THIRD EDITION Baxter’s THE FOOT AND ANKLE IN SPORT David A. Porter, MD, PhD Sports Foot and Ankle Orthopedic Sports Medicine Methodist Sports Medicine/TOS Indianapolis Director of Foot and Ankle Rotation Orthopedics Indiana University Indianapolis, Indiana Lew C. Schon, MD, FACS Director of Foot and Ankle Fellowship and Service Department of Orthopedics MedStar Union Memorial Hospital Baltimore Associate Professor Department of Orthopedics and Biomedical Engineering Johns Hopkins University Baltimore, Maryland Elsevier 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 BAXTER’S THE FOOT AND ANKLE IN SPORT, THIRD EDITION ISBN: 978-0-323-54942-4 Copyright © 2021 by Elsevier, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. 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Abousayed, MD, MSc Don Baxter, MD Resident Former Clinical Professor and Fellowship Director Orthopedic Orthopedic Surgery Department, U of Texas Medical School and Baylor College of Medicine Albany Medical Center, Houston Texas Wynantskill, New York Associate Lecturer Karim Boukhemi, MD Orthopaedic Surgery UC Davis Dept of Orthopedics Kasr Al-Ainy Hospitals, Cairo University College of Medicine University of California, Davis Cairo, Egypt Sacramento, California Annunciato Amendola, MD Nathaly Caicido Cruz Professor Foot and Ankle Fellow Orthopedic Surgery Foot and Ankle Unit Orthopaedics and Traumatology Department Duke University Clínica Alemana Durham, North Carolina Santiago Orthopaedic Surgery Universidad del Rosario Robert B. Anderson, MD Bogotá Colombia Founder Foot and Ankle Surgery Universidad del Desarrollo Foot and Ankle Santiago, Chile OrthoCarolina, Charlotte, North Carolina Debbie Carroll, DA MPT Director, Foot and Ankle Physical Therapist Titletown Sports Medicine and Orthopedics Rehabilitation Bellin Hospital Methodist Sports Medicine Green Bay, Wisconsin Indianapolis, Indiana Gustavo Goncalves Arliano Sr, MD Rebecca Cerato, MD Professor Orthopaedic Surgeon Departamento de Ortopedia e T raumatologia Mercy Medical Center Universidade Federal de São Paulo The Institute for Foot and Ankle R econstruction São Paulo, Brazil Baltimore, Maryland Lara Atwater, MD, BA Felipe Andres Chaparro, MD Fellow Foot & Ankle Surgeon Institute for Foot and Ankle Reconstruction Foot & Ankle Center, Orthopaedic Surgery Mercy Medical Center Clinica Universidad de los Andes Baltimore, Maryland Santiago Foot & Ankle Surgeon Erin Richard Barill, BSc, PT/ATC Foot & Ankle Division, Orthopaedic Surgery Director of Sports Medicine Hospital San José Athletic Training Santiago, Chile Indianapolis Colts Indianapolis, Indiana Apisan Chinanuvathana, MD Lerdsin Hospital Gonzalo F. Bastias, MD Foot and Ankle Service Foot and Ankle Unit Institute of Orthopedic Surgery Department of Orthopedic Surgery Bangkok, Thailand Clinica Indisa Santiago, Foot and Ankle Unit Thomas O. Clanton, MD Instituto Traumatologico “Dr. Teodoro Gebauer” Director Foot and Ankle Sports Medicine Santiago, Chile Orthopedic Surgery The Steadman Clinic Vail, Colorado v vi CONTRIBUTORS J. Chris Coetzee, MD Eric Giza, MD Orthopedic Foot and Ankle Surgeon Chief, Foot & Ankle Surgery Orthopedics Department of Orthopedics Twin Cities Orthopedics University of California, Davis Minneapolis, Minnesota Sacramento, California Cesar de Cesar Netto, MD Joaquim Grava Assistant Professor Sport Club Corinthians Paulista (SCCP) Orthopedics and Rehabilitation Team Physician of Sport Club Corinthians Paulista University of Iowa Instituto Grava Iowa City, Iowa Clinical Fellow Michael C. Greaser, MD Foot and Ankle Surgery Assistant Professor Medstar Union Memorial Hospital Department of Orthopedic Surgery Baltimore, Maryland UT Health Science Center at Houston McGovern Medical School, Peter A. de Leeuw, MD PhD Houston, Texas Orthopedic Surgery Academic Medical Center Gregory P. Guyton, MD University of Amsterdam Attending Amsterdam, The Netherlands Orthopedic Surgery MedStar