Mark S Myerson

University of New South Wales, Kensington, New South Wales, Australia

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Publications (240)319.23 Total impact

  • Source
    Ettore Vulcano · Camilla Maccario · Mark S Myerson
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    ABSTRACT: The most difficult aspect regarding treatment of the pediatric flatfoot is understanding who needs surgery, when it is necessary, and what procedure to be done. A thorough history, clinical examination, and imaging should be performed to guide the surgeon through an often complex treatment path. Surgical technique can be divided in three categories: Soft tissue, bony, and arthroereisis. This paper will describe the joint preserving techniques and their application to treat the pediatric flatfoot deformity.
    Full-text · Article · Feb 2016 · World Journal of Orthopaedics
  • Amiethab Aiyer · Graham F Dall · Jeffrey Shub · Mark S Myerson
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    ABSTRACT: Background: The Cotton osteotomy has been used to correct residual forefoot supination in flexible flatfoot deformity reconstruction. The purpose of this study was to delineate the radiographic effects of the Cotton osteotomy by controlling for concomitant procedures used for deformity correction. Methods: We retrospectively analyzed 67 patients who underwent a Cotton osteotomy as part of a flatfoot reconstructive procedure. We evaluated 12 radiographic parameters including the articular surface angles of the foot, Meary angle, and a newly defined medial arch sag angle (MASA). Twenty-eight of these patients were matched to a cohort that did not undergo a Cotton osteotomy. Results: In all patients who underwent a Cotton osteotomy, there were statistically significant changes in the articular surface angles and medial arch height (P < .05). No radiographic secondary sag of the medial column was seen at final follow-up. Compared to 28 matched controls, the Cotton osteotomy did not improve Meary angle but provided an additional 6.5 degrees correction of the MASA (P = .002). After reliability testing, the intraclass correlation coefficient was found to be substantial for the MASA compared to Meary angle. Discussion: The data suggest that the MASA was a useful radiographic tool for assessing midfoot collapse in the setting of pes planovalgus. The current study demonstrated the corrective capacity of the Cotton osteotomy on the MASA; at final follow-up, there was no evidence of radiographic instability. This is suggestive that a naviculocuneiform arthrodesis may not be warranted for medial column stabilization in the setting of flatfoot reconstruction. Level of evidence: Level III, case control study.
    No preview · Article · Dec 2015
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    ABSTRACT: While the Lapidus procedure is a widely accepted technique for treatment of hallux valgus, the optimal fixation method to maintain joint stability remains controversial. The purpose of this study is to evaluate the biomechanical properties of new shape memory alloy (SMA) staples arranged in different configurations in a repeatable first tarsometatarsal arthrodesis model. Ten sawbones models of the whole foot (n = 5 per group) were reconstructed using a single dorsal staple or two staples in a delta configuration. Each construct was mechanically tested non-destructively in dorsal four-point bending, medial four-point bending, dorsal three-point bending, and plantar cantilever bending with the staples activated at 37°C. The peak load (newton), stiffness (newton per millimeter), and plantar gapping (millimeter) were determined for each test. Pressure sensors were used to measure the contact force and area of the joint footprint in each group. There was a statistically significant increase in peak load in the two staple constructs compared to the single staple constructs for all testing modalities with P values range from 0.016 to 0.000. Stiffness also increased significantly in all tests except dorsal four-point bending. Pressure sensor readings showed a significantly higher contact force at time zero (P = 0.037) and contact area following loading in the two staple constructs (P = 0.045). Both groups completely recovered any plantar gapping following unloading and restored their initial contact footprint. The biomechanical integrity and repeatability of the models was demonstrated with no construct failures due to hardware or model breakdown. SMA staples provide fixation with the ability to dynamically apply and maintain compression across a simulated arthrodesis following a range of loading conditions.
