The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
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The authors present a system against postoperative pain in forefoot operations, which functions by continuous infusion of anesthetic in the malleolar internal space. The system (Single-Day Baxter Infusor) was utilized in 145 patients who had undergone forefoot surgery. The effectiveness of the method was evaluated by means of a numeric scale (0 to 5) reflecting pain level. The method was effective in controlling postoperative pain in 110 cases (score 0 to 1); 25 cases (score 2) reported pain in the dorsal hallux, in the deep peroneal area, whereas in 10 cases (score 4 to 5 on the scale), nonsteroidal anti-inflammatory drugs had to be administered.
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The authors radiographed and dissected 200 fresh frozen cadaveric specimens selected randomly from the general United States population. A 21% incidence of inferior calcaneal exostosis formation was identified. Of those specimens identified as having an inferior calcaneal exostosis, there was a 52.4% incidence of heel spurs that were in the plantar fascia and a 47.6% incidence of heel spurs that were identified superior to the plantar fascia. ⋯ By knowing these fascial measurements, the practitioner will be aided intraoperatively in determining what level of fasciotomy to perform. This could help obviate some of the postoperative biomechanical sequelae that can occur with total releases, and immediate postoperative excessive ambulation by the patient. This study may help to gain insight into the true etiology of heel spur syndrome/plantar fasciitis.