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The Role of Peroneal Tendinopathy and the Cavovarus Foot and Ankle. Clin Podiatr Med Surg 2021; 38:445-460. [PMID: 34053654 DOI: 10.1016/j.cpm.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Peroneal tendon pathology is often an overlooked and underdiagnosed condition. It is often confused with chronic ankle instability. It is important when surgically managed to assess the condition of the tendons, muscle viability and strength, and associated cavovarus deformity. Complex reconstruction may be needed, including 2-stage procedures with a silicone rod and tendon transfer.
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Koh D, Liow L, Cheah J, Koo K. Peroneus longus tendon rupture: A case report. World J Orthop 2019; 10:45-53. [PMID: 30705840 PMCID: PMC6354104 DOI: 10.5312/wjo.v10.i1.45] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/14/2018] [Accepted: 01/01/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Peroneal tendinopathies are an under-diagnosed and potentially under-treated pathology. If left untreated it can be a cause of chronic lateral hindfoot pain. Its diagnosis is challenging owing to its low incidence and vague clinical presentation.
CASE SUMMARY We share a case of a patient who experienced a chronic lateral ankle pain exacerbated after alighting from a bus. This patient came to our attention only after failing conservative management on two separate occasions. Plain radiographs and magnetic resonance imaging revealed rupture of the peroneus longus tendon (PLT). Findings were confirmed intra-operatively and tenodesis of the PLT to the peroneus brevis was performed. Patient was kept non-weight-bear with his foot everted and in plantarflexion before being converted to an off-loading boot at two weeks. Patient was started on a progressive rehabilitation programme at six weeks and was able to return to work shortly after with excellent outcomes.
CONCLUSION We aim to share our experience in managing this patient and propose some pointers guided by available literature to avoid missing this commonly overlooked pathology.
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Affiliation(s)
- Don Koh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 169856, Singapore
| | - Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 169856, Singapore
| | - Joseph Cheah
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 169856, Singapore
| | - Kevin Koo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 169856, Singapore
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Schick F, Karanjia H, Daniel J, Dheer S, Langman C, Taweel N, Sullivan P, Lebaron T. Spontaneous Fracture of the Os Peroneum With Rupture of the Peroneus Longus Tendon. J Foot Ankle Surg 2018; 57:790-793. [PMID: 29631970 DOI: 10.1053/j.jfas.2017.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Indexed: 02/03/2023]
Abstract
Rupture of the peroneus longus tendon with or without an associated os peroneum fracture is rare and uncommonly encountered in the published data. Owing to the infrequent nature, a high index of suspicion is required. Otherwise, the opportunity for the injury to result in a delayed or missed diagnosis is increased. We report the case of a 39-year-old male with spontaneous rupture of the peroneus longus tendon and associated fracture of the os peroneum. The spontaneous rupture and fracture were diagnosed from the history, physical examination, and imaging findings. The patient elected to undergo operative repair, with excellent results, full recovery, and full return to normal function.
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Affiliation(s)
- Faith Schick
- Podiatrist, Department of Podiatry, Rothman Institute, Philadelphia, PA.
| | - Homyar Karanjia
- Podiatrist, Department of Podiatry, Rothman Institute, Philadelphia, PA
| | - Joseph Daniel
- Orthopaedic Surgeon, Department of Orthopaedic Foot and Ankle Surgery, Rothman Institute, Philadelphia, PA; Associate Professor of Orthopaedic Surgery, The Stanley Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Residency Director, Rowan University School of Osteopathic Medicine, Stratford, NJ
| | - Sachin Dheer
- Director, Musculoskeletal Imaging and Intervention, Kennedy Health System, Philadelphia, PA; Adjunct Clinical Instructor, Department of Radiology, Thomas Jefferson University, Philadelphia, PA
| | - Charles Langman
- Podiatrist, Department of Podiatry, Rothman Institute, Philadelphia, PA
| | - Nicholas Taweel
- Podiatrist, Department of Podiatry, Rothman Institute, Philadelphia, PA
| | - Paul Sullivan
- Podiatrist, Department of Podiatry, Rothman Institute, Philadelphia, PA
| | - Trenton Lebaron
- Orthopaedic Surgery Resident, Postgraduate Year 1, Department of Orthopaedic Surgery, Rowan University School of Osteopathic Medicine, Stratford, NJ