    Full-text · Article · Dec 2015
  • Source
    Ettore Vulcano · Joseph A Tracey · Mark S Myerson
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    ABSTRACT: Background: The reliability of range of motion (ROM) measurements has not been established for the hallux metatarsophalangeal (MTP) joint in patients with hallux rigidus. The aim of the present study was to prospectively assess the clinical versus radiographic difference in ROM of the arthritic hallux MTP joint. Method: One hundred consecutive patients who presented with any grade of hallux rigidus were included in this prospective study to determine the hallux MTP range of motion. Clinical range of motion using a goniometer and radiographic range of motion on dynamic x-rays was recorded. Results: The mean difference between clinical and radiographic dorsiflexion was 13 degrees (P < .001). For all measurements, clinical dorsiflexion was equal to or less than radiographically measured dorsiflexion. The difference was significantly greater in patients with a clinical dorsiflexion of less than 30 degrees than in patients with 30 degrees or more. Radiographic measurement of hallux dorsiflexion had an excellent intra- and interobserver reliability. Conclusion: We describe a reliable, reproducible, and straightforward method of measuring hallux MTP ROM that improved upon measuring clinical ROM. Level of evidence: Level II, prospective comparative study.
    Full-text · Article · Dec 2015
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    ABSTRACT: Background: The optimal fixation method for the first tarsometatarsal arthrodesis remains controversial. This study aimed to develop a reproducible first tarsometatarsal testing model to evaluate the biomechanical performance of different reconstruction techniques. Methods: Crossed screws or a claw plate were compared with a single or double shape memory alloy staple configuration in 20 Sawbones models. Constructs were mechanically tested in 4-point bending to 1, 2, and 3 mm of plantar displacement. The joint contact force and area were measured at time zero, and following 1 and 2 mm of bending. Peak load, stiffness, and plantar gapping were determined. Results: Both staple configurations induced a significantly greater contact force and area across the arthrodesis than the crossed screw and claw plate constructs at all measurements. The staple constructs completely recovered their plantar gapping following each test. The claw plate generated the least contact force and area at the joint interface and had significantly greater plantar gapping than all other constructs. The crossed screw constructs were significantly stiffer and had significantly less plantar gapping than the other constructs, but this gapping was not recoverable. Conclusions: Crossed screw fixation provides a rigid arthrodesis with limited compression and contact footprint across the joint. Shape memory alloy staples afford dynamic fixation with sustained compression across the arthrodesis. A rigid polyurethane foam model provides an anatomically relevant comparison for evaluating the interface between different fixation techniques. Clinical relevance: The dynamic nature of shape memory alloy staples offers the potential to permit early weight bearing and could be a useful adjunctive device to impart compression across an arthrodesis of the first tarsometatarsal joint. Level of evidence: Therapeutic, Level V: Bench testing.
    No preview · Article · Dec 2015 · Foot & Ankle Specialist
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    ABSTRACT: Background: Metatarsus adductus (MA) is a congenital condition that may lead to the development of hallux valgus (HV). The associated anatomic deformities may lead to recurrence of the HV in patients with MA. The goals of the study were to identify radiographic rates of recurrence of HV following surgery for HV in patients with MA. Methods: Between 2002 and 2013, 587 patients who underwent HV surgery were retrospectively identified. The radiographic parameters recorded included the hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the metatarsus adductus angle (MAA) obtained from initial radiographs and at final follow-up. The MAA was considered abnormal if the value was greater than 20 degrees. Radiographic recurrence was defined as HV deformity >20 degrees. Results: The rate of radiographic recurrence of HV was 15% in patients without MA and 29.6% in patients with MA (P < .05). In the group with MA, rate of deformity recurrence did not differ among the operative procedures performed (Lapidus, 28.5%; distal first metatarsal osteotomy, 29.4%; proximal first metatarsal osteotomy, 28.9%). Patients with severe MA (MAA > 31 degrees) were found to have a recurrence rate of 18%, whereas those with less severe MA (MAA < 31 degrees) were found to have a recurrence rate of 82%. Of the patients with severe MA who did not have radiographic recurrence of HV, 60% had undergone a Lapidus arthrodesis and realignment arthrodesis of the second/third tarsometatarsal joints. Conclusion: The rate of radiographic recurrence for patients with MA undergoing HV correction was ~30%. This finding was consistent with our hypothesis that MA increases the risk of radiographic recurrence of HV deformity irrespective of the procedure performed. We believe the lower rate of recurrence of HV among patients with severe MA deformities is suggestive that more complete management of the deformity is warranted. Level of evidence: Level III, retrospective comparative series.
