Clinics in podiatric medicine and surgery
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External fixation as a modality is a versatile and minimally invasive stabilization option that should not be forgotten even as new and specially designed implants for nearly each bone become more fashionable. As a temporary traction device, the external fixator can help condition the soft tissues and, if closed reduction was sufficient, it can stay in place for definitive treatment. ⋯ External fixation instead of plaster cast allows for better care of skin and soft tissues. External fixation also has its advantages as a minimally invasive external compression device in specific indications for arthrodesis, especially in infected cases.
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Clin Podiatr Med Surg · Apr 2002
ReviewAchilles rupture in the athlete. Current science and treatment.
Achilles tendon ruptures became increasingly common in the latter half of the 20th century. Once the diagnosis is made, the patient's goals and objectives should be clearly stated. The treatment choice should incorporate the patient's needs, desires, objectives, and functional goals to assure an optimal result.
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Regional anesthesia (RA) is the anesthetic of choice for all foot and ankle surgery. Advances in anesthetic equipment and techniques have made peripheral nerve blocks the perfect anesthetic technique for these patients, who should be educated about them in their surgeon's office. ⋯ GA has a higher morbidity and complication rate compared to RA. Performance of a peripheral nerve block, or PNB, requires proper training, equipment, and support personnel in order to handle any and all complications, including general anesthesia.
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The complete care of burns to the foot can be complex or straightforward, depending on the nature of the burn. Appropriate care requires experience and training. The keys to good management of burns to the feet are understanding the pathophysiology of burns, appropriate acute management of the burns, and appropriate initial reconstruction guided by the long-term needs of the patient.
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Tears of the peroneus brevis tendon are more frequent than reported in the literature. Because of the vague pain associated with structures of the lateral ankle, peroneal tears are frequently misdiagnosed. Physical signs such as swelling along the course of the peroneal tendon sheath, pain with eversion, and subluxing tendons are diagnostic of peroneal pathologic conditions. ⋯ Débridement and tubularization are recommended for less extensive tears. In more severe cases, resection of the damaged tendon and tenodesis of the proximal and distal segments to the peroneus longus are necessary. Return to maximum activity is prolonged, but with proper patient selection, evaluation, and treatment, good to excellent results can be expected.