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van Dijk PA, Miller D, Calder J, DiGiovanni CW, Kennedy JG, Kerkhoffs GM, Kynsburtg A, Havercamp D, Guillo S, Oliva XM, Pearce CJ, Pereira H, Spennacchio P, Stephen JM, van Dijk CN. The ESSKA-AFAS international consensus statement on peroneal tendon pathologies. Knee Surg Sports Traumatol Arthrosc 2018; 26:3096-3107. [PMID: 29767272 PMCID: PMC6154028 DOI: 10.1007/s00167-018-4971-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 04/27/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Peroneal tendon injuries are a significant cause of lateral ankle symptoms in the active population. Accurate diagnosis and prompt treatment is important for minimizing the risk of long-term sequelae associated with chronic peroneal tendinopathy. Although several studies have been published on diagnostic strategies and treatment outcomes, there is no consensus on the optimal management of peroneal tendon pathologies. PURPOSE The purpose of this ESSKA-AFAS consensus statement was to conduct an international and multidisciplinary agreed guideline on management of patients with peroneal tendon pathologies. METHODS Using the Nominal Group Technique, a panel comprised of sixteen specialists spanning nine countries was convened by the ESSKA-AFAS board. In preparation for the meeting, relevant questions were identified and supported by a systematic literature search. During the meeting, the panel members gave presentations on each question, and the evidence supporting each subject was then vetted by open discussion. Statements were thereafter adjusted on the basis of the discussion and voted upon to determine consensus using a 0-10 range Likert scale. Agreement was confirmed when a mean score of at least 7.5 was reached. CONCLUSION This ESSKA-AFAS consensus statement on the optimal management of peroneal tendon pathologies is the result of international and multidisciplinary agreement combined with a systematic review of the literature. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Pim A van Dijk
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
- Academic Center for Evidence based Sports medicine (ACES), Amsterdam, The Netherlands.
- Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands.
| | | | | | | | | | - Gino M Kerkhoffs
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence based Sports medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - Akos Kynsburtg
- National Institute for Sports Medicine, Budapest, Hungary
| | | | | | | | - Chris J Pearce
- Division of Foot and Ankle Surgery, National University Hospital, Singapore, Singapore
| | - Helder Pereira
- Centro Hospitalar Póvoa de Varzim-Vila do Conde, Póvoa de Varzim, Portugal
- Ripoll y De Prado Sports Clinic: Murcia-Madrid-FIFA Medical Center of Excellence, Madrid, Spain
| | | | | | - C Niek van Dijk
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Ripoll y De Prado Sports Clinic: Murcia-Madrid-FIFA Medical Center of Excellence, Madrid, Spain
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The ESSKA-AFAS international consensus statement on peroneal tendon pathologies. KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY : OFFICIAL JOURNAL OF THE ESSKA 2018. [PMID: 29767272 DOI: 10.1007/s00167-018-4971-x.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
INTRODUCTION Peroneal tendon injuries are a significant cause of lateral ankle symptoms in the active population. Accurate diagnosis and prompt treatment is important for minimizing the risk of long-term sequelae associated with chronic peroneal tendinopathy. Although several studies have been published on diagnostic strategies and treatment outcomes, there is no consensus on the optimal management of peroneal tendon pathologies. PURPOSE The purpose of this ESSKA-AFAS consensus statement was to conduct an international and multidisciplinary agreed guideline on management of patients with peroneal tendon pathologies. METHODS Using the Nominal Group Technique, a panel comprised of sixteen specialists spanning nine countries was convened by the ESSKA-AFAS board. In preparation for the meeting, relevant questions were identified and supported by a systematic literature search. During the meeting, the panel members gave presentations on each question, and the evidence supporting each subject was then vetted by open discussion. Statements were thereafter adjusted on the basis of the discussion and voted upon to determine consensus using a 0-10 range Likert scale. Agreement was confirmed when a mean score of at least 7.5 was reached. CONCLUSION This ESSKA-AFAS consensus statement on the optimal management of peroneal tendon pathologies is the result of international and multidisciplinary agreement combined with a systematic review of the literature. LEVEL OF EVIDENCE V.
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Painful Os Peroneum Syndrome: Underdiagnosed Condition in the Lateral Midfoot Pain. Case Rep Radiol 2016; 2016:8739362. [PMID: 27478674 PMCID: PMC4949343 DOI: 10.1155/2016/8739362] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 06/23/2016] [Indexed: 11/17/2022] Open
Abstract
Os peroneum is an accessory ossicle located within the peroneus longus tendon. The painful os peroneum syndrome (POPS) results from a wide spectrum of conditions, including fractures, diastases, and other causes. POPS can result in tenosynovitis or discontinuity of the peroneus longus tendon with a clinical presentation of pain in the lateral aspect of the midfoot. Authors report a typical case of POPS, illustrating this entity through different imaging methods (radiographs, ultrasound, and magnetic resonance imaging). We emphasize the prevalence of this ossicle and discuss painful complications.
