Leclercia Adecarboxylata and Pseudomonas Oryzihabitans Infection after Achilles Tendon Repair: A Case Report and Literature Review.

Leclercia adecarboxylata and Pseudomonas oryzihabitans are two bacteria rarely seen in human infections. We present an unusual case of a patient who developed a localized infection with these bacteria after repair of a ruptured Achilles tendon. We also present a review of the literature regarding infection with these bacteria within the lower extremity.

Primary Tumoral Calcinosis in a Pediatric Patient: A Rare Presentation.

Tumoral calcinosis is a benign, progressive disorder characterized by massive periarticular deposition of calcium salts into subcutaneous and deeper tissue layers. While a majority of cases present secondary to underlying metabolic disorders, it can rarely present as a primary, idiopathic phenomenon. We present an atypical case of a pediatric patient with a large, ulcerated pedal soft tissue mass found to be consistent with primary tumoral calcinosis. This was confirmed by histopathologic analysis and comprehensive metabolic workup. The patient underwent surgical excision of the mass, with complete resolution of symptoms and no recurrence after a 1-year follow-up period.

Isolated Forefoot Juvenile Xanthogranuloma: Unique Case Study and Treatment in a Pediatric Patient.

Juvenile xanthogranuloma is a benign histiocytic cell proliferative disorder that occurs in early childhood. The most common presentation occurs within the first 2 years of life with papular or nodular changes to the skin on the head, neck or upper trunk. This case study documents the findings and treatment of a single solitary soft tissue mass in the forefoot of a 17-year-old patient. Unique to this case, the initial diagnosis of tuberous xanthoma was made and, with referral to an outside hospital, changed to a juvenile xanthogranuloma. In addition, unlike most juvenile xanthogranulomas in the literature, there was no superficial dermatological abnormality seen clinically. This change was not a dramatically different diagnosis, but further immunohistochemical staining was necessary for ultimate diagnosis. The soft tissue mass was self-contained to the deeper tissue layers and not the epidermis. The patient was followed for 12 months for possible recurrence and medical workup, without postoperative complications. The purpose of this study was to report on a unique finding and presentation of a xanthogranulomatous soft tissue mass in the forefoot of a pediatric patient.

Arthroscopic Treatment of Osteochondral Lesions of the Talus Utilizing Juvenile Particulated Cartilage Allograft: A Case Series.

The treatment options for osteochondral lesions of the ankle are scarce, and newer modalities are becoming available. We describe a minimally invasive arthroscopic approach with implantation of juvenile particulated allograft to facilitate the growth of true hyaline cartilage in patients with osteochondral lesions of the talus. The purpose of this study was to subjectively review clinical outcomes using the validated Foot and Ankle Outcomes Score in patients who underwent this technique. Our technique was performed on 82 consecutive patients with average follow-up of 24 (range 9 to 86) months. We found that 28 (88%) of 32 patients who responded to the questionnaire had good or excellent results for activities of daily living; 26 (82%) of 32 patients had at least a good result for both pain and symptoms; and 25 (78%) of 32 had at least a fair result for functional sports and quality of life.

Leiomyoma of the Foot: A Case Report and Literature Review.

Leiomyomas within the foot are rare occurrences that are difficult to diagnose clinically and radiographically. They are benign and tend to be slow growing, often with minimal or no pain. We present an unusual case of a worker's compensation patient who presented with a new-onset mass within his foot that was thought to be a fibroma, but was later discovered to be a fast-growing leiomyoma after surgical excision. We also present a review of the literature regarding leiomyomas within the foot and ankle.

Nontraumatic Osteonecrosis of the Distal Tibia: A Case Presentation and Review of the Literature.

Osteonecrosis, although commonly occurring in the hip, can also affect the leg and foot. In the foot, it most commonly occurs in the talus. The incidence of osteonecrosis occurring in the tibia is relatively rare. We report a case of a woman who presented to our clinic with ankle pain that was idiopathic in nature. Subsequent magnetic resonance imaging showed findings consistent with osteonecrosis of the bilateral distal tibias and several other lesions located in the shoulder, hip, and calcaneus. The present report also serves as a review of both etiology and treatment of osteonecrosis as it relates to the lower extremity.

Transmetatarsal amputation in the setting of antiphospholipid antibody syndrome.

Antiphospholipid syndrome is a hypercoagulable disease that can present foot and ankle surgeons with a unique challenge in treating patients who present with thrombosis and ischemia despite having normal pedal pulses. Appropriate perioperative management is imperative in these patients, because limb- and life-threatening complications can occur postoperatively, despite aggressive anticoagulation. We present the case of a 46-year-old male who underwent a transmetatarsal amputation and, despite aggressive therapy, developed a myriad of complications postoperatively. At 10 months postoperatively, the patient was doing well in an accommodative orthotic with minimal pain while receiving continued aggressive therapy and follow-up examinations by a number of specialists to treat his antiphospholipid syndrome.

Arthroscopic De Novo NT(®) juvenile allograft cartilage implantation in the talus: a case presentation.

Osteochondral defects of the talus are a challenging subject facing foot and ankle surgeons. The available treatment options have relatively good subjective outcomes; however, they are limited by the ability to reproduce hyaline cartilage, the need for multiple surgeries, and high morbidity. We present a new technique using DeNovo NT(®) juvenile allograft cartilage implantation introduced into a talar lesion arthroscopically in a single procedure to repair a posteriomedial talar osteochondral defects in a healthy, active 30-year-old female. The patient tolerated the procedure well. At the 6-month follow-up visit, the patient had returned to full activity, and at 24 months, she remained completely pain free.