Foot & ankle
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A retrospective study of 22 ankles in 22 patients with osteochondral talar dome lesions between 1975 and 1983 has indicated that surgical treatment yields superior results to conservative therapy. Thirteen male and 9 female patients, ages 9 to 72 years, average age 28 years, showed 10 medical lesions (Berndt and Harty classification (stage I (one); stage II/III (nine)) and 12 lateral lesions (stage II/III (5), stage IV (7)). Examination follow-up on 19 patients (86%) has averaged 24 months. ⋯ Nineteen of the 22 patients had surgical therapy with 79% excellent or good, 21% fair, and no poor results. Five of the eight patients who elected prolonged conservative therapy finally had surgery. Of the three remaining patients conservatively treated, there were two fair results and one poor result.
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Ankle diastasis without associated fracture occurs in a latent form in which the diastasis is detected only by stress radiographs, and in a frank form with the diastasis visible on routine, unstressed radiographs. Whereas latent ankle diastasis requires no reduction and can be treated by cast immobilization, frank diastasis requires anatomical reduction of the ankle mortise. The method of reduction depends upon the particular type of frank diastasis. ⋯ Good results were obtained in four patients. Fair results secondary to stiffness and pain on activity were present in two patients. All patients maintained anatomical reduction of the ankle mortise following removal of the tibiofibular screw.
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This article illustrates several case reports of occult foreign bodies of the foot. The patients came for treatment from weeks to years after the inciting incident with chronic, sterile, draining wounds. The diagnosis of these foreign bodies can be quite difficult. Several radiographic and clinical clues are included, yet the single most valuable tool for the physician remains a high index of suspicion.
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A simplified, predictable method of peripheral nerve block at the ankle and foot with a long acting anesthetic agent bupivacaine (Marcaine) 0.5% is presented. Combined with the use of a pneumatic tourniquet it allows the performance of mid and forefoot surgery on an inpatient or outpatient basis. It alleviates the risks of general or spinal anesthesia and avoids the use of analgesics for a period of 10 to 25 hours. ⋯ The sural nerve is blocked subcutaneously at one fingerbreadth distal to the tip of the lateral malleolus. The results have been excellent to good. No adverse reactions occurred affecting the central nervous system of the myocardium.
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The biomechanical evaluation of patients with painful heels has received only limited attention although the potential morbidity and disability associated with such an ailment can be severe. An objective analysis of the patient's foot function during gait can produce useful information to assess the underlying pathology. This method can also help to evaluate the efficacy of various existing treatment protocols. ⋯ Characteristic deviations from the normal impulse distribution were noted in these patients which provided the basis for differentiating the pathological condition between the patients with painful heel pads and those with plantar fasciitis. The effectiveness of using heel cups as a therapeutic device was also assessed. Although significant gait changes were not associated with the insertion of heel cups, they did seem to shift the foot-floor impulse forward from the heel region, which made them effective in patients afflicted with localized heel pain, but not in those with plantar fasciitis.