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van Dijk PAD, Lubberts B, Verheul C, DiGiovanni CW, Kerkhoffs GMMJ. Rehabilitation after surgical treatment of peroneal tendon tears and ruptures. Knee Surg Sports Traumatol Arthrosc 2016; 24:1165-74. [PMID: 26803783 PMCID: PMC4823352 DOI: 10.1007/s00167-015-3944-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/09/2015] [Indexed: 12/26/2022]
Abstract
PURPOSE The purpose of this study was to provide an overview of the available evidence on rehabilitation programmes after operatively treated patients with peroneal tendon tearsand ruptures. METHODS A systematic review was performed, and PubMed and EMBASE were searched for relevant studies. Information regarding the rehabilitation programme after surgical management of peroneal tendon tears and ruptures was extracted from all included studies. RESULTS In total, 49 studies were included. No studies were found with the primary purpose to report on rehabilitation of surgically treated peroneal tendon tears or ruptures. The median duration of the total immobilization period after primary repair was 6.0 weeks (range 0-12), 7.0 weeks (range 3.0-13) after tenodesis, 6.3 weeks (range 3.0-13) after grafting, and 8.0 weeks (range 6.0-11) after end-to-end suturing. Forty one percent of the studies that reported on the start of range of motion exercises initiated range of motion within 4 weeks after surgery. No difference was found in duration of immobilization or start of range of motion between different types of surgical treatment options. CONCLUSION Appropriate directed rehabilitation appears to be an important factor in the clinical success of surgically treated peroneal tendon tears and ruptures. There seems to be a trend towards shorter immobilization time and early range of motion, although there is no consensus in the literature on best practice recommendations for optimizing rehabilitation after surgical repair of peroneal tendon tears or ruptures. It is important to adjust the rehabilitation protocol to every specific patient for an optimal rehabilitation. LEVEL OF EVIDENCE Systematic Review, Level IV.
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Affiliation(s)
- Pim A. D. van Dijk
- />Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands , />Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands , />Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands , />Foot and Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Bart Lubberts
- />Foot and Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Claire Verheul
- />Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands , />Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands , />Orthopaedic Manual Therapy and (Sport)Physiotherapy, ManualFysion, Amsterdam, The Netherlands
| | - Christopher W. DiGiovanni
- />Foot and Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Gino M. M. J. Kerkhoffs
- />Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands , />Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands , />Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
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Guimerá V, Lafuente A, Zambrana L, Rodriguez-Niedenführ M, Sañudo JR, Vazquez T. The peroneocuboid joint: morphogenesis and anatomical study. J Anat 2014; 226:104-12. [PMID: 25384452 DOI: 10.1111/joa.12249] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2014] [Indexed: 01/20/2023] Open
Abstract
The peroneocuboid joint, between the peroneus longus tendon and the cuboid bone, has not been anatomically well-defined and no embryological study has been published. Furthermore, the ossification of the os peroneum (a sesamoid inside the peroneus longus tendon) and its associated pathology has been considered to be generated by orthostatic and/or mechanical loads. A light microscopy analysis of serially sectioned human embryonic and fetal feet, the analysis of human adult feet by means of standard macroscopic dissection, X-ray and histological techniques have been carried out. The peroneus longus tendon was fully visible until its insertion in the 1st metatarsal bone already at embryonic stage 23 (56-57 days). The peroneocuboid joint cavity appeared at the transition of the embryonic to the fetal period (8-9th week of gestation) and was independent of the proximal synovial sheath. The joint cavity extended from the level of the calcaneocuboid joint all the way to the insertion of the peroneus longus tendon in the 1st metatarsal bone. The frenular ligaments, fixing the peroneus longus tendon to the 5th metatarsal bone or the long calcaneocuboid ligament, developed in the embryonic period. The peroneus longus tendon presented a thickening in the area surrounding the cuboid bone as early as the fetal period. This thickening may be considered the precursor of the os peroneum and was similar in shape and in size relation to the tendon, to the os peroneum observed in adults. To the best of our knowledge, this is the first study to show that the os peroneum, articular facets of the peroneus longus tendon and cuboid bone, the peroneocuboid joint and the frenular ligaments appear during the embryonic/fetal development period and therefore they can not be generated exclusively by orthostatic and mechanical forces or pathological processes.
