Sesamoidectomía peroneal por necrosis séptica

Introducción: Los sesamoideos del hallux son huesos constantes de pequeño tamaño y lentiformes. Se localizan en la región plantar de la cabeza del primer metatarsiano dentro de la cápsula de la primera articulación metatarsofalángica. El diagnóstico diferencial de metatarsalgia sobre el primer radio del pie, sin antecedente traumático, incluye patologías referidas a los sesamoideos y otras. Entre las primeras se encuentran principalmente la sesamoiditis, las fracturas de estrés y la necrosis avascular de los sesamoideos. Objetivo: Presentar un caso de sesamoiditis y su evolución después del tratamiento quirúrgico. Presentación del caso: Mujer de 25 años con un cuadro de fractura por estrés del sesamoideo peroneal. Tras infiltración seriada con corticoesteroides, desencadenó una necrosis séptica del sesamoideo. Se determinó realizar una sesamoidectomía por abordaje plantar. Conclusiones: La sesamoidectomía resulta una opción quirúrgica en procesos degenerativos de los sesamoideos, cuando los tratamientos conservadores son insuficientes. El abordaje plantar se considera adecuado para la extirpación del sesamoideo peroneal. Esta técnica requiere un adecuado seguimiento posoperatorio para optimizar la cicatrización plantar.

Introduction: The hallux sesamoid are constant bones of small size and lentiform. They are located in the plantar region of the first metatarsal head within the capsule of the first metatarsophalangeal joint. The differential diagnosis of metatarsalgia over the first radius of the foot, without traumatic history, includes pathologies related to the sesamoids and others. Among the former are mainly sesamoiditis, stress fractures and avascular necrosis of the sesamoids. Objective: To report a case of sesamoiditis and its evolution after surgical treatment. Case report: This the case of a 25-year-old woman with a stress fracture of the fibular sesamoid. After serial infiltration with corticosteroids, it triggered a septic sesamoid necrosis, it was decided to perform a sesamoidectomy by plantar approach. Conclusions: Sesamoidectomy is a surgical option in degenerative processes of the sesamoids, when conservative treatments are insufficient. The plantar approach is considered adequate for removal of the fibular sesamoid. This technique requires adequate postoperative follow-up to optimize plantar healing.

Orthotic treatment for stage I and II posterior tibial tendon dysfunction (flat foot): A systematic review.

OBJECTIVE: To investigate whether orthotic treatment is effective for the treatment of posterior tibial tendon dysfunction stages I and II (flat foot). DATA SOURCES: Five databases (PubMed, Scopus, PEDro, SPORTDiscus and The Cochrane Library) were searched for potential RCTs from their inception until August 2020. REVIEW METHODS: Only randomised controlled trials (RCT) that included subjects diagnosed with posterior tibial dysfunction in the initial stage and treated with orthotic treatments were selected. The outcomes assessed were whatever symptom related to posterior tibial tendon dysfunction stage I and II. Included RCTs were appraised using the Cochrane collaboration risk of bias tool. RESULTS: Four RCT articles and 186 subjects were included. 75% were at high risk of bias for blinding of participants and personnel. Three different types of conservative treatment were used in the studies: foot/ankle-foot orthoses, footwear and stretching /strengthening exercises. Foot orthoses, together with exercise programmes, seemed to improve the effect of orthotic treatment. Foot orthoses with personalised internal longitudinal arch support were more effective than flat insoles or standard treatments in reducing pain. CONCLUSIONS: The use of orthotic treatment may be effective in reducing pain in the early stages of posterior tibial tendon dysfunction. Further research is needed into individualised orthotic treatment and high-intensity monitored exercise programmes.

Analysis and Assessment through Mechanical Static Compression Tests of Damping Capacity in a Series of Orthosis Plantar Materials Used as Supports.