    No preview · Article · Nov 2015 · Foot & Ankle International
  • Dawid Burger · Amiethab Aiyer · Mark S. Myerson
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    ABSTRACT: Adult patients presenting with an overcorrected clubfoot often have had a posteromedial release. They present later in life and have compensated quite well despite the development of deformity. Minor trauma may lead to the onset of acute symptoms. A spectrum of deformity exists. Key features include a dorsally subluxated navicular, a dorsal bunion from overpull of the tibialis anterior tendon, valgus of the ankle or hindfoot or both, and a flattop talus. This article details the diagnostic approach to the overcorrected clubfoot patient and options for management of the various components of the deformity.
    No preview · Article · Sep 2015 · Foot and Ankle Clinics of North America
  • Lauren E. Geaney · Mark S. Myerson
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    ABSTRACT: Traditional treatment for stage II posterior tibial tendon (PTT) dysfunction includes flexor digitorum longus (FDL) transfer combined with various osteotomies. However, the FDL has been shown to be much weaker than the PTT and thus may not be the ideal tendon for transfer. Furthermore, the peroneus brevis continues to be a deforming force following reconstructive surgery and may contribute to recurrent deformity. This paper presents a novel technique consisting of posterior tibial tendon reconstruction with allograft and peroneus brevis to longus transfer combined with various osteotomies necessary for correction.
    No preview · Article · Sep 2015 · Techniques in Foot & Ankle Surgery
  • Raheel Shariff · Mark S Myerson
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    ABSTRACT: Metatarsus elevatus and gastrocnemius tightness contribute to the development of functional hallux rigidus. Although several osteotomies have been described for functional hallux rigidus, certain osteotomies are commonly used in practice for the correction of functional hallux rigidus, a long first metatarsal or an elevated metatarsal, or an unstable tarsometatarsal joint. Proximal plantarflexion osteotomy is used only in the presence of an elevated first metatarsal with a limit to dorsiflexion but without the presence of arthritis at the first metatarsophalangeal joint. In the presence of arthritis at the metatarsophalangeal joint, the decision is between an oblique distal metatarsal osteotomy and the shortening periarticular osteotomy. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Sep 2015 · Foot and ankle clinics
  • M.J. Welck · M.S. Myerson
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    ABSTRACT: Subtalar distraction arthrodesis is performed in certain situations where there is loss of subtalar height, reduced talar declination and evidence of anterior tibiotalar impingement. Standard evaluation includes the assessment of the lateral talocalcaneal angle, calcaneal pitch, talocalcaneal height and talar declination angle on a weight bearing lateral radiograph. We present a case of erosive valgus subtalar osteoarthritis with subtalar collapse managed with a subtalar distraction arthrodesis. A weight bearing CT (WB-CT) scan was used in the assessment. The value of WB-CT for this indication is discussed, along with a discussion on surgical technique, complications and future directions.
    No preview · Article · Aug 2015 · Foot and Ankle Surgery
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    ABSTRACT: First metatarsophalangeal (MP) arthrodesis in the setting of bone loss is a difficult problem. Bone loss may compromise stability of implant fixation. Union rates may be adversely affected by these circumstances. The primary goals of this cadaveric, biomechanical study were to (1) investigate stiffness of a dual mini-plate construct versus a standard MP arthrodesis plate in the setting of severe bone loss and (2) evaluate arthrodesis interface motion when an interpositional graft is used. Twelve matched cadaveric samples were used in this study. In a given pair, both dual mini-plate fixation and standard MP arthrodesis plate were used. Interpositional graft was used in 6 of the specimen pairs. After implantation, soft tissues were dissected away and specimens were placed into a cantilever bending setup. A cantilever load was applied at a rate of 6 mm/min until catastrophic failure of the test construct or 5-mm plantar gapping of either bone block interface. Based on load to failure data, there were no differences between the various constructs in terms of stiffness. There was a high degree of calculated plantar gapping with the placement of a bone block, irrespective of the fixation type. Although no construct differences were observed in terms of stiffness, the dual mini-plate is an alternative option for fixation when asymmetric bone loss is either seen on the phalangeal or metatarsal head side. The high degree of plantar gapping of the proximal interface with the placement of the bone block may have implications for healing potential across the arthrodesis site. This is the first biomechanical study investigating the stiffness of multiple constructs for MP arthrodesis in the setting of severe bone loss. Furthermore, this is the first study to introduce a biomechanical rationale for difficulties in healing for this particular clinical scenario. Level V, Bench testing. © 2015 The Author(s).
