Foot & ankle specialist
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Foot & ankle specialist · Dec 2011
Efficacy of intravenous tissue plasminogen activator in frostbite patients and presentation of a treatment protocol for frostbite patients.
Frostbite can be a devastating and even debilitating injury. Early identification and proper treatment of frostbite is critical in saving digits and limbs. Tissue plasminogen activator (tPA) has been shown to be effective in reducing the number of digits amputated after severe frostbite injury. Nothing has been presented in the podiatric literature regarding the use of tPA in treating frostbite patients for preserving toes and feet. Intravenous tPA and IV heparin were used to treat severe frostbite injuries that did not show improvement after rapid rewarming, had absent Doppler pulses in the distal limb or digits, showed limited or no perfusion by Tc-99 3-phase bone scan, and had no contraindications to use of tPA. All 11 patients included in this study were treated at Hennepin County Medical Center between 2008 and 2010. A total of 73 digits (upper and lower extremity) were considered at risk for amputation after evaluation with Tc-99 bone scan. Of those digits that were affected, 43 were amputated. Intravenous tPA is a safe and effective treatment to reduce the number of digital amputations after severe frostbite injury. The authors' protocol for treating severe frostbite includes the use of tPA. ⋯ Therapeutic, Level IV.
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Foot & ankle specialist · Dec 2011
Long-term results of neurectomy in the treatment of Morton's neuroma: more than 10 years' follow-up.
The objective of this retrospective study was to evaluate the long-term follow-up results of neurectomy clinical outcomes and complications in the treatment of Morton's neuroma. ⋯ Therapeutic, Level IV, Retrospective case series.
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Huge population of aggressively developing country like India is catered by more than 20,000 orthopedic surgeons but with very few dedicated foot & ankle surgeons. This area of orthopedics has not yet established its place as a specialty of medicine. Most of newer treatment concepts & methodologies are yet to establish its place in India in spite of huge suffering population. ⋯ Commonly seen forefoot, midfoot & hindfoot problems in India & their routine care is discussed. Article also addresses very tough but interesting journey of first foot & ankle surgeon of India & story of rise & fall of first Indian foot & ankle centre of excellence. Contribution in form of educational efforts & deep market penetration is deemed from west to uplift Indian foot & ankle scenario which is summed up as: lack of awareness, opportunity and negligence.