Introduction: A calcaneus fracture is a rare heel bone fracture which has potentially debilitating results. For long there has been a debate over the preferred mode of treatment – surgical or conservative. The aim of this study was to compare the outcomes of operative and conservative management. Material and methods:30 patients with unilateral, closed, displaced, intra- articular fractures of the calcaneus were selected during December 2020 to January 2022 who were carefully segregated according to fracture severity and occupation into operative and conservative group. AOFAS score was calculated to assess functional outcome at follow up of 12, 26 & 52 weeks. Correlation of Bohler’s and Gissane Angle with functional outcome was observed. Time to return of employment was observed. Results: The mean age was 33.4 with male preponderance (93%), 40% of them being construction worker by occupation. The most common mode of trauma was fall from height (83%). At 1 year follow up – 85.7% & 14.3% patients had excellent and good outcome respectively, and 87.5% and 12.5% patients had excellent and fair outcome respectively; in the operative and conservative group respectively. The mean time of return to employment was primarily affected by the type of occupation, severity of fracture and not by the type of management. Conclusion: Operative intervention with plating is the preferred mode of treatment, more so as the fracture severity increases in terms of better functional outcome and return to employment at the end of 1-year. Chronic pain was the most common complication in both groups.

The mainstay of treatment in Ponseti's method of clubfoot correction is tendoachillis tenotomy. Alternatively we have tried botulinum toxin type A injection into gastronemius-soleus muscle to relax it and thus lengthen to give 15% dorsiflexion. A prospective study was done among all the patients below 2 year of age with Idiopathic Clubfoot who were treated by Ponseti method. When foot is ready for tenotomy after serial casting , either a tenotomy or BOTOX (10 IU/Kg) injection was given . Babies were followed up for a minimum of 12 months. The severity of the deformity was graded according to Pirani Scoring. A total of 35 feet confirmed by experts to have Untreated Idiopathic Clubfoot were enrolled in the study.
Observations

Total feet- 35
No. of children- 20
Bilateral deformity- 15
Unilateral deformity- 05
Males- 12 , Females- 8Results:
Average age at presentation – 5months
Average number of cast before tenotomy or botox : 5

Children who presented late (age at presentation) required more number of casts before any intervention when compared to those who presented early.In unilateral cases , affected limb is shorter than normal.Mean pirani score in botox grp pre and post treatment are 5 and 0.5. Mean pirani score in tenotomy grp pre and post treatment are 5 and 0
Conclusion :
Chemical tenotomy using botulinum toxin type A is equally effective as surgical tenotomy in idiopathic CTEV treated by Ponseti method.

ABSTRACT
Introduction: A new classification system for ankle fractures have been proposed by the author to address the drawbacks of the recently used systems, Lauge-Hansen, Denis weber and AO/OTA.
The new system is descriptive, and includes the medial and lateral malleoli and the syndesmotic injury.
In this study we are testing the validity of the new system.

Methods:44 randomly selected AP X ray films of ankle fractures were classified independently by six raters; two foot and ankle surgeons, two orthopedic surgeons, and two orthopedic residents on two occasions. The author and a radiologist have rated the x-rays and that was regarded as the gold standard classification for each case. The ratings were subsequently analyzed and then compared to the gold standard classification and validity calculated.
Results: The inter-observer agreement between the six raters was 50%, corresponding to kappa 0.55 and weighted kappa 0.62, the Intra-observer variation was 80.7%, corresponding to kappa 0.61 and weighted kappa 0.66. An agreement of 79.7% equivalent to kappa 0.63, and weighted kappa 0.76 the ratings against the gold standard rating. The agreement corresponds to substantial according to Landis and Koch. The kappa value of inter- and Intra-observer agreement ranged from 0.62 to 0.76.
Conclusions: The study results show substantial agreement between the six raters, and between the raters and the gold standard rating. Consequently, we conclude that the new ankle fracture classification system accurate and valid.

