteotomy, the hardware can be a source of significant pain. Patients, especially females, should be cautioned about potential hardware-related pain and a possible follow-up procedure to remove the hardware.

Background: Non-operational treatments for Morton's neuroma remain controversial because it was believed sclerosing injections do not change nerve fibers on a cellular level. Up to 80% success rates with 4% ethanol sclerosing have been documented while the remainder require operational removal of the painful nerve. We sought to evaluate the histological characteristics of Morton's neuromas treated with either 4% ethanol sclerosing injection versus steroid injection alone from patients who required removal of the nerve for pain relief. Methods: A retrospective histologic review was performed on 24 consecutive patients who were treated with either sclerosing injection versus non-sclerosing injection and underwent nerve removal between 2012 to 2015. Results: 19 patients met inclusion criteria, of which 8 patients received sclerosing injections and 11 patients received non-sclerosing injections. Intraneural fibrosis was seen higher in the non-sclerosing injection group (p = 0.008). Conclusions: Histological changes are seen in Morton's neuroma with the use of 4% ethanol sclerosing injection contrary to prior studies.