Antimicrobial prophylaxis.

This paper discusses when antimicrobial prophylaxis should be initiated and when it is not recommended as an effective treatment or means of prophylaxis. Various surgical procedures take complete advantage of the effectiveness of such prophylaxis against the emergence of infection and complications; however, the possibility of superinfection is always present and should not be overlooked by the attending physician.

Surgical management of hallux limitus and rigidus in the young patient.

As demonstrated in a recent survey, hallux limitus and rigidus are often the presenting complaints of our young population. Normal first metatarsophalangeal joint function depends not only on an intact articulation but also sesamoidal mobility and the capacity for the first metatarsal to plantarflex. Whereas acute or chronic microtrauma can impair articular surfaces, first metatarsal plantarflexion can be limited in cases of hypermobility, excessive metatarsal length, immobility of the first metatarsocuneiform joint, or metatarsus primus elevatus. Conservative therapy can be more effective in relieving the symptoms of hallux limitus or rigidus in young patients; however, surgical intervention is often necessary or desirable. The choice of surgical procedure should be based on the etiology of the deformity, as well as the degree of articular degeneration. It is the senior author's opinion that young patients with hallux limitus or rigidus are best served by the performance of cheilectomy with osteotomies designed to create an internal rocker bar mechanism. Procedures designed to shorten or plantarflex the first metatarsal should be reserved for obvious cases of excessive metatarsal length or elevation.

The early diagnosis of peripheral vascular disease.

The time has long since passed when gangrene followed by amputation was the anticipated outcome of peripheral vascular disease of the extremities. Nevertheless, today in the United States it is estimated that there are more than half a million amputees. With preventive measures, early diagnosis, and adequate treatment, gangrene will be avoided and the patient will retain the use of his limbs.

A systematic approach to examining the patient with nail disease.

The majority of patients who present to the clinician for podiatric care do so because of complaints involving the nail and its surrounding structures. All too often the clinician's examination of the nail is incomplete and in many instances completely overlooked. The authors present a systematic approach to the examination of the patient who presents with nail pathology.

Nail changes secondary to environmental influences.

Environmental medicine is a dynamic medical specialty that integrates medicine, mathematics, biology, and engineering. In this article an overview of how environmental agents affect the nail is presented. In addition, the three major routes of exposure (inhalation, dermal, and gastrointestinal) to environmental agents are discussed. Selected physical, chemical, and pharmaceutical agents and their effect on the nail structure are presented in the text.

Applied biomechanics of bone: functional and clinical perspectives.

Proper locomotion depends on the presence of a strong, intact skeletal system that is able to withstand the stresses and strains of everyday life. In this article, the authors discuss the function of force on bones from a clinical and biomechanical viewpoint. As is presented, bone is a living, viable organ that responds to both external and internal stimuli.

Workers' compensation.

Workers' compensation is a system through which the injured worker is assured by law of a partial income during the period in which he or she is unable to work. Presented in this article is a general discussion of the role of workers' compensation in our industrial society and how it relates to the practice of podiatric medicine.