Graham A Hamilton

Kaiser Family Foundation, Washington, Washington, D.C., United States

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Publications (25)7.65 Total impact

  • Christy M King, Graham A Hamilton, Lawrence A Ford
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    ABSTRACT: Hallux valgus with or without first ray insufficiency has been strongly implicated as a contributing factor in lesser metatarsal overload. The principle goals of a bunionectomy are to relieve the pain, correct the deformity, and restore first metatarsophalangeal joint congruity. Until now, little evidence has been available to assess the effects of bunionectomy procedures on forefoot pressure. The primary aim of the present prospective study was to evaluate the preoperative and postoperative plantar pressures after 2 specific bunionectomies: the chevron bunionectomy and Lapidus arthrodesis. A total of 68 subjects, 34 in each group, were included for radiographic and pedographic evaluation. Both procedures demonstrated radiographic improvements in the mean intermetatarsal and hallux abductus angles. The mean hallux plantar pressure decreased significantly in both procedure groups (p < .001). However, Lapidus group exhibited an increase in the mean fifth metatarsal head plantar pressure (p = .008) and pressure under the fifth metatarsal as a percentage of the total forefoot pressure (p = .01). Furthermore, the pressure under the second metatarsal as a percentage of the total forefoot pressure decreased significantly (p = .01). This study suggests that the Lapidus arthrodesis and chevron bunionectomy both provide correction for hallux valgus deformity, but when comparing forefoot load sharing pressures, the Lapidus arthrodesis appeared to have greater influence on the load sharing distribution of forefoot pressure than did the bunionectomy employing the chevron osteotomy.
    The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons 07/2014; 53(4):415-9.
  • Christy M. King, Graham A. Hamilton, Lawrence A. Ford
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    ABSTRACT: Hallux valgus with or without first ray insufficiency has been strongly implicated as a contributing factor in lesser metatarsal overload. The principle goals of a bunionectomy are to relieve the pain, correct the deformity, and restore first metatarsophalangeal joint congruity. Until now, little evidence has been available to assess the effects of bunionectomy procedures on forefoot pressure. The primary aim of the present prospective study was to evaluate the preoperative and postoperative plantar pressures after 2 specific bunionectomies: the chevron bunionectomy and Lapidus arthrodesis. A total of 68 subjects, 34 in each group, were included for radiographic and pedographic evaluation. Both procedures demonstrated radiographic improvements in the mean intermetatarsal and hallux abductus angles. The mean hallux plantar pressure decreased significantly in both procedure groups (p < .001). However, Lapidus group exhibited an increase in the mean fifth metatarsal head plantar pressure (p = .008) and pressure under the fifth metatarsal as a percentage of the total forefoot pressure (p = .01). Furthermore, the pressure under the second metatarsal as a percentage of the total forefoot pressure decreased significantly (p = .01). This study suggests that the Lapidus arthrodesis and chevron bunionectomy both provide correction for hallux valgus deformity, but when comparing forefoot load sharing pressures, the Lapidus arthrodesis appeared to have greater influence on the load sharing distribution of forefoot pressure than did the bunionectomy employing the chevron osteotomy.
    The Journal of Foot and Ankle Surgery. 01/2014; 53(4):415–419.
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    ABSTRACT: Obesity is an epidemic in the United States and is associated with an increased risk of musculoskeletal problems. Rotational injuries of the ankle with a Weber C fibula fracture have a greater risk of syndesmosis disruption and instability. The goal of the present study was to explore the association between obesity and ankle fractures. Using a retrospective review, the radiographs of 280 patients with an ankle fracture were reviewed and classified using the Weber classification, which was then associated with the body mass index, gender, age, diabetes, tobacco use, and osteoporosis. Patients with a body mass index of 30 kg/m(2) or greater (odds ratio 1.78), men (odds ratio 1.74), and age 25 years or younger (odds ratio 3.97) had greater odds of having a Weber C ankle fracture (compared with Weber A and B) and Weber C and B (compared with Weber A). Diabetes mellitus, osteoporosis/osteopenia, and current tobacco use were not significantly associated with the severity of the ankle fracture. The results from the present study suggest that obesity presents a greater risk of sustaining a more proximal distal fibula fracture.
