Last update: July 31, 2015

Latest News

July 2015


Foot Ankle Int. 2015 Jul 9.

Hind- and Midfoot Motion After Ankle Arthrodesis

van der Plaat LW, van Engelen SJ, Wajer QE, Hendrickx RP, Doets KH, Houdijk H, van Dijk CN.


After ankle arthrodesis (AA), compensatory increased range of motion in adjacent joints might lead to increased osteoarthritis. Evaluation of patient-reported outcomes after AA with validated questionnaires is rare. Likewise, reliable radiographic analysis of the position of the AA, expected to influence the range of motion of the hind- and midfoot, is lacking. Therefore, the current study was performed.
Seventeen patients with unilateral AA were included. Sagittal hind- and midfoot range of motion was measured radiographically. The position of the AA in the sagittal and coronal planes and osteoarthritis of adjacent joints were also evaluated radiographically. Measurements were compared to the contralateral side. Patient-reported outcomes via validated questionnaires were compared to a control group (n = 18).
Average follow-up was 3.5 years. Mean combined hind- and midfoot sagittal range of motion after AA equaled that of the contralateral side (20.8 vs 21.0 degrees; P = .93). The tibiotalar angle after AA equaled that of the contralateral side (107 vs 107 degrees; P = .86). The talus was translated posteriorly after AA (T-T ratio 0.45 vs 0.34; P < .001). Low intraclass correlation coefficients (ICC) precluded reliable evaluation of the coronal position of the hindfoot (ICC, 0.07 and -0.34) and osteoarthritis in adjacent joints (ICC range, 0-0.54). SF-36 physical health scores after AA are lower as compared with those of controls (50 vs 56; P = .01). Scores on the Foot and Ankle Outcome Score and Ankle Osteoarthritis Scale were also significantly lower. Patient satisfaction with AA was high (average visual analog scale score, 83).
No increased sagittal range of motion in the hind- and midfoot after AA was found at 3.5 years of follow-up as compared with the contralateral side. Tibiotalar angles were equal. The talus was translated posteriorly. The hindfoot alignment view was not suitable to analyze the position of the hindfoot. Low ICC of the Kellgren and Lawrence scale precluded evaluation of osteoarthritis of adjacent joints. Patients scored lower than controls on self-reported outcome questionnaires but were satisfied with the result of AA.


The 15th Amsterdam Foot & Ankle Course took place on the 17th and 18th of June 2015. There were 76 participants coming from all continents. The average score for the lectures, interactive computer courses, live surgery and of course the hands-on time in the cadaver lab sessions was 4,47(out of 5)!


Quotes of participants:
"Very balanced course, interesting interactive lectures, useful life surgery and instructive hands-on cadaver time. Even the social program is really good. Thanks for everything professor van Dijk!"

"Great course! Professor van Dijk is an excellent teacher and a good man. Keep on going!"

"Learning to do a good arthroscopy from the man himself. His tips and tricks makes me a better surgeon in only two days. I thoroughly enjoyed it!"


Next year course dates are 22th and 23th of June 2016.




The first Advanced Amsterdam Foot & Ankle Course took place on the 17th and 18th of June 2105. The 34 enthusiastic participants reward the course with an average score of 4,5!(out of 5).


Quotes of participants:
"A few years ago I went to the beginner course which was very wonderful and I learned a lot. During the advanced course we had more cadaver time to practice difficult procedures with very helpful course instructions from professor van Dijk!"

"It was really an honor to participate in the first advanced foot and ankle course. Great course and great faculty!"

"I did my first FHL-transfer!!! Wow what a course!"


Next year course dates are 23th and 24th of June 2016.



June 2015


 Knee Surg Sports Traumatol Arthrosc. 2015 Jun 5.

Randomized comparison of tape versus semi-rigid and versus lace-up ankle support in the treatment of acute lateral ankle ligament injury.

van den Bekerom MP, van Kimmenade R, Sierevelt IN, Eggink K, Kerkhoffs GM, van Dijk CN, Raven EE.


