Clinics in podiatric medicine and surgery
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Clin Podiatr Med Surg · Jul 2006
ReviewTarsal tunnel syndrome: a compression neuropathy involving four distinct tunnels.
Tarsal tunnel syndrome is a complex and often under-diagnosed or misdiagnosed condition that affects the foot and ankle. It is a compression neuropathy of the posterior tibial nerve as it passes in the anatomic tarsal tunnel in the medial ankle under flexor retinaculum. ⋯ Internal neurolysis facilitates a second level of nerve decompression in needed cases. Physical therapy protocols have made it possible for patients to return to ambulation with limited long-term down time.
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Clin Podiatr Med Surg · Jul 2006
ReviewConservative treatment of peripheral neuropathy and neuropathic pain.
There are many types of peripheral nerve disorders that lead to peripheral neuropathy. Symptoms associated with peripheral neuropathy lack consistent, easy to treat qualities, and provide a constant challenge for physicians who encounter the sequelae of neuropathy. This review discusses medications, nutritional supplements, and topical and physical modalities that are effective in treating neuropathy associated with diabetes.
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Compression of the deep peroneal nerve is commonly referred to as anterior tarsal tunnel syndrome. Although rare, this syndrome remains poorly diagnosed. The syndrome is characterized by pain, weakness, and sensory changes of the foot and ankle. ⋯ If conservative management fails to relieve the symptoms, surgical decompression of the entrapped nerve can be performed. The deep peroneal nerve is released from compressive forces in the entrapment site. This can be performed at the more proximal level at the extensor retinaculum or more distally at the level of the tarsal metatarsal site.
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Fractures of the forefoot are common injuries of various causes. Although not crippling, forefoot fractures can be debilitating if they go undiagnosed or are mistreated. Whenever patients complain of foot pain with ambulation or difficulty ambulating, radiographs should be taken as part of a standard routine to assess for bony pathology. This article discusses the classification and treatment of metatarsal fractures, digital and sesamoid fractures, and open fractures about the forefoot.
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Clin Podiatr Med Surg · Apr 2006
ReviewLisfranc fracture-dislocations: current treatment and new surgical approaches.
Anatomic reduction and restoration of the acute or chronic fracture-dislocation of the tarso-metatarsal joint is essential and needs to be addressed early in the patient's treatment with internal or external fixation. Long-term results following this injury can be associated with chronic instability, posttraumatic arthrosis, and poor functional outcomes. In this article, the authors review the current treatments of internal fixation and introduce new surgical techniques for addressing the acute or chronic tarso-metatarsal injuries with the application of circular multiplane external fixation devices.