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Affiliation(s)
- V Guimerá
- Department of Orthopaedic Surgery and Traumatology, Hospital '12 de Octubre', Madrid, Spain
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Abstract
BACKGROUND There is a range of different types of tears and pathology of the peroneal tendons. One of the least common types is the tear of the peroneus longus associated with fracture, enlargement, or entrapment at the cuboid tunnel of the os peroneum. The purpose of this study was to evaluate the pathologic patterns of these uncommon peroneal tendon tears, to review the treatment, and to report the patient outcomes following treatment with excision of the os peroneum, debridement, and tenodesis of the peroneus longus to the peroneus brevis. METHODS A 5-year retrospective review of all patients with peroneal tendon tears identified 12 patients operatively treated for peroneus longus tendon tears with associated pathology of the os peroneum, and in whom there was a viable peroneus brevis. All patients were treated with an operative procedure consisting of excision of the os peroneum, debridement, and tenodesis of the peroneus longus to the peroneus brevis. Mean age was 51.5 (range, 33 to 73) years, including 7 males and 5 females. Operative and radiographic records were reviewed to characterize the nature of the peroneus longus tears and associated pathology. Preoperative and postoperative AOFAS hindfoot, SF-36 questionnaires, and Visual Analog Scale (VAS) pain scores were compiled and patient records were reviewed for complications. Mean follow-up after surgery was 63.3 (range, 12 to 114) months. RESULTS All of the patients had an os peroneum associated with a complex, irreparable tear of the peroneus longus tendon. The peroneus longus was typically enlarged, fibrotic, and adhered to the surrounding tissues. In 8 patients, the peroneus longus tendon tear was associated with a fracture of the os peroneum, and in 4 patients with an enlarged and entrapped os peroneum which prevented movement at the cuboid tunnel. Of the 12 patients, 9 had partial tears of the peroneus brevis, which were treated with debridement and suture repair. AOFAS hindfoot scores increased from a preoperative mean of 61 (range, 46 to 75) to a postoperative mean of 91.7 (range, 60 to 100). Mean preoperative SF-36 Physical Component Scores (PCS) increased from 36 to 52 postoperatively. Mean VAS pain scores decreased from a preoperative mean of 6.3 (range, 4 to 8) to a postoperative mean of 1.0 (range, 0 to 4). Complications included 2 patients with sural neuritis and 3 with superficial delayed wound healing successfully treated nonoperatively. CONCLUSION Tears of the distal peroneus longus tendon, which are much less commonly reported than tears of the peroneus brevis, can be associated with pathology of the os peroneum. Excision of the os peroneum, tendon debridement, and tenodesis of the longus to brevis was an effective surgical technique. LEVEL OF EVIDENCE Level IV, case series.
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Maurer M, Lehrman J. Significance of sesamoid ossification in peroneus longus tendon ruptures. J Foot Ankle Surg 2011; 51:352-5. [PMID: 22188903 DOI: 10.1053/j.jfas.2011.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Indexed: 02/03/2023]
Abstract
Ruptures of the peroneus longus tendon are uncommon, with a small number of case reports found in published studies. The presence of an os peroneum can predispose the peroneus longus tendon to rupture at the cuboid level with or without concomitant fracture, or fracture through a partite os peroneum. Whether the os peroneum can be represented by various stages of ossification is still a matter of debate. We present 2 cases of acute peroneus longus tendon rupture at the cuboid notch in the presence of an intact os peroneum in the ossified and nonossified form. We treated patients with excision of the os peroneum and tenodesis of the peroneus longus to the peroneus brevis tendon.
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Affiliation(s)
- Mark Maurer
- Crozer-Keystone Podiatric Surgical Residency, Springfield, PA, USA.
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Affiliation(s)
- Vincent Y Ng
- Ohio State University Medical Center, Department of Orthopedics, 4110 Cramblett Hall, 456 W 10th Ave, Columbus, Ohio 43210, USA. Vincent.Ng@ osumc.edu
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Chadwick C, Highland AM, Hughes DE, Davies MB. The importance of magnetic resonance imaging in a symptomatic "bipartite" os peroneum: a case report. J Foot Ankle Surg 2010; 50:82-6. [PMID: 20870425 DOI: 10.1053/j.jfas.2010.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Accepted: 08/02/2010] [Indexed: 02/03/2023]
Abstract
Although well reported in the literature, fractures of the os peroneum are uncommon and can be difficult to differentiate from symptomatic multipartite sesamoids. The location of the os peroneum within the tendon of peroneus longus can make it difficult to excise without compromising or sacrificing the tendon, and, subsequently, necessitating reconstruction or tenodesis to peroneus brevis. In this article, we describe the case of an adult female who presented with a fractured os peroneum that radiographically appeared bipartite, and necessitated excision with reconstruction of the peroneus longus. In retrospect, with the benefit of histology and careful review of the preoperative magnetic resonance image scans, simple excision of the medial fragment of the ossicle may have obviated the need for tendon reconstruction by maintaining the integrity of the peroneus longus tendon.
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Affiliation(s)
- Carolyn Chadwick
- Specialist Registrar in Orthopaedics, Sheffield Foot & Ankle Unit, Northern General Hospital, Sheffield, UK.
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