    The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons 07/2012; 51(5):543-7.
  • Ruth A Peace, Graham A Hamilton
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    ABSTRACT: End-stage arthritis of the first metatarsophalangeal joint (MTPJ) typically results in anexophytic process with marked limitation of motion. Pain may occur from the degenerative process itself and/or the bone spur formation that may become directly inflamed from shoe gear. The best surgical treatment for end-stage arthrosis of the big toe joint continues to be a controversial topic despite hallux rigidus being recognized clinically for more than 100 years. Although joint-sparing procedures are considered, arthrodesis is recommended, as this procedure is definitive and produces predictable results.
    Clinics in Podiatric Medicine and Surgery 07/2012; 29(3):341-53.
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    ABSTRACT: Open reduction with internal fixation for unstable ankle fractures is relatively predictable with excellent outcomes. However, the management of ankle fractures in the elderly remains less predictable secondary to the various co-morbidities associated with advanced age. A retrospective chart review of 216 patients over the age of 60 that sustained an ankle fracture, was performed to determine the incidence of complications after ORIF of ankle fractures in an elderly population in the perioperative course. Secondly, the incidence of complications in patients that had locking plate fixation compared to those that had non-locking plate fixation was determined. Lastly, the effect of early weight bearing on the incidence of complications was analyzed. There was not a statistically significant difference in the complication rates between the group with co-morbidities (19.01%) and those without (11.96%). The postoperative complication with the highest incidence was wound dehiscence (9.7%), and only diabetes significantly predicted wound dehiscence. The fixation construct and weight-bearing protocol failed to significantly predict any of the indexed complications. Overall, the results suggest that surgical treatment of unstable ankle fractures in the elderly is fairly predictable with an acceptable complication rate. The complication rates are higher with increased age and diabetes, but they failed to reach statistical significance. Conventional plating appears to provide adequate stability without increased risk of hardware failure. In addition patients that were allowed to walk within the first 2 weeks postoperatively did not experience a higher rate of hardware failure.
    Foot and Ankle Surgery 06/2012; 18(2):103-7.
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    ABSTRACT: Despite a late start within the realm of arthroscopy, foot and ankle arthroscopy proves to be an important diagnostic and treatment tool for the foot and ankle specialist. As indication for arthroscopy increases, complications associated with foot and ankle arthroscopy must be revisited. We reviewed 405 foot and ankle arthroscopic procedures performed on 390 patients in 4 different facilities over a 3-year period extending from January 2005 to August 2008. Two-hundred-sixty foot and ankle arthroscopic procedures on 251 patients met our inclusion criteria. A total of 246 ankle and 14 posterior subtalar arthroscopic procedures were performed with a mean follow-up of 10.7 ± 3.5 months. Patient demographics, preoperative findings, intraoperative technique, and postoperative course were reviewed. We failed to identify statistically significant predictive factors for complications. Arthroscopy performed in combination with adjunctive procedures showed a trend toward higher complication rate, although statistical significance was not noted. Overall, 20 cases (7.69%) experienced arthroscopy-related complications, and this finding was comparable with previously published results. The most common complication was cutaneous nerve injury, which involved 9 cases (3.46%), and localized superficial infection, which involved 8 cases (3.08%). Injury to the superficial peroneal nerve accounted for 5 of the cutaneous nerve injuries. There were no cases of arthroscopy-related vascular injury. All cases of superficial postoperative infection resolved with antibiotic therapy, and none of the cases required return to the operating room. These results were also similar to published data.
    The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons 12/2011; 51(3):281-4.