Introduction. We present our experience in treating the wounded who received mine-explosive injuries (MEI) in the 2020 Patriotic War in Azerbaijan to liberate the territories occupied by Armenia.
Materials and methods: examination and treatment of 6 wounded with MEI in the back of the foot. The average age of patients is 23.6 years (min. 20, max.-27). The term of admission of patients for reconstructive treatment is from 15 to 40 days. All patients had damage according to the classification of Gustilo R.B. and Anderson J.T. 3-B-C. According to Sanders classification -4. All patients refused amputations and agreed to undergo reconstructive surgery. All patients underwent 4-5 reconstructive surgeries, including 2 patients who underwent plasty of wounds in the heel area with a sural flap. The use of the Ilizarov technique and apparatus and the new operation developed by us made it possible to avoid amputations.
Results. In all patients, the infectious process was eliminated and the hindfoot was restored. The shortening was eliminated in 4 patients. Everyone walks in orthopedic shoes with a full load using a cane. Two have moderate pain.
Discussion: In our opinion, the removal of all fragments of the calcaneus and talus is the prevention of the infectious process and makes it possible to create a support from the distal tibia. One of the main points in the reconstruction is the relief of the infectious process.
Conclusion: We believe that the proposed direction of treatment of such wounded needs further research and improvement.

Abstract: Background: Symptomatic osteochondral lesions of the talus are a common condition. In up to half of cases presented with ankle sprains, secondary chondral lesions have been described. manifestations usually nonspecific including pain, swelling, stiffness, and mechanical symptoms of locking and catching. Surgical treatment is often required especially in chronic cases and acute cases with displaced articular fragments. Patients and Methods: Between March 2014 and March 2018, 18 patients underwent autologous osteochondral transplantation for the management of chondral lesion of the talus. The mean patient age at the time of surgery was 33.34 years (range, 20-43 years). All patients were followed for a minimum of 1 year after surgery. The mean follow-up time was 16.5 months (range, 12-24 months). Clinical outcomes were evaluated according to a visual analog scale (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS) score were used in all cases. Results: The mean FAOS scores improved from 49.43 points preoperatively to 84.62 points postoperatively (range, 75-95 points).The mean VAS score was significantly improved from 7.16 ± 0.8 to 2.6 ± 1.1. One patient reported donor site knee pain after surgery, and one patient required a bone graft and refixation of the medial malleolar osteotomy. Conclusions: According to this study, the treatment of patients with full-thickness and osteochondral defects in the talus with osteochondral autografting gave significant improvement with relative efficacy, safety, and cost-effectiveness. Keywords; talus; chondral lesions; Osteochondral fracture; OATS Level of evidence: IV

Background- The present study describes a case series of five symptomatic adults with type II accessory navicular bone and flexible pesplanovalgus deformity. Methods- Five patients underwent osteosynthesis using compression screw and posterior medial displacement calcaneal osteotomy. Results-The mean follow-up was 59.6±14.87 months. The mean age of the patients was 28.6±7.16. The mean synchondrosis-ossicle-talar angle was 34.65±18.49 degrees. There was a 100% union and no recurrence. One patient had transient sural nerve neuroma which recovered within 6 months. The American Orthopaedic Foot and Ankle Society scoring system improved from 64.41±0.93 to 98.89±2.62 at 36 months (F=106.28, P<0.01). The visual analog scale scores improved from 7.30±1.70 to 041±0.18 at 36 months (F=30.48, P<0.01). The calcaneal pitch angle (P=0.0001) increased from 15.50±0.73 to 20.39±0.790 while the Meary’s angle (P=0.0001) decreased from 14.14±0.50 to 10.33±0.970. Conclusion- Osteosynthesis and medial displacement osteotomy shows promising results in flexible pes planovalgus.

