Summary. Relevance. Calcaneus non-union (CNU) occurs in 1.3% of fracture cases; however, according to different authors, the frequency of this complication is much higher and is about 10%. Objective: to describe the clinical and roentgenological findings in patients with CNU; to highlight important aspects of diagnostics and surgical treatment. Materials and Methods. 9 patients with CNU have been observed. There were 7 males and 2 females. The average age was 34±1.5 (range 23-52) years. The average term from trauma to surgery was 13.5±1.5 (range 6-21) months. Changes in vertical talus-first metatarsal angle (vT1MA), pain syndrome (VAS), ankle range of motion, and foot function using AOFAS have been investigated. The indication for surgical treatment was symptomatic foot deformity; a subtalar arthrodesis with bone graft was used. Results. CNU was observed in 7 cases (77.8%) after the conservative treatment and in 2 cases (22.2%) after the surgical treatment. Roentgenologycally, the most characteristic feature was the extensor position of the talus and the associated with it the positive value of vT1MA, which causes an inverse relationship with the range of extension of the foot and reduces the height of the calcaneus. A subtalar arthrodesis with bone graft was performed in 7 cases (77.8%); in 2 cases (22.2%), the procedure was combined with calcaneus closing wedge osteotomy because of significant loss of hindfoot height. Bone fusion occurred within 8-10 weeks. vTMFA was 13±10 (13-150) before surgery and 8±10 (8-100) after surgery. Functional result by AOFAS was 63±2 points before surgery and 84±2 points 6 months after surgery. Conclusions. Calcaneus non-union is not accompanied by pain syndrome and is detected when the patient consults a doctor. The necessity of surgery in this case is decided on the basis of a detailed clinical and X-ray analysis and CT of the foot, taking into account the deformity of the hindfoot and the need for correction.

Summary. The pain after amputations is a global problem of modern medicine. There are three distinct clinical entities that can form the postamputation pain: phantom limb pain (PLP), phantom sensations (PSs), and residual limb pain (RLP). PLP and PSs are pathophysiological phenomena, which need complex conservative treatment. RLP is a local condition that arises from neuroma, excessive scarring, osteophites, etc. and can be resolved by surgery. Objective: to analyze the results of surgical treatment of patients with symptomatic neuromas after lower limb amputations (LLA). Materials and Methods. The study included 43 patients with symptomatic neuromas 3–10 years after LLA. There were 40 male and 3 female patients (mean age 33.9±3 years). Amputations were caused by trauma (33 cases), mine-blast injury (7 cases), diabetes (1 case), and oncology (2 cases). The level of amputation was thigh (3 cases), knee (1 case), and ankle (39 cases). The pain intensity was measured by the VAS (Visually Analog Scale) and prosthesis using by the ALAC (Artificial Limb and Appliance Centre, USA) scale. Results. RLP had 43 patients (100%), PLP – 8 (8.6%), and PSs – 35 (81.4%) patients. The average level of pain was 7.4±0.9. Prosthesis was used in 74.4% (32 patients), but 11 of them used prosthesis for cosmetic or transportation reasons (levels I and II by the ALAC scale). Complications after surgery were presented by hematoma (3 cases), marginal skin necrosis (2 cases), and tearing of m. gastrocnemius from the tibia after the fall on the stump (1 case). The results were assessed in 35 patients in terms from 1 to 15 years. The pain severity decreased from 7.4±0.9 to 3.2±0.6 (p˂0.05; two-sample t-test). The number of RLP cases decreased to 11 (31.4%), but the number of PLP and PSs cases did not significantly change (PLP – 5 cases or 14.3%; PSs – 27 cases or 77.1%). The prosthesis using rised to 100% due to functionality (III–VI levels by the ALAC scale). Conclusions. Surgical method is the main treatment of symptomatic neuromas after LLA. The surgery must expect proximal neurotomy and, if need, reamputation and stump reconstruction. This approach helps to reduce pain and improves the functional ability of persons with LLA.

Summary. The assessment of foot and ankle function still remains an actual issue of the modern orthopedics. Objective: comparative qualitative analysis of the most common assessment systems of foot and ankle function. Materials and Methods. The search from PubMed databases from 1946 to 2021 was done. 8898 publications were detected in which assessment systems of foot and ankle function have been used. 12 assessment systems presented in 5705 publications were selected for analysis (inclusion criterion – no less than 40 publications): AOFAS scale, VAS, SF-36 EQL, FFI, FAOS, FAAM, FADI, BFS, MOFAQ, FFI-R, Roles&Maudsley scale, VAS FA. The analysis predicted the assessment system philosophy: numerical estimate, VAS, Likert scale, patient- or investigatororiented, and reliability evidence. Results. Most of the analized assessment systems meet criteria of reliability (r>0.8; Kronbach’s α≥0.9). For Roles&Maudsley scale and VAS, FA reliability has not been established. The validity fluctuates widely. Conclusions. The choice of an assessment system must meet the research tasks. The consideration of strong and weak sides of assessment systems promotes their adequate combinations to avoid the bias effect.

Summary. Triple arthrodesis (TA) is a final surgical decision in treatment of the acquired flat foot (FF). Objective: to study late outcomes of TA in the acquired FF; to establish factors influencing functional outcome of treatment. Materials and Methods. The study included 51 patients (56 feet) with acquired FF at the age 32 – 77 years (54.7±1.2 years). Vertical and horizontal talometatarsal angles (TMA), as well as calcaneal inclination angle were determined by standing radiographs of the foot. The severity of osteoarthritis of the ankle joint (AJ) was assessed according to the Kellgren-Lawrence classification; range of motion in the AJ was determined according to the 0-pass method. Foot function was assessed by the dynamics of indicators: AOFAS scale (hindfoot and ankle joint), FFI (Italian version), quality of life (Roles and Maudsley scale), and VAS (pain). Establishment of factors influencing the outcome of treatment was performed using regression-correlation and factor analysis. Results. Long-term results were studied in 32 cases. Cases of non-unions were registered at the following levels: talonavicular (2) and calcaneocuboidea (2). The dynamics of skiological indicators was significantly positive (p˂0.05; unpaired t-test). According to the AOFAS scale, 2 excellent, 19 good and 11 satisfactory results of treatment were obtained. Significant influence of pain level (inverse dependence) and range of foot extension (direct dependence) on the result (regression analysis) were determined, as well as significant effect of ankle osteoarthritis on the function of the foot (Fisher’s exact test; 0.002). Conclusions. TA in the treatment of acquired FF is an effective surgery that provides favorable results in cases of severe deformity, degenerative changes in the joints, and contraindications to extra-articular corrective osteotomies.