Foot & ankle specialist
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Foot & ankle specialist · Oct 2014
Sonographically guided therapeutic injections in the meniscoid lesion in patients with anteromedial ankle impingement syndrome.
We describe a sonographically guided technique to perform therapeutic injections for anteromedial ankle impingement syndrome. Scans are carried out using a high-frequency small footprint linear array transducer, positioned along the anteromedial aspect of the tibiotalar joint. A 25 gauge needle is advanced under direct sonographic guidance into the "meniscoid lesion" (area of scarring), and a standardized therapeutic mixture is injected extra-articularly. Image-guided injections have a positive influence on clinical decision making by improving patient management, increasing the accuracy of diagnosis, and decreasing patient pain. Sonography allows confirmation of correct injection placement, resulting in increased accuracy and more successful patient outcomes. ⋯ Therapeutic, Level V, Expert Opinion.
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Foot & ankle specialist · Oct 2014
Simultaneous first metatarsophalangeal joint arthrodesis and sesamoidectomy with a single dorsomedial incision.
First metatarsophalangeal (MTP) arthrodesis is a well-accepted procedure for the treatment of end-stage hallux rigidus. Despite the excellent and predictable clinical results, the procedure does not address the metatarso-sesamoid joint complex. There has been one case report of arthritis of the metatarsal sesamoid joint as uncommon cause of post-arthrodesis hallux pain. Additionally, we have noted this complication in our practice as well despite the paucity of reported cases in the published literature. Resection of either the tibial or fibular sesamoid is an acceptable treatment for recalcitrant sesamoid pain; however, resection of both the tibial and fibular sesamoids as would be required for arthritic changes is not encouraged to prevent the risk of a cock-up toe deformity. Arthrodesis of the first MTP joint eliminates the possibility of this complication. Resection of the sesamoids following a first MTP fusion requires a separate incision with additional morbidity and risk to the medial plantar digital nerve. This second surgical intervention is not without morbidity and carries additional cast to the patient, which can be avoided if the pathology is appropriately identified preoperatively. We describe the surgical indications and novel technique for a first MTP arthrodesis and total sesamoid resection through a standard dorsomedial incision. The approach adds minimal surgical time and morbidity and eliminates the source of plantar first MTP pain that is present in a cohort of patients with hallux rigidus. ⋯ Level IV, Case Series.
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Foot & ankle specialist · Aug 2014
Continuous Infragluteal Sciatic Nerve Block for Postoperative Pain Control After Total Ankle Arthroplasty.
Continuous peripheral nerve blocks (CPNB) for postoperative pain control are being used more frequently for total ankle arthroplasty. The purpose of this study was to compare the amount of opioid analgesia used in patients with an infragluteal CPNB to that of patients with no CPNB for postoperative pain management after total ankle replacement. ⋯ The mean postoperative narcotic use in oral morphine equivalents was 64.6 mg in the CPNB group compared to 129.6 mg in the no CPNB group (P < .001). Using an infragluteal CPNB as a means of postoperative pain control in patients undergoing a total ankle replacement is associated with significantly decreased opioid use compared to patients receiving no CPNB.
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Foot & ankle specialist · Apr 2014
ReviewTreatment of isolated peroneus longus tears and a review of the literature.
Isolated peroneus longus tendon tears are rare and represent a frequently overlooked source of lateral ankle pain and dysfunction. Only few cases of isolated peroneus longus tendon tears have been reported and a common treatment algorithm does not exist. The purpose of this study was to give an overview of the literature and to present our experience of 6 consecutive cases that have been treated successfully by operation and immobilizing cast. ⋯ This study indicates that lateral ankle pain may be due to isolated acute or chronic peroneus longus tendon tears. Thorough clinical and radiological diagnosis is necessary to detect this uncommon injury in time. Patients with acute onset of symptoms and short time between symptoms and diagnosis tend to fare better than the chronic tears and delayed diagnosis. Surgical intervention yields successful and predictable results.
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Foot & ankle specialist · Dec 2013
Comparative StudyUtilization of silver hydrogel sheet dressing on postsurgical incisions: a pilot study in foot and ankle surgery.
Silver hydrogel dressings are antimicrobial, nonadherent, and have an absorptive capacity many times their weight. Fifty-nine (49.44 ± 16.85 years) foot and ankle patients with incisions >1 cm were prospectively enrolled to compare infection, scarring, and complication rates between the postoperative use of a silver hydrogel sheet (SHS) dressing and a standard petroleum-based (P) dressing. Overall, there were 5 (8.47%) infections; 4 (6.78%) superficial and 1 (1.69%) deep. ⋯ Compared with SHS patients, the P patients had a greater incidence of incisional complications (1 [3.45%] vs 8 [26.67%], respectively; P = .03). The percent change in scar length was greater in the SHS group (18.04 ± 41.10%) when compared with the P group (2.00 ± 9.93%; P < .001) while the percent change in scar width was similar in the 2 groups (P = .19). The lower incidence of incisional complications and the greater reduction in scar length suggest that the inherent properties of the silver hydrogel dressing aid in postsurgical healing.