Union Memorial Hospital Peter Edwards, MD Baltimore, Maryland Senior Attending Orthopedic Surgery Amgad M. Haleem, MD, PhD Ohio Orthopedic Center of Excellence Assistant Professor Columbus, Ohio Orthopedic Surgery Oklahoma University, Richard D. Ferkel, MD Oklahoma City, Oklahoma Program Director Lecturer Sports Medicine Fellowship Orthopaedic Surgery Southern California Orthopedic Institute Cairo University Van Nuys, Los Angeles Cairo, Egypt Assistant Clinical Professor Orthopedic Surgery Mary Hastings, PT DP MSCI APT UCLA Program in Physical Therapy Los Angeles, California Washington University School of Medicine St. Louis, Missouri Lucas Fonseca, MD Unifesp Elias Hermida Orthopedic Department Orthopaedic and Traumatology Surgeon Federal University of São Paulo Member of the Mexican Orthopaedic and Traumatology College São Paulo, Brazil Certified by Mexican Orthopaedic and Traumatology Council -Inter- national AAOS member -International NASS member -Director of LCDR Apiporn Garnjanagoonchorn, MD PM&R Hospital de Ortopedia para Niños “German Díaz Lombardo” Mexico Research Fellow City -Director of Spine Surgery Fellowship, Universidad La Salle Orthopedic and Rehabilitation Director of Trauma Service at Hipódromo de las Americas, Mexico City MedStar Union Memorial Hospital John Hopkins Hospital Luis Felipe Hermida, MD Baltimore, Maryland Orthopaedic Surgeon Staff Physician Orthopaedics and Traumatology Rehabilitation Centro Medico ABC Somdech Phra Pinklao Hospital Mexico City, Mexico Bangkok, Thailand Foot and Ankle C onsultant Adam M. Huff, MD Indianapolis Colts, Community Physician Network Indianapolis Indianapolls, Indiana Foot and Ankle Consultant Indiana University, Purdue University, University Indianapolis Indiana CONTRIBUTORS vii Kenneth J. Hunt, MD Rover Krips, MD PhD Associate Professor and Chief, Foot and Ankle Surgery Orthopedic Surgery Department of Orthopedic Surgery Academic Medical Center University of Colorado, School of Medicine Amsterdam Aurora, Colorado Afdelind Orthopaedie Diaconessenhuis Leiden Jim Jastifer, MD Leiden, The Netherland Foot and Ankle Orthopedic Surgeon Surgery R. Jay Lee, MD Borgess Medical Center Assistant Professor Kalamazoo, Michigan Orthopedics Johns Hopkins Juan Pedro Kalb, MD Baltimore, Maryland Department of Orthopedic Surgery Clinica del Campestre, Shuyuan Li, MD PhD Medellin, Research Coordinator Antioquia, Colombia Steps2Walk Miami, Florida David C. Karli, MD, MBA Steadman Clinic-Physician Partner Gustavo Damasio Magliocca, MD Greyledge Technologies, LLC Medical Department Vail, CO Sociedade Esportiva Palmeiras São Paulo, Brazil Moosa Kazim, MD FRCS(C) Medical Director Dave Himanshu Malhar, MBBS, MS Ortho Orthopedics and Sports Medicine Orthopaedics Orthosports Medical Center, Abhishek Hospital Dubai, United Arab Emirates Vaddodara Gujarat, India Cesar Khazen Foot and Ankle Department Peter Maurus, MD Hospital de Clinicas Caracas Orthopedic Surgeon, Foot and Ankle Surgery Caracas, Venezuela Mercy Hospital Steindler Orthopedic Clinic Garbriel E. Khazen, MD Iowa City, Iowa Foot and Ankle Department Hospital de Clinicas Caracas, Jeremy McCormick, MD Caracas, Venezuela Associate Professor Orthopedic Surgery Amed Khedr, MD MSc PhD Washington University School of Medicine Lecturer St. Louis, Missouri Orthopedic Surgery Cairo University William C. McGravey, MD Cairo, Egypt Associate Professor of Orthopedic Surgery Clinical Fellow Orthopedic Surgery Orthopedic Surgery Orthopedic Residency Program Director University of Pittsburgh Orthopedic Surgery Pittsburgh, Pennsylvania University of Texas Health Science Center-Houston Houston, Texas Walter Klyce, MD Poggi Research Fellow Alireza Mousavian, MD Pediatric Orthopedics Assistant Professor Johns Hopkins University Orthopedic Surgery Baltimore, Maryland Mashhad University of Medical Sciences Mashhad Christopher Kreulen, MD MS Khorasan Razavi, Iran Assistant Professor Orthopedics University of