High plantar pressure is the cause of multiple types of foot injuries and one of the main reasons for patient visits in podiatry and traumatology. Therefore, there is a need to acquire specific tools to address such injuries. The aim of this study was to determine the absorption capacity of selected materials applied as plantar supports and their response to pressure. The study had a cross-sectional design. A total of 21 materials were chosen and different material families were assessed, including ethylene-vinyl acetate, polyurethane foams, and polyethylene foams. Static compression tests were performed to analyze each material. The system is ideally suited for lower-force applications, small components, biomedical applications, and lower-strength materials. Damping was determined using mathematical calculations performed on the study data. It was found that materials with a low Shore A, or soft materials, exhibited worse absorption capacity than harder materials. Ethyl-vinyl acetates had good absorption capacity, polyurethane foams had a poor absorption capacity, and soft materials provided better adaption to impact. The results suggested that damping is not determined by the hardness of the material, and materials within the same family exhibit different damping capabilities.

A Rare Intermetatarsal Coalition With Rigid Fifth Metatarsal Deformity and Symptomatic Plantar Lesion.

Coalition or synostosis of the foot is a relatively uncommon abnormality. Some cases of synostosis of the foot, primarily involving the midfoot and hindfoot, have been reported. However, intermetatarsal coalition is extremely rare, with only a small number of cases reported. We report a case of a unilateral, congenital metatarsal coalition between the fourth and fifth metatarsal bones in a 27-year-old female. She had initially been referred because of a symptomatic plantar lesion under the fifth metatarsal head. Surgery consisted of separating the affected metatarsals, combined with a proximal osteotomy, which proved successful in establishing pain-free and more natural weightbearing.

A report of a rare case of myxoinflammatory fibroblastic sarcoma.

Myxoinflammatory fibroblastic sarcoma of the soft tissues is a rare low-grade tumor of uncertain origin that most often occurs on the extremities of adults. The tumor predominantly involves the subcutaneous tissues of the hands and feet. Despite being a rare neoplasm, owing to its varied histologic appearance, myxoinflammatory fibroblastic sarcoma should be differentiated from various benign and malignant soft-tissue lesions. Myxoinflammatory fibroblastic sarcoma has been well described in pathology journals but not in the surgical literature. We report a case of myxoinflammatory fibroblastic sarcoma in a 19-year-old man with a plantar ulcer lesion in his left foot. To our knowledge, this is the first reported case in the literature involving the epidermis.

The use of autologous platelet gel in toenail surgery: a within-patient clinical trial.

A number of studies have stressed the importance of platelets in acute and chronic wound healing, although their clinical utility remains controversial. To analyze the use of autologous platelet gel in the surgical treatment of ingrown toenails, a within-patient clinical trial was conducted. Thirty-five healthy volunteers (70 feet) underwent surgical treatment for bilateral ingrown hallux nails. Recovery time (days), postoperative pain (analog chromatic scale), and inflammation (digital circumference) at 48 hours postoperative were the outcomes of interest. Recovery time and postoperative pain were less in the experimental group, although the differences of means were not statistically significant. Based on these results, we suggest that local application of APG in surgical ingrown toenail wounds may produce a slight increase in acute inflammatory phase dermal wound healing, but it does not cause a statistically significant reduction in recovery times or postoperative pain.

Platelet gel for the surgical treatment of onychocryptosis.

BACKGROUND: The growth factors derived from platelets contained in platelet-rich plasma comprise a series of molecules that favor the production of collagen with the proliferation of fibroblasts and new blood vessels. These substances exert their effect on the cells, acting in all the stages of cicatrization, especially in hemostasis and early fibroplasia. METHODS: Thirty-five patients (70 feet) were selected, operated on both sides for ingrown hallux nails, and subjected to two different experimental conditions in a crossover clinical trial with positive control of treatment. Two main variables were analyzed: on one side, the bleeding, according to three preestablished categories, and on the other, the mean time of cicatrization in days. RESULTS: Significant differences (P < .001) were found between the two groups for bleeding. We observed that cicatrization time did not differ significantly between the two treatments. CONCLUSION: The use of platelet gel for the treatment of onychocryptosis by single nonincisional matricectomy can guarantee good hemostasis, with a significant reduction in bleeding, but does not produce a clinically significant reduction in cicatrization time.