Foot and ankle clinics
-
Foot and ankle clinics · Sep 2002
ReviewApproach alternatives for treatment of osteochondral lesions of the talus.
Osteochondral lesions of the talus are common injuries, especially in the athletic population. Although multiple etiologies exist, lateral lesions have a higher incidence of association with a specific traumatic event. It has been postulated that lateral lesions are produced when the anterolateral aspect of the talar dome impacts the fibula on application of an inversion or dorsiflexion stress to the ankle [2]. ⋯ Most medial lesions are located on the posterior talar dome, and a medial malleolar osteotomy is usually required. Osteotomies, in particular of the medial malleolus, should be approached carefully. The possible complications of nonunion and malunion can lead to progressive arthritis of the ankle joint.
-
The key to syndesmosis injuries is early recognition of the injury pattern and appropriate treatment. The clinician must be wary of the ankle sprain that is slow to heal. ⋯ Late repairs or reconstructions never have as favorable an outcome as the properly repaired acute injury. Postoperative rehabilitation should be monitored closely and care should be taken to avoid early return to activity that could result in reinjury or damage to the surgical repair or reconstruction.
-
Foot and ankle clinics · Jun 2002
ReviewComplex regional pain syndrome and chronic pain management in the lower extremity.
CRPS is a difficult clinical entity to manage; it requires close and regimented follow-up to ensure that progress is being made. Early recognition is important so that treatment plans to prevent a long-standing or permanent disability made be instituted. Treatments such as physical therapy, medications, regional anesthesia, and neuromodulation may decrease their morbidity and return the patient to a more functional status.
-
Foot and ankle clinics · Mar 2002
Review Historical ArticleInterphalangeal joint arthrodesis of the lesser toes.
Fusion of the PIP joint of the lesser toes provides sound correction of deformity of that joint. Fusion is achieved reliably in most cases and fibrous ankylosis is well tolerated in those that fail. Patients at the extremes of the age scale are perhaps less tolerant of the procedure; complaints include poor cosmesis and subjective lack of control of the toes [18]. ⋯ Complete failure of surgery occurs when muscular imbalance or pre-existing deformity at another level is not properly addressed. This may result in patient complaints of persistent metatarsalgia or toe deformity despite a successful PIP fusion. The use of either sound fixation or a stable bony construct is recommended, as it is likely to reduce the incidence of mal-union and non-union.
-
Foot and ankle clinics · Mar 2001
ReviewOperative treatment of the difficult stage 2 adult acquired flatfoot deformity.
In the flexible pes planovalgus deformity of stage 2 posterior tibial tendon dysfunction, osteotomies appear to have a significant role in operative management by restoring more normal biomechanics, allowing tendon transfers to function successfully. The options when considering osteotomies for stage 2 disease include lateral column lengthening, medial displacement calcaneal osteotomy, and combined double osteotomy technique. The tight Achilles tendon should be lengthened as well. ⋯ More recently, the intermediate 5-year follow-up has been assessed for this combination of procedures, and similar results were found. There was a high rate of patient satisfaction and functional improvement, and surgical correction of the flatfoot deformity was maintained and compared favorably with the contralateral normal foot. Although the intermediate follow-up found a 14% incidence of calcaneocuboid arthrosis, 50% of these patients had preoperative evidence of calcaneocuboid joint arthritis. (ABSTRACT TRUNCATED)