Gastrocnemius recession to treat isolated foot pain.

BACKGROUND: Gastrocnemius recession is performed to correct an isolated gastrocnemius equinus contracture of the ankle that may accompany foot and ankle pathology in the adult. It has been proposed that this equinus deformity leads to excessive strain throughout the foot, thus causing pain. This can manifest itself in the form of plantar fasciitis, metatarsalgia, posterior tibial tendon insufficiency, osteoarthritis, and foot ulcers. The purpose of this retrospective study was to review the efficacy of the gastrocnemius recession in providing pain relief for patients who have foot pain without structural abnormality who have failed conservative treatment and have an isolated gastrocnemius contracture. MATERIALS AND METHODS: Twenty-nine patients (34 feet) who had chronic foot pain without any structural abnormality other than an isolated gastrocnemius contracture underwent a gastrocnemius recession and were available for follow up at an average of 19.5 (range, 7 to 44) months. The outcome measurements were related to pain relief (Visual Analog Scale) and patient satisfaction. RESULTS: Preoperatively the average pain score was 8/10 which improved postoperatively to 2/10. Twenty-seven patients (93.1%) said they would recommend this procedure for isolated foot pain to a friend. Twenty-seven patients (93.1%) said they were satisfied with the results of the procedure. Twenty-three of 25 patients (92%) who had a unilateral procedure stated they would have the contralateral leg done if needed. CONCLUSION: Gastrocnemius recession was found to be an effective procedure when used to relieve recalcitrant foot pain in those patients with an isolated gastrocnemius contracture without deformity.

Surgical management and treatment algorithm for the subtle cavovarus foot.

BACKGROUND: Subtle cavovarus foot is a condition that can lead to significant foot pain and disability. We review the results of our treatment algorithm at medium-term followup. MATERIALS AND METHODS: Thirty-five consecutive patients with lateral based symptoms due to an underlying congenital subtle cavovarus foot type were surgically corrected. Various procedures were utilized, including some combination of the following: lateral displacement calcaneus osteotomy, peroneus longus to brevis transfer, dorsiflexion first metatarsal osteotomy, and Achilles tendon lengthening. Twenty-three patients, with 29 feet, returned for followup examination. The mean patient age at the time of surgery was 43.4 years, and the mean followup to date was 4.4 years. RESULTS: The mean AOFAS ankle hindfoot score preoperatively was 45, and postoperatively was 90. Radiographically, the medial cuneiform to floor height changed from 3.5 cm preoperatively to 3.0 cm postoperatively. The talo-first metatarsal angle improved 7.5 degrees postoperatively. There were no nonunions. No patients to date have gone on to fusions or revisions. Ten feet (34%) required hardware removal. All patients had resolution of their symptoms following hardware removal. CONCLUSION: The surgical management for the subtle cavovarus foot based on the proposed treatment algorithm provided symptomatic relief, longstanding correction, and high patient satisfaction.

Tibial compartment syndrome and the cavovarus foot.

Compartment syndrome of the leg is an orthopedic emergency that requires a high index of suspicion for diagnosis and a low threshold for surgical management to prevent devastating complications. Where the clinical findings are subtle, continuous monitoring of compartment pressures, with clinical correlation, is the key to diagnosis. Surgical management should include decompression of all four compartments and early rehabilitation to prevent ischemic contracture. If contracture develops, it may cause varying degrees of equinocavovarus deformity of the foot and ankle. Appropriate evaluation and careful surgical planning that considers all components of this complex deformity are essential for obtaining good clinical results.

First ray injuries.

The first ray differs from the other rays in its position and its importance with weight bearing. Because it is a critical structure in the formation of the tripod of the foot, injuries to this ray can cause critical alterations in the biomechanics of the foot. This allows for pathologic weight-bearing points of contact and deformity that lead to a disabling gait. Physicians who are involved in the care of the foot and ankle should be familiar with the spectrum of injuries that concern the first ray. These injuries, their management, and sequelae are reviewed.

Calcaneus fractures: a review article.

Calcaneus fractures are a significant burden to society. Assessment and treatment of these injuries has improved significantly. The use of CT scanning has allowed a greater understanding of the pathologic anatomy of these fractures, and has provided for prognostic classification systems with respect to outcome. The treatment options are diverse and are reviewed.

Complications After Popliteal Block for Foot and Ankle Surgery.

BACKGROUND: A popliteal nerve block is a common analgesic procedure for patients undergoing surgery on their knee, foot, or ankle. This procedure carries less risk in a surgical setting compared with other forms of anesthesia such as a spinal block. Previous reports demonstrated few to no complications with the use of this nerve block, but it is unclear whether these data are consistent with the recent increase in use of this analgesic procedure for lