The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
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Peroneal tendon dislocation with recurrent subluxation over the lateral malleolus, both acute and chronic, is well documented in the literature. However, there remains a subset of patients who report symptoms similar to peroneal subluxation that do not actually display active or passive displacement of the tendon over the lateral malleolus. In this article, we describe 7 patients who were followed prospectively for the treatment of ultrasound-confirmed, retrofibular, intrasheath subluxation without the typical lateral subluxation or dislocation of the tendon over the malleolus. Six of the 7 patients had either a low-lying peroneal muscle belly or a peroneus quartus muscle and tendon, 6 experienced a tear of either 1 or both of the peroneal tendons, and 1 of the 7 had only a peroneus brevis tendon tear without any other muscle anomaly. Repair of concomitant tendon pathology and resection of the low-lying muscle belly to a point proximal to the fibro-osseous tunnel of the retromalleolar space resulted in elimination of the subluxation symptoms and improvement in American College of Foot and Ankle Surgery ankle scores in 3 patients who were treated operatively. ⋯ 4.
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In this article we describe a method of closed reduction of a supination-eversion stage IV ankle fracture, complete with step-by-step instructions and a video depiction of the reduction maneuver.
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A deep peroneal intraneural cyst of the first web space of the foot is presented. Analysis of the magnetic resonance image scans revealed not only a connection with the medial aspect of the second metatarsophalangeal joint, but also the presence of an interconnected cyst within the lateral digital branch of the hallux. These characteristic magnetic resonance image findings are consistent with those previously described for a peroneal intraneural ganglion cyst that arose from the superior tibiofibular joint, and include (1) origin (ascent) from the second metatarsophalangeal joint with propagation along the articular branch and into the dorsal digital branch of the second toe, (2) cross-over within the shared epineurial sheath of the deep peroneal nerve, and (3) further propagation (descent) within the dorsal digital branch of the hallux. The analogous features between intraneural ganglion cysts affecting small and large-caliber nerves support the fundamental principles of the unified articular (synovial) theory for the formation of intraneural ganglia, including (1) a connection to a synovial joint, (2) dissection of joint fluid through a capsular rent along the articular branch into the parent nerve, and (3) intra-epineurial, pressure-dependent propagation of cyst fluid along paths of least resistance. ⋯ 4.
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Complex regional pain syndrome (CRPS) is a condition that is often associated with the extremities. This chronic pain syndrome, when localized to the lower extremity, includes peripheral changes such as edema, temperature alterations, limited range of motion, loss of or excessive perspiration, pain out of proportion to any stimulus, and trophic alterations of the skin, hair, and nails. In this report, we describe the case of a patient who developed complex regional pain syndrome following an ankle injury and surgery. This case report highlights treatment options that are available to patients experiencing complex regional pain, including the use of a spinal cord stimulator. ⋯ 4.