  • Jake Lee, Graham Hamilton, Lawrence Ford
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    ABSTRACT: Chronic lateral ankle instability (CLAI) can be a debilitating condition. The literature has shown that it is also associated with a number of intra-articular pathologies of the ankle. Some argue that if unaddressed, these intra-articular pathologies can predispose patients to osteoarthritis. Previous studies of patients who underwent prelateral stabilization ankle arthroscopy have shown a high number of pathologies, including osteochondral lesions of the talus. The current study reviewed a consecutive series of patients diagnosed with CLAI who underwent ankle arthroscopy followed by a modified Brostrom-Gould procedure to validate the previous studies. Intraoperative reports on 28 ankles in 28 consecutive patients were reviewed from 2004 to 2008. All 28 ankles (100%) demonstrated varying degrees of synovitis. Talar cartilage fibrillation was observed in 7 patients (25%), and talar dome cartilage defect was visualized in 4 patients (14%). Talar dome osteochondral defect was seen in 2 patients (7%), loose bodies were found in 3 patients (11%), Bassett's lesion was seen in 2 patients (7%), and anterolateral impingement was seen in 4 patients (14%). Distal anterior tibial osteophytosis was seen in 4 patients (14%). This study confirms the high number of intra-articular pathologies in association with CLAI.
    Foot & Ankle Specialist 09/2011; 4(5):284-9.
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    ABSTRACT: Medial column arthrodesis and calcaneal osteotomies are commonly used for adult acquired flatfoot surgical reconstruction. In this retrospective study, 41 patients (47 feet) with a mean age of 55 ± 13.5 years underwent a medial column arthrodesis, with or without calcaneal osteotomy, between 1999 and 2007. The indication for surgery was a painful flatfoot deformity with peritalar subluxation, and a fault in the naviculocuneiform joint. At a mean of 9.6 (range 3-43) months postoperatively, in patients who underwent a medial column arthrodesis, radiographs showed a mean decrease in the talonavicular coverage angle of 10.2° ± 8.7° (P < .001), and mean increases in the lateral talometatarsal and calcaneal inclination angle of 10.7° ± 5.1° (P < .001) and of 3.2° ± 2.7° (P < .001), respectively. In patients who underwent a combined medial column arthrodesis and a medializing calcaneal osteotomy, the talonavicular coverage angle decreased by a mean of 12.1° ± 6.1° (P < .001), while the lateral talometatarsal angle and calcaneal inclination angle increased by a mean of 12.3° ± 6.1° (P < .001) and 3.1° ± 2.7° (P < .001), respectively, from preoperative values. Four nonunions (4 of 47, 8.51%) occurred at the naviculocuneiform joint and 1 nonunion (1 of 32, 3.13%) occurred at the tarsometatarsal joint. These findings demonstrate marked improvement of radiographic flatfoot parameters following a medial column arthrodesis with or without a medializing calcaneal osteotomy.
    The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons 01/2011; 50(2):176-81.
  • Graham A Hamilton, Lawrence A Ford, Sandeep Patel
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    ABSTRACT: Arthrodesis of the first metatarsophalangeal joint is a powerful procedure that can improve the load-bearing capabilities of the forefoot and assist in medial arch stability. It is the mainstay of treatment for patients with severe arthritic deformity of the great toe joint, because it addresses the importance first ray weight-bearing has on the rest of the foot. In select individuals, fusion can also be effective as a primary procedure in the treatment of hallux valgus. Rather than cause detrimental effects to the function of the foot, this article suggests that first metatarsophalangeal arthrodesis can actually improve faulty mechanics secondary to a dysfunctional joint.
    Clinics in Podiatric Medicine and Surgery 08/2009; 26(3):459-73, Table of Contents.
  • Lawrence A Ford, Graham A Hamilton
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    ABSTRACT: Selecting the appropriate surgical procedure for the treatment of hallux valgus not always is clear. Every procedure has its merits depending on the individual and circumstances. Correcting pain and deformity, avoiding recurrence, and preserving or re-establishing normal foot function should be the goals of bunion surgery. Although radiographic measurements can be helpful, their weight is not as important as understanding the function of the first ray in each patient. This article attempts to guide procedure selection based on re-establishing normal foot function as much as possible while meeting patients' goals and expectations.