Functional treatment is the optimal non-surgical treatment for acute lateral ankle ligament injury (ALALI) in favour of immobilization treatment. There is no single most effective functional treatment (tape, semi-rigid brace or lace-up brace) based on currently available randomized trials.
This study is designed as a randomized controlled trial to evaluate the difference in functional outcome after treatment with tape versus semi-rigid versus lace-up ankle support (brace) for grades II and III ALALIs. The Karlsson score and the FAOS were evaluated at 6-month follow-up.
One hundred and ninety-three patients (52 % males) were randomized, 66 patients were treated with tape, 58 patients with a semi-rigid brace and 62 patients with a lace-up brace. There were no significant differences in any baseline characteristics between the three groups. Mean age of the patients was 37.3 years (35.1-39.5; SD 15.3). Ninety-five males (49 %) were included. One hundred and sixty-one (59 + 50 + 52) patients completed the study through final follow-up; 32 % lost at follow-up. In two patients treated with tape support, the treatment was changed to a semi-rigid brace because of dermatomal blisters. Except for the difference in Foot and Ankle Outcome Score sport between the lace-up and the semi-rigid brace, there are no differences in any of the outcomes after 6-month follow-up.
The most important finding of current study was that there is no difference in outcome 6 months after treatment with tape, semi-rigid brace and a lace-up brace.

May 2015

J Pediatr Orthop. 2015 May 6.

Treatment of Calcaneal Apophysitis: Wait and See Versus Orthotic Device Versus Physical Therapy: A Pragmatic Therapeutic Randomized Clinical Trial.

Wiegerinck JI, Zwiers R, Sierevelt IN, van Weert HC, van Dijk CN, Struijs PA.


Calcaneal apophysitis is a frequent cause of heel pain in children and is known to have a significant negative effect on the quality of life in affected children. The most effective treatment is currently unknown. The purpose of this study is to evaluate 3 frequently used conventional treatment modalities for calcaneal apophysitis.
Three treatment modalities were evaluated and compared in a prospective randomized single-blind setting: a pragmatic wait and see protocol versus a heel raise inlay (ViscoHeel; Bauerfeind) versus an eccentric exercise regime under physiotherapeutic supervision. Treatment duration was 10 weeks.
age between 8 and 15 years old, at least 4 weeks of heel pain complaints due to calcaneal apophysitis based, with a minimal Faces Pain Scale-Revised of 3 points. Primary exclusion criteria included other causes of heel pain and previous similar treatment. Primary outcome was Faces Pain Scale-Revised at 3 months. Secondary outcomes included patient satisfaction and Oxford Ankle and Foot Questionnaire (OAFQ). Points of measure were at baseline, 6 weeks, and 3 months. Analysis was performed according to the intention-to-treat principles.
A total of 101 subjects were included. Three subjects were lost to follow-up. At 6 weeks, the heel raise subjects were more satisfied compared with both other groups (P<0.01); the heel raise group improved significantly compared with the wait and see group for OAFQ Children (P<0.01); the physical therapy group showed significant improvement compared with the wait and see group for OAFQ Parents (P<0.01). Each treatment modality showed significant improvement of all outcome measures during follow-up (P<0.005). No clinical relevant differences were found between the respective treatment modalities at final follow-up.
Treatment with wait and see, a heel raise inlay, or physical therapy each resulted in a clinical relevant and statistical significant reduction of heel pain due to calcaneal apophysitis. No significant difference in heel pain reduction was found between individual treatment regimes. Calcaneal apophysitis is effectively treated by the evaluated regimes. Physicians should deliberate with patients and parents regarding the preferred treatment.


Our department has recently received recognition of the International Olympic Committee (IOC) as IOC Research Center for Prevention of Injury and Protection of Athlete Health. Only nine centers worldwide have received this recognition. We received this recognition together with the VU
Over the next four years, all nine centers will be tasked with researching, developing and implementing effective preventive treatment methods for sports-related injuries and illnesses.