    No preview · Article · Apr 2015 · Foot & Ankle Specialist
  • Source
    Ettore Vulcano · J. Kent Ellington · Mark S. Myerson
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    ABSTRACT: The preferred surgical approaches to subtalar fusion are the sinus tarsi incision, the medial incision, and the extensile lateral approach. The choice of one over the other depends on the underlying pathology, previous surgeries, associated foot pathologies, soft tissue quality, and medical comorbidities. This article reports on several cases of subtalar joint fusion. Copyright © 2015 Elsevier Inc. All rights reserved.
    Full-text · Article · Apr 2015 · Foot and Ankle Clinics of North America
  • Source
    Andrew R Hsu · Steven L Haddad · Mark S Myerson
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    ABSTRACT: Total ankle arthroplasty (TAA) is an increasingly popular treatment option for patients with end-stage ankle arthritis. Although improved short- and long-term clinical and radiographic outcomes have been achieved with TAA, revision surgery may be necessary in the setting of aseptic loosening, subsidence, impingement, arthrofibrosis, or infection. Factors such as patient selection, implant design, and surgical technique can all contribute to TAA failure. Treatment of patients with a painful TAA is complex and requires careful consideration of symptom history, workup, and nonsurgical and surgical treatment options. Surgical management of failed TAA includes arthrodesis, revision surgery, or below-knee amputation. Copyright 2015 by the American Academy of Orthopaedic Surgeons.
    Full-text · Article · Mar 2015 · The Journal of the American Academy of Orthopaedic Surgeons
  • Mark S. Myerson · Amiethab A. Aiyer · Dawid Burger
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    ABSTRACT: Rupture of the tibialis anterior tendon is often not clinically recognized. It typically occurs in the atraumatic setting and leads to a steppage gait. For sedentary individuals, nonoperative management may be considered. In more active individuals with stable soft-tissue envelope and a stable neurovascular status, reconstruction of the tendon is a viable option. This technique paper introduces a novel technique that bypasses the need to open the extensor retinaculum and avoids potential wound complications. Levels of Evidence: Diagnostic Level 5. See Instructions for Authors for a complete description of levels of evidence.
    No preview · Article · Feb 2015 · Techniques in Foot & Ankle Surgery
  • M. Myerson · R. Shariff
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    ABSTRACT: The adult flexible flatfoot has a vast spectrum of deformity, which makes decision making for management quite challenging. Furthermore the patient’s activity levels also dictate the kind of surgical intervention which may need to be adopted. This article highlights the evolution in the classification and treatment rationale of this condition based on the author’s experiences. We also describe certain new techniques such as an allograft tendon reconstruction specifically the work up and surgical techniques which have formed part of our treatment algorithm. © 2014, Croatian Medical Association and School of Medicine. All rights reserved.
    No preview · Article · Jan 2015 · Medicina Fluminensis
  • Lauren E Geaney · Mark S Myerson
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    ABSTRACT: Hallux metatarsophalangeal (MP) joint arthrodesis for hallux varus is generally reserved for severe deformity, failed surgery or the development of osteoarthritis. The purpose of this study was to determine the radiologic results of arthrodesis of the hallux MP joint following treatment for hallux varus. Our hypothesis was that in the process of correcting the hallux valgus angle, the 1-2 intermetatarsal angle (1-2 IMA) and hallux valgus angle (HVA) will be improved due to correction of the deforming forces. A retrospective review was performed on 26 patients with 29 feet that had symptomatic hallux varus deformities treated with arthrodesis of the hallux MP joint between September 1, 2002, and December 31, 2012. The 1-2 IMA and HVA were measured on the preoperative and most recent postoperative films and compared. Twenty-nine patients were followed with postoperative weight-bearing radiographs. Two were men and 24 were women. Twelve were performed on the right foot, 17 on the left, including 3 bilateral cases. Fourteen patients had concomitant procedures on the ipsilateral forefoot. The average 1-2 IMA changed from 4.8 degrees to 8.4 degrees, a difference of 3.6 degrees (P < .05), and the average HVA changed from -20.7 degrees to 8.1 degrees (P < .05). Our study showed that a hallux MP joint arthrodesis in patients with hallux varus resulted in a predictable increase in the 1-2 IMA. Level IV, case series. © The Author(s) 2014.