    Clinics in Podiatric Medicine and Surgery 08/2009; 26(3):395-407, Table of Contents.
  • Shannon M Rush, Meagan Jennings, Graham A Hamilton
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    ABSTRACT: Surgical treatment of talus fractures can challenge even the most skilled foot and ankle surgeon. Complicated fracture patterns combined with joint dislocation of variable degrees require accurate assessment, sound understanding of principles of fracture care, and broad command of internal fixation techniques needed for successful surgical care. Elimination of unnecessary soft tissue dissection, a low threshold for surgical reduction, liberal use of malleolar osteotomy to expose body fracture, and detailed attention to fracture reduction and joint alignment are critical to the success of treatment. Even with the best surgical care complications are common and seem to correlate with injury severity and open injuries.
    Clinics in Podiatric Medicine and Surgery 02/2009; 26(1):91-103.
  • Shannon M Rush, Graham A Hamilton, Lynn M Ackerson
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    ABSTRACT: A review was conducted of 23 patients who underwent implantation of mesenchymal stem cell allograft for revision foot or ankle surgery. Composed of viable mesenchymal stem cells derived from cadaveric donor tissue, the graft had osteogenic, osteoinductive, and osteoconductive properties, and was capable of direct new bone formation at the site of implantation. In all of the cases, radiographic new bone formation was observed at the area of implantation and a 91.3% union rate was observed, and no evidence of graft rejection or complications associated with implantation were recorded. Wilcoxon rank sum tests were used to determine whether gender, diabetes, chronic renal insufficiency, neuropathy, number of previous surgeries, and smoking were associated with time to healing. Spearman's rank correlation coefficient was calculated in an effort to identify the influence of continuous numeric variables on the time to bone healing. Based on the outcomes observed in this retrospective study, it appears that mesenchymal stem cell allograft is a beneficial biological adjunct to bone healing, and serves as a suitable bone autograft substitute in revision foot and ankle surgery. Level of Clinical Evidence: 4.
    The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons 01/2009; 48(2):163-9.
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    ABSTRACT: We reviewed the medical records and radiographs of 35 patients (3 males, 32 females; mean age 40.8 years) who underwent isolated, modified Lapidus arthrodesis for forefoot pathology in 39 feet. The purpose of the review was to evaluate the structural radiographic changes of the medial longitudinal arch (MLA) following isolated arthrodesis of the first tarsometatarsal joint. Pre- and postoperative standardized measurements of sagittal plane views of the foot were assessed to examine change in the MLA construct. The talo-first metatarsal angle and medial cuneiform height both had statistically significant changes, 2.97 degrees (range, 0-11.5 degrees) and 3.44 mm (range, 0-13 mm) (P < .0001) respectively. Our findings suggest that the Lapidus arthrodesis may influence the medial longitudinal arch.
    The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons 01/2008; 47(6):510-4.
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    ABSTRACT: To identify complications that necessitated revision surgery after the primary operation, a multicenter retrospective chart review was conducted for 646 patients who received either a modified chevron-Austin osteotomy (270 patients), modified Lapidus arthrodesis (342 patients), or closing base wedge osteotomy (34 patients) to correct hallux valgus deformity. Revision surgery for complications was calculated and compared. All surgery was performed by 1 of 5 staff foot and ankle surgeons at Kaiser Permanente medical centers. Complications included recurrent hallux valgus, iatrogenic hallux varus, painful retained hardware, nonunion, postoperative infection, and capital fragment dislocation. The rates of revision surgery after Lapidus arthrodesis, closing base wedge osteotomy and chevron-Austin osteotomy were similar with no statistical difference between them. The total rate for re-operation was 5.56% among patients who received chevron-Austin osteotomy, 8.82% among those who had a closing base wedge osteotomy, and 8.19% for patients who received modified Lapidus arthrodesis. Among patients who had the chevron-Austin osteotomy procedure, rates of re-operation were 1.85% for recurrent hallux valgus and 1.48% for hallux varus. Among patients who had the modified Lapidus arthrodesis, rates of re-operation were 2.92% for recurrent hallux valgus and 0.29% for hallux varus. Among patients who had the closing base wedge osteotomy, rates of reoperation were 2.94% for recurrent hallux valgus and 2.94% for hallux varus. The collected comparative complication rates should serve to provide adjunctive information for foot and ankle surgeons and patients regarding hallux valgus surgery.
