Foot & ankle international
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Hallux sesamoid fractures are challenging to treat. Symptomatic nonunion is a common problem after nonoperative treatment. Surgical fixation of the fracture can result in successful union, but is technically challenging and can be associated with prolonged return to activities (RTA). Sesamoidectomy is an alternative surgical option that may provide reliable outcomes and allow an earlier RTA in athletes. The purpose of this case-series study was to evaluate a cohort of athletic patients with a hallucal sesamoid fracture treated with sesamoidectomy. ⋯ This case series demonstrates good results after sesamoidectomy for sesamoid fractures in athletic individuals with reliable pain relief and RTA within 11.6 weeks. Progressive hallux valgus remains a concern after medial sesamoidectomy, with an incidence of 1 in 24 cases in this study.
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Ankle fractures are the most common fracture treated by orthopaedic surgeons in the United States. Isolated lateral malleolus fractures are treated nonoperatively, while associated deltoid disruption injuries are unstable and usually treated by fixation of the fracture. Various stress radiographs and MRI have been used to determine deltoid competency and the subsequent need for operative stabilization of lateral malleolus fractures. To date, no standardization of stress radiography has been performed. The aim of this study was to evaluate the ability of weightbearing ankle X-rays to determine stability and their reliability. ⋯ This study suggests a weightbearing radiograph of an isolated lateral malleolus fracture cannot determine deltoid ligament integrity and thus need for fibular operative fixation.
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The results of surgical treatment for tarsal tunnel syndrome have been suboptimal, especially in the absence of space-occupying lesions. We attribute this to a poor understanding of the detailed anatomy of the `tarsal tunnel' and potential sites of nerve compression. ⋯ We believe better understanding of the anatomical relationships of the tarsal tunnel and a clear communication system among anatomists, neuroradiologists and foot and ankle surgeons will facilitate accurate preoperative localization of the site of nerve compression possibly leading to better outcomes.
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Continuous perineural blocks are increasingly popular for postoperative pain control. While the reported incidence of neuropathic symptoms has been low, the experience of the lead author suggested it may be much higher. The objectives of this study were to elucidate the incidence of patient-reported neuropathic symptoms following continuous popliteal block (CPB) for postoperative pain control in patients undergoing foot and ankle surgery, to characterize these symptoms and to identify preoperative risk factors. ⋯ The incidence of neuropathic symptoms may be much higher than previously reported. Smoking may be a risk factor for the development of neuropathic symptoms.