April 2015

During the combined AEA-SEROD meeting in Madrid, Prof C.Niek van Dijk was appointed as Honorary member of the Spanish Arhroscopy Association (AEA)
It is for the first time in the existence of the AEA that they decided to appoint an honorary member . This makes him the first honorary member of their Society.
With a certificate he also received the gold pin which is reserved for the pastpresidents of the AEA.
On the picture also John Bergfeld (pastpresident of ISAKOS) who was appoited honorary member of SEROD. 

A new chapter, Arthroscopic assisted Retrograde Drilling for large talar Cystic lesions, has been added to the book on surgical techniques. Please go to the index to find out which chapters are online at the moment and to view the future chapters.

March 2015


Arthroscopy. 2015 Mar 19.

Arthroscopic Treatment for Anterior Ankle Impingement: A Systematic Review of the Current Literature.

Zwiers R, Wiegerinck JI, Murawski CD, Fraser EJ, Kennedy JG, van Dijk CN.


To provide a comprehensive overview of the clinical outcomes of arthroscopic procedures used as a treatment strategy for anterior ankle impingement.
A systematic literature search of the Medline, Embase (Classic), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases was performed. Studies that met the following inclusion criteria were reviewed: studies reporting outcomes of arthroscopic treatment for anterior ankle impingement; studies reporting on more than 20 patients; a study population with a minimum age of 18 years; and studies in the English, Dutch, German, Italian, or Spanish language. Two reviewers independently performed data extraction. Extracted data consisted of population characteristics, in addition to both primary and secondary outcome measures. The Downs and Black scale was used to assess the methodologic quality of randomized and nonrandomized studies included in this review.
Twenty articles were included in this systematic review. Overall, good results were found for arthroscopic treatment in patients with anterior ankle impingement. In the studies that reported patient satisfaction rates, high percentages of good to excellent satisfaction were described (74% to 100%). The percentages of patients who would undergo the same procedure again under the same circumstances were also high (94.3% to 97.5%). Complication rates were low (4.6%), particularly with respect to major complications (1.1%). The high heterogeneity of the included studies made it impossible to compare the results of the studies, including between anterolateral impingement and anteromedial impingement.
Arthroscopic treatment for anterior ankle impingement appears to provide good outcomes with respect to patient satisfaction and low complication rates. However, on the basis of the findings of this study, no conclusion can be made in terms of the effect of the type of impingement or additional pathology on clinical outcome.



J Orthop Trauma. 2015 Mar 14.

Posterior Malleolar Fracture Patterns.

Mangnus L, Meijer D, Stufkens SA, Mellema JJ, Steller EP, Kerkhoffs GM, Doornberg JN.


To 1) characterize posterior malleolar fracture morphology using Cole fracture mapping; and 2) study reliability of Quantification of Three-Dimensional Computed Tomography (Q3DCT)-modelling for posterior malleolar fractures with respect to quantification of fragment size (mm) and true articular involvement (mm).
CT-scans of a consecutive series of 45 patients with an ankle fracture involving the posterior malleolus were reconstructed to calculate 1) fracture maps, 2) fragment volume; 3) articular surface of the posterior malleolar fragment; 4) articular surface of intact tibia and 5) articular surface of the medial malleolus by three independent observers. 3D-animation of this technique is shown on www.traumaplatform.org.
Fracture mapping revealed 1) a continuous spectrum of postero-lateral oriented fracture lines and 2) fragments with postero-lateral to postero-medial oriented fracture lines extending into the medial malleolus. Reliability of measurements of the volume and articular surface of posterior malleolar fracture fragments was defined as almost perfect according to the categorical system of Landis (inter-class coefficient (ICC), range 0.978 - 1.000).
Mapping of posterior malleolar fractures revealed a continuous spectrum of Haraguchi III to I fractures, and identified Haraguchi type II as a separate pattern. Q3DCT-modelling is reliable to assess fracture characteristics of posterior malleolar fracture fragments. Morphology might be more important than posterior malleolar fracture size alone for clinical decision making.

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