The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
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Schwannoma is a benign tumor that arises from the peripheral nerve sheath. It presents as a discrete, often tender, and palpable nodule associated with neurogenic pain or paresthesia when compressed or traumatized. The growth rate is usually slow, and these lesions seldom exceed 2 cm in diameter. ⋯ The patient did not encounter any motor deficits; however, early results showed some subjective numbness. Few reports have been published of schwannomas arising from the tibial nerve. Marginal excision appears to be the recommended therapy for this tumor, without any evidence of recurrence at 9 months of follow-up.
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The superficial peroneal nerve presents great anatomic variability regarding its emergence from the crural fascia, course, branching pattern, and distribution area. Entrapment neuropathy of the superficial peroneal nerve has been documented in the published data, resulting in pain and paresthesia over the dorsum of the foot. We report a case of a female cadaver in which an accessory superficial peroneal sensory nerve was encountered. ⋯ After fascial penetration, the supernumerary nerve was distributed to the skin of the proximal dorsum of the foot and lateral malleolar area. A potential entrapment site of the nerve was observed at the lateral malleolar area, because the accessory nerve traveled through a fascial tunnel while perforating the crural fascia, and presented with distinct post-stenotic enlargement at its exit point. The likely presence of such a very rare variant and its potential entrapment is essential for the physician and surgeon to establish a correct diagnosis and avoid complications during procedures to the foot and ankle region.
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Myiasis is the infestation of the skin and mucous membranes by fly larvae. Myiasis of the lower extremity caused by Chrysomya bezziana is rarely fatal, but it can be associated with considerable morbidity. Proper wound exploration and en masse removal of all the larvae using thorough wound debridement can eradicate the infestation and promote wound healing. In the present report, the management of 4 separate cases of lower extremity infestation with fly larvae is described.
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Patients with podiatric foreign body injury commonly present to the emergency department. Often, the foreign object cannot be easily located or removed, and radiographs are frequently obtained to aid in localization. ⋯ We present 2 pediatric cases in which an ultrasound-guided needle localization technique was used to facilitate successful removal of small, difficult to visualize foreign bodies from the plantar foot. Ultrasound-guided needle localization reduced the required incision length and depth and helped to minimize the risk of damage to surrounding tissue.
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The percutaneous technique of Achilles tendon repair seems to offer satisfactory clinical and functional results, although these results have been evaluated mainly using objective rating scales. Recently, some "subjective" rating scales have been combined to evaluate the results of various surgical treatments. The purpose of the present study was to compare the results of a percutaneous Achilles tendon repair evaluated objectively using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and subjectively using the Medical Outcomes Study, short-form, 36-item questionnaire (SF-36) questionnaire. ⋯ The relation between the objective (AOFAS) and subjective (SF-36) results showed a significant correlation (Pearson's correlation coefficient) between the physical functioning (r = 0.597, p = .011) and bodily pain (r = 0.663, p = .004) SF-36 domains, and a nonstatistically significant correlation with the other SF-36 domains. Very similar results were found using the nonparametric Spearman rho correlation coefficient. These results suggest that regarding pain and function, the AOFAS ankle-hindfoot score and SF-36 provide complementary information; therefore, we believe that the SF-36 questionnaire should be used with the AOFAS ankle-hindfoot score for a more complete evaluation of the outcome.