Background: neglected rupture of the tendoachillis is technically challenging as the tendon is usually retracted and there is a large defect after proper debridement and scar excision. Different procedures and techniques were described for the management of such patients. Direct repair may not be possible and augmentation methods are challenging when the defect exceeds 5 cm, especially if the distal stump is grossly tendinopathic. This study aimed to evaluate the functional outcomes of management of 13 patients presented with neglected insertional rupture of tendoachillis by using hamstring autograft fixed through transosseous tunnel Methods: ipsilateral hamstring autograft has been used in the reconstruction of tendoachilis using a transosseous tunnel and non-absorbable sutures. Results: there was a significant improvement in both VAS and AOFAS Ankle-Hindfoot scales. At one year, the mean VAS score was 0. The mean AOFAS Ankle-Hindfoot score was 94±5. The mean operative time was 70±15 minutes. The patient was back to full daily function, could single-leg heel raise, and was gradually returning to sport. One case had a superficial wound infection that was managed by repeated dressing and antibiotic therapy. Conclusion: using hamstring autograft in the reconstruction of neglected Achilles rupture and transosseous fixation can achieve satisfactory improvements in patient-reported outcomes up to 1-year post-surgery.
Keywords: hamstring autograft, transosseous tunnel, Neglected Tendoachillis rupture.

Introduction: We aim to investigate the morphology of heel bone using CT-based morphometrics in our population. The objective of this study is to analyse the structural and trabecular pattern variations of calcanei and to find out the relationship corresponding to age, sex, and demographics. Materials and Methods: It was a Cross-sectional study. The patients underwent 3D NCCT evaluation of foot and ankle for any reason at AIIMS, Jodhpur during the period of study. No patient was subjected to CT study exclusively for the purpose of this study. The sagittal, coronal, and axial scans were acquired from the CT scan studies (Siemens SOMATOM Definition Flash Dual Source Dual Energy 128 X 2 slice CT scanner) of sample population in the form of DICOM (Digital Imaging and Communications in Medicine) files. The included studies were analyzed using the Horos® software version 3.3.5 (Horos 92 Project). The maximum stretch of every parameter was pre-defined and marked considering their clinical relevance in field of Orthopaedics and Trauma. All statistical analysis was carried out using SPSS statistics version 25.0 (SPSS Inc., Chicago, IL, USA). Results and Conclusions: There is scarcity of analytical studies representing calcaneal morphology in Indian scenario. The ideal measurements of the implants (various plates and screws) for Indian patients can be worked out and generalized using a CT based analysis of intact calcanei. It can have many other wide ranging implication in context of gait analysis, osteoporosis, mapping of calcaneum, etc.

Introduction:TaloCalcaneal Coalition is often associated with a rigid valgus flatfoot. Surgical resection alone is the treatment of choice.But in TCC with severe valgus flatfoot deformity with hindfoot valgus>16°and posterior subtalar facet narrowing>50% resection alone does not alleviate the painful symptomatology.osteotomy 3C,with/without coalition resection,has been used in our department since 2013 to relieve symptoms while correcting foot deformity and preserving mobility of the talonavicular/calcaneo-cuboid joints.Material and methods:between 2013 and 2020,4 adolescents aged 15 ½ years on average (14 to 17 years), presented with a symptomatic TCC associated with severe valgus flatfoot.All of them benefited from a resection of the TCC associated with a 3C osteotomy.Clinical follow-up ranged from one year to 7 years.ResultsThe mean follow-up was 4 years.The patients had a favourable evolution with disappearance of pain and excellent correction of the deformityThe 3C osteotomy completely corrected the valgus deformity.Discussion:It is generally accepted that resection is the treatment of choice for a small TCC associated with a large posterior facet without degenerative lesions and a minimal valgus deformity of the hindfoot.However,the surgical procedure of choice for TCC associated with a flat foot with severe valgus deformity has not been definitively determined.Although triple arthrodesis has been recommended for those who do not meet all three criteria,we believe that treatment of the valgus deformity appears to be as important as that of the coalition by combining the 3C osteotomy with resection.Conclusion: 3C osteotomy is effective in correcting the deformity and relieving pain in rigid flat feet, as well as in flexible flat feet.