California, Davis Medical Center Sacramento, California viii CONTRIBUTORS Mark S. Myerson, MD Carlos Enrique Ramirez, MD Executive Director and Founder Foot and Ankle Surgeon Steps2Walk Orthopedic Baltimore, Maryland Centro Médico Imbanaco Cali Devon Nixon, MD Professor Resident Orthopedic Surgery Department of Orthopedic Surgery Universidad del Valle Washington University in St. Louis Cali St. Louis, Missouri Valle Del Cauca, Colombia James A. Nunley, MD Andrew Roney, BA J Leonard Goldner Endowed Professor Foot and Ankle Orthopaedic Surgery Hospital for Special Surgery Duke University New York, New York Durham, North Carolina Gregory Y. Rowdon, MD Martin O’Malley, MD Team Physician Attending Orthopedic Surgeon Athletics Foot and Ankle Surgery Purdue University Hospital for Special Surgery (HSS) W Lafayette, Indiana New York Associate Professor Lew Schon, MD, FACS Orthopedics Director of Foot and Ankle Fellowship and Service Weill Medical College of Cornell University Department of Orthopedics New York, New York MedStar Union Memorial Hospital Baltimore Jakrapong Orapin, MD Associate Professor Orthopaedic Surgeon Department of Orthopedics and Biomedical Engineering Orthopaedic Surgery Johns Hopkins University Ramathibodi Hospital, Mahidol University Baltimore, Maryland Bangkok, Thailand Elliot N. Schwartz, MD Christian A. Ortiz Sr, MD Medical Director Chief Clark Miller Center for the Evaluation and Treatment of Stress Foot Ankle Surgery Fractures Clinica Alemana Northern California Institute for Bone Health, Inc. Orinda Santiago, Chile Institute Director Northern California Institute for Bone Health, Inc. Pedro Augusto Pontin Orinda, California Care Club and Sociedade Esportiva Palmeiras (SEP) Department of Orthopedic Surgery Nikesh Shah, MS (Ortho) University of Sao Paulo Director Orthopaedics David A. Porter, MD PhD Indrapuri Hospital Sports Foot and Ankle Vadodara Orthopedic Sports Medicine Gujrat, India Methodist Sports Medicine/TOS Indianapolis Rajiv Sumanlal Shah, MS (Ortho) Director of Foot and Ankle Rotation Foot & Ankle Orthopaedics Orthopedics Sunshine Global Hospital Indiana University Vadodara, India Indianapolis, Indiana Scott B. Shawen, MD Orthopedic Foot & Ankle Surgeon Foot and Ankle Institute OrthoCarolina Charlotte, North Carolina CONTRIBUTORS ix Jonathan P. Smerek, MS MD Adriaan van Zyl, MBChB MMed Associate Professor Visiting Consultant Orthopaedics Department of Orthopedics Orthopaedics Indiana University School of Medicine University of Stellenbosch Indianapolis, Indiana Cape Town Orthopedic Surgeon Kenneth Smith, BA MD Louis Leipoldt Mediclinic Resident Physician Cape Town Orthopedics Western Cape, South Africa University of Alabama at Birmingham Birmingham, Alabama Emilio Wagner, MD Staff Foot and Ankle Unit Yasuhito Tanaka, MD Orthopedic and Traumatology Professor and Chair Clinica Alemana Department of Orthopaedic Surgery Santiago, Head Foot and Ankle Unit Nara Medical University Orthopedic and Traumatology Kashihara, Japan Hospital Padre Hurtado, Santiago, Chile Michel A. Taylor, MD MSc FRCSC Orthopedic Surgery Norman E. Waldrop III, MD University of Arizona Attending Physician Tucson, Arizona Department of Orthopedic Surgery Andrews Sports Medicine and Orthopedic Center David Taylor, MD Birmingham, Alabama Sports Medicine Fellow Methodist Sports Medicine Xu Xiangyang, MD Indianapolis, Indiana Professor Department of Orthopaedics Wisutthinee Thueakthong, MD PM&R Shanghai Jiaotong University Medical College Physical Medicine&Rehabilitation Ruijin Hospital Bhumibol Adulyadej Hospital Shanghai, China Bangkok, Thailand Zijun Zhang, MD PhD Andrew M. Tucker, MD Director Medical Director Orthobiologic Lab MedStar Sports Medicine MedStar Union Memorial Hospital MedStar Union Memorial Hospital Baltimore, Maryland Baltimore, Maryland Yuan Zhu, MD Pim A.D. van Dijk, BSc Orthopedic Surgeon PhD Student Orthopedic Department Department of Orthopaedic Surgery Foot & Ankle Center Academic Medical Center Shanghai Ruijin Hospital Amsterdam, The Netherlands Shanghai Jiaotong University School Of Medicine Shanghai, China C. Niek van Dijk, MD PhD Head Department of Orthopaedic Surgery Academic Medical Center Amsterdam, The Netherlands P R E FA C E The third edition of “Baxter’s The Foot and Ankle in Sport” is ground-breaking videos educate more about our approach and finally here! We are excited to enhance your knowledge and the anatomy. skills with this unique updated textbook. So, “What’s new?” The chapter on Medical and Metabolic Considerations in the We have created five fresh chapters and have done major revi- Athlete is the most up-to-date and authoritive treatise on the sion on over 50% of the chapters. More than 50% of the authors subject. The full extensive chapter is available online, but a more are new to this edition and reflect diversity in experience and streamlined version is in the written text. We recommend you perspective. We have included new, younger authors, as well as avail yourself of the whole chapter. We have also included the retained some of the best names in orthopedic athletic foot and chapter, The Team in the Care of the Athlete, to help with assess- ankle care. To further enhance the reader’s experience, we have ing this critical area within the care of the athlete. The chapter incorporated a video section highlighting radiographic and specifically discusses how the healthcare provider and specialist ultrasonographic techniques as well as physical assessment of can interact with all the other providers, caregivers, patient rep- the dancer. resentatives, and team administrators. We have taken an inter- This text focuses on the evaluation, decision making, treat- view and key word approach and think it delivers at every level ment algorithms, and rehabilitation of the athlete at all levels. from perspective of the athlete, athletic trainer, general man- Often, the technical surgical approaches to athletes are similar ager, parent, and specialist. Tendonoscopy and Arthroscopy of to the nonathlete, but the decision making, impact on return other Foot and Ankle Joints looks at the ever-expanding role of to play, interplay with other healthcare providers and caregivers, arthroscopy and endoscopy in the evaluation and treatment of as well as the rehabilitation of the athlete take more specific the foot and ankle. The Military Athlete is a unique new chapter detailed education. We have attempted to elucidate this aspect that delineates and addresses needs, circumstances, and con- of care well. siderations in this special population of athletes. We are not We start the book off in this edition with a thorough outline aware of another foot and ankle text that addresses this. Lastly, and explanation of a good, standard foot and ankle examina- we have also added a chapter on the ever-expanding Orthobio- tion that we use on most all our athletes, Evaluation of the Ath- logics in Foot and Ankle Surgery. This chapter gives up-to-date lete. This is a complete rework of the 2nd edition chapter and information on biological additives, subchondroplasty, cartilage takes a totally different approach. To augment the chapter, we substitution, and other bone and cartilage options for operative have included extensive videos on examination to better help and nonoperative treatment. We think it is a must-read for all the reader incorporate the exam into their practice. We have those caring for the athlete. also integrated unique ultrasound examination of common foot We hope you enjoy the book. We welcome any feedback you and ankle ailments and dynamic radiographic examination of would like to give us. As always, we hope all your foot and ankle other foot and ankle injuries. A series of videos on assessment of patients get better. the dancer is presented to enlighten our readers. We hope these David A. Porter, MD, PhD, and Lew Schon, MD, FACS xi