    No preview · Article · Dec 2014 · Foot & Ankle International
  • Mark S. Myerson

    No preview · Article · Nov 2014 · Foot and Ankle Clinics of North America
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    ABSTRACT: Metatarsus adductus (MA) is a congenital condition in which there is adduction of the metatarsals in conjunction with supination of the hindfoot through the subtalar joint. It is generally believed that MA precedes the development of hallux valgus. Historically, studies have demonstrated that patients with a history of MA were ~3.5 times more likely to develop hallux valgus. The purpose of this study was to identify the relative prevalence of MA in patients undergoing surgery for symptomatic hallux valgus.
    No preview · Article · Sep 2014 · Foot & Ankle International
  • Casey Jo Humbyrd · Mark S Myerson

    No preview · Article · Sep 2014 · Foot & Ankle International
  • Mark S Myerson · Raheel Shariff · Alan J Zonno
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    ABSTRACT: Background: Little has been published on the management of infected total ankle replacements. This study reviewed our experience with this difficult clinical problem. Methods: From 2002 to 2011 we retrospectively evaluated patients requiring prosthesis removal for infection following primary or revision total ankle replacement. Infections were classified as acute postoperative, late chronic, or remote hematogenous. The demographics, treatment, and outcome of the infected replacements were evaluated. Results: Of 613 replacements performed during this time period, 15 infections occurred at our institution and 4 from other institutions were treated. These 19 cases included 15 late chronic infections, 3 early postoperative infections, and 1 acute hematogenous infection. Fourteen of the infections occurred in a subset of 433 prostheses (3.2%) placed between 2002 and 2009 when we used an implant with a unique design that necessitated a tibiofibular syndesmosis fusion for the tibial component support (Agility, Depuy). One infection occurred out of 139 other prostheses (0.7%) between 2009 and 2011 when we switched to an anatomic design fixed bearing implant system. Prosthesis salvage was attempted in the 3 early postoperative and 1 acute hematogenous cases, however they all required subsequent removal of the prosthesis. Mean time to removal of the prosthesis after the index arthroplasty was 18 months. Mean follow-up was 19 months from the time of prosthesis removal. Three of the 19 patients underwent successful revision with replacement, 6 with arthrodesis, 7 with a permanent antibiotic spacer, and 3 patients required a transtibial amputation. Conclusion: Only a limited number of patients who develop a deep infection following primary or revision total ankle arthroplasty can expect to undergo successful joint-preserving revision ankle arthroplasty. Level of evidence: Level III, retrospective case series.
    No preview · Article · Jul 2014 · Foot & Ankle International

Publication Stats

7k Citations
319.23 Total Impact Points


  • 2015
    • University of New South Wales
      • Surgical and Orthopaedic Research Laboratory (SORL)
      Kensington, New South Wales, Australia
  • 2011-2015
    • Mercy Hospital Miami
      Miami, Florida, United States
  • 2002-2015
    • Weil Foot and Ankle Institute
      Chicago, Illinois, United States
    • Mercy Medical Center
      • Institute for Foot and Ankle Reconstruction
      Baltimore, Maryland, United States
    • Hebrew University of Jerusalem
      • Department of Orthopaedic Surgery
      Yerushalayim, Jerusalem, Israel
  • 2012
    • TRIA Orthopaedic Center
      블루밍턴, Minnesota, United States
    • St Joseph Medical Center (MD, USA)
      تاوسن، مریلند, Maryland, United States
  • 2008
    • University of Michigan
      • Department of Orthopaedic Surgery
      Ann Arbor, Michigan, United States
    • University of Zurich
      • Department of Pediatric Orthopaedics
      Zürich, ZH, Switzerland
  • 2007
    • Mercy Medical Center
      Мейсон-Сити, Iowa, United States
  • 1989-2007
    • Union Memorial Hospital
      Baltimore, Maryland, United States
  • 1999
    • American Academy of Orthopaedic Surgeons
      Роземонт, Illinois, United States
  • 1994
    • Mayo Clinic - Rochester
      • Department of Orthopedics
      Рочестер, Minnesota, United States
    • University of Maryland, Baltimore
      Baltimore, Maryland, United States