Foot & ankle
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Pes planus has been suggested as a factor in the development of bunions in adolescents. This study objectively evaluated the radiographs of 36 adolescents with 66 hallux valgus deformities for the presence of associated flatfeet. ⋯ Only 26.6% of these adolescents had an increased intermetatarsal angle and 8.1% an abnormal metatarsus varus angle as compared with the published norms. Measurements of pes planus including talar pitch, calcaneal plantar angle, dorsoplantar talonavicular angle, and lateral talocalcaneal angle showed an incidence of flatfeet in adolescents with bunions that was 8 to 24 times greater than expected.
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Occult malunion of the ankle is a condition in which the talus appears to be situated in its normal position on standard radiographs. The lateral malleolus, however, is incompletely reduced. ⋯ The malunion of the lateral malleolus is best visualized on lateral radiographs or tomograms. This condition can be corrected by osteotomizing the lateral malleolus and restoring the integrity of the distal tibiofibular joint by pulling the lateral malleolus distally and internally rotating it.
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Sensory nerve neuromas caused by incisions on the dorsum of the foot are a common cause of failed foot surgery and can be severely painful and disabling. Thirty-seven patients with 55 symptomatic sensory nerve neuromas were evaluated and treated at the Painful Foot Center. Ten patients with moderately severe symptoms chose not to undergo surgery and were treated with oversized shoes with or without protective orthoses. ⋯ Thirteen of the 23 obtained good results, four obtained fair results, and six obtained poor results. Thus, a total of 20 patients (74%) obtained clinically satisfactory results, and seven (26%), unsatisfactory results. It is much easier to prevent a sensory neuroma by meticulous surgical technique than to treat a highly symptomatic neuroma.
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Case Reports
Simultaneous open dislocation of the metatarsophalangeal and interphalangeal joints of the hallux: a case report.
Simultaneous open dislocations of the hallux metatarsophalangeal and interphalangeal joints is previously unreported. Reducibility of the isolated metatarsophalangeal joint dislocation is often implied by the sesamoid separation and/or the existence of a sesamoid fracture. In the open dislocations of the metatarsophalangeal and interphalangeal joints of the hallux reported in this article, the ease of reduction is related instead to the severe disruption of the capsule.
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A late complication of fracture with dislocation involving the tarsometatarsal joints of the foot (Lisfranc fracture) is progressive degenerative arthritis and pain. A dowel-graft arthrodesis technique is described that uses percutaneous bone graft from the iliac crest supplemented by crossed-wire fixation. ⋯ Follow-up evaluation (mean, 37 months) of 13 of the 15 patients demonstrated satisfactory pain relief in 11 patients, whereas 2 were dissatisfied. Complications included three instances of nonunion and one postsurgical reflex sympathetic dystrophy syndrome.