    The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons 01/2008; 47(4):267-72.
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    ABSTRACT: This multicenter study retrospectively reviewed the medical records and radiographs of 15 consecutive patients (17 feet; mean patient age, 54.1 years), who underwent revision "bone-block" Lapidus arthrodesis for a symptomatic nonunion. In all cases but one, the procedure was performed with ipsilateral autogenous bone grafting. All cases used either screw fixation or a combination of screw and plate fixation. Patients were monitored for a minimum of 6 months postoperatively to assess clinical and radiographic union. Successful union was seen in 14 (82%) of the 17 feet that underwent revision. Nonunion was documented in 3 (18%) cases. These results support a favorable rate of union with the described surgical technique. Chi-square tests of association were used to determine whether gender, fixation, bone stimulation, and smoking were predictive of or associated with bone healing. Active smoking in the perioperative period was a predictor of nonunion (P = .05). Based on these findings, the authors recommend aggressive preoperative counseling, and smoking should be considered a relative contraindication to revision surgery.
    The Journal of Foot and Ankle Surgery 01/2007; 46(6):447-50. · 0.86 Impact Factor
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    ABSTRACT: A retrospective radiographic review of 57 feet was conducted to compare maintenance of correction of the modified Lapidus arthrodesis with the first metatarsal closing base wedge osteotomy for moderate to severe hallux valgus deformity. Radiographic parameters were measured on the preoperative, early postoperative, and greater than 11-month postoperative weightbearing radiographs. These measurements included the intermetatarsal angle, the hallux abductus angle, and the tibial sesamoid position. The patients who underwent the closing base wedge osteotomy had an average initial intermetatarsal correction of 10.4 degrees; for the modified Lapidus arthrodesis, it was 7.6 degrees. The patients who underwent the closing base wedge osteotomy had an average loss of intermetatarsal correction of 2.55 degrees from early to late postoperative radiographs; for the modified Lapidus arthrodesis, it was 1.08 degrees. Our results demonstrated that the modified Lapidus arthrodesis maintains correction to a greater degree than the first metatarsal closing base wedge osteotomy with statistical significance (P = .0039). Both the modified Lapidus arthrodesis and the first metatarsal closing base wedge osteotomy are effective procedures with respect to degree of radiographic correction for moderate to severe hallux valgus deformities.
    The Journal of Foot and Ankle Surgery 01/2007; 46(5):358-65. · 0.86 Impact Factor
  • Shannon M Rush, Lawrence A Ford, Graham A Hamilton
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    ABSTRACT: To evaluate morbidity associated with surgical lengthening of the gastrocnemius, medical records were reviewed retrospectively for 126 patients (mean age, 49.7 years; range, 8-78 years) who had undergone open gastrocnemius recession. Ten patients had isolated recession; 116 had gastrocnemius recession with an additional foot or ankle procedure on the ipsilateral limb. During a mean follow-up period of 19 months (range, 6-50 months), all patients were examined for any postoperative complications associated with the recession. Complications were defined as the presence of postoperative infection, wound dehiscence, nerve problems, decreased muscle strength, scar problems, or calcaneus gait (overlengthening). Uncomplicated outcome was defined as absence of all these complications and return to regular activity, both occurring during a follow-up of at least 6 months. Postsurgical complications developed in 9 (6%) of the 126 patients: 6 (4%) had scar problems, 2 (1.33%) had wound dehiscence, 2 (1.33%) had infection, 3 (2%) had nerve problems, and 1 (0.67%) developed complex regional pain syndrome. No patient complained of either a limp or gait disturbance. Neither persistent decrease in muscle strength nor calcaneus gait was seen. These data suggest that the open gastrocnemius recession procedure has low associated morbidity.
    The Journal of Foot and Ankle Surgery 05/2006; 45(3):156-60. · 0.86 Impact Factor
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    ABSTRACT: Medical records were reviewed for 90 patients (101 amputations) (mean age 64.3 years, range 39 to 86 years) who underwent transmetatarsal amputation (TMA). The mean follow-up period, excluding those patients who either died or went on to a more proximal amputation less than 6 months after TMA, was 2.1 years. Patients were examined for any postoperative complications associated with TMA. Complications were defined as hospital mortality occurring less than 30 days postoperatively; stump infarction with or without more proximal amputation; postoperative infection; chronic stump ulceration; stump deformity in any of 3 cardinal planes; wound dehiscence; equinus and calcaneus gait. An uncomplicated outcome was defined as the absence of all these complications and an ability to walk on the residuum with a diabetic shoe and filler after a minimum follow-up of 6 months. The chi(2) tests of association were used to determine whether diabetes, a palpable pedal pulse, coronary artery disease, end-stage renal disease, cerebral vascular accident, or hypertension were predictive of or associated with healing. A documented palpable pedal pulse was a predictor of healing (P = .0567) and of not requiring more proximal amputation (P = .03). End-stage renal disease predicted nonhealing (P = .04). A healed stump was achieved in 58 cases (57.4%). Postsurgical complications developed in 88 cases (87.1%). Two patients died within 30 days postoperatively. These data suggest that TMA is associated with high complication rates in a diabetic and vasculopathic population.
    The Journal of Foot and Ankle Surgery 01/2006; 45(2):91-7. · 0.86 Impact Factor
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    ABSTRACT: Fracture dislocations/subluxations of the tarsometatarsal joint are complex injuries that are often misdiagnosed. Prompt recognition and treatment of Lisfranc injuries decrease the likelihood of long-term sequelae. The original (1909) classification system was modified in 1982 and again in 1986. The 1986 classification system, developed by Hardcastle et al, is used most widely in clinical practice and is cited most often in the biomedical literature. For this-or any-classification system to be beneficial, however, multiple observers must be able to use it in a consistent manner, and a high level of interrater agreement should exist. This study examined interrater reliability among clinicians using the modified Hardcastle classification system for Lisfranc fracture dislocations. Thirteen Lisfranc injury radiographs were evaluated by 21 independent observers consisting of surgeons and residents (podiatric and orthopedic) as well as musculoskeletal radiologists, who classified radiographs according to the modified Hardcastle classification system. We used kappa statistics to evaluate the degree of interrater reliability for the entire group. A mean weighted kappa value of 0.54 was found for the group. Moderate interrater agreement was observed among clinicians interpreting the modified Hardcastle classification system for Lisfranc fracture dislocations.
    The Journal of Foot and Ankle Surgery 01/2006; 45(5):300-3. · 0.86 Impact Factor
  • Graham A Hamilton, Lawrence A Ford
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    ABSTRACT: Diagnosis and treatment of longitudinal tears of the tibialis anterior tendon are not well documented in the surgical literature. Described here is successful primary surgical repair of a longitudinally torn tibialis anterior tendon in a 60-year-old woman.
    Journal of the American Podiatric Medical Association 07/2005; 95(4):390-3. · 0.77 Impact Factor

Publication Stats

187 Citations
7.65 Total Impact Points

Institutions

  • 2012–2014
    • Kaiser Family Foundation
      Washington, Washington, D.C., United States
  • 2003–2011
    • Kaiser Permanente
      • Department of Orthopedics and Podiatric Surgery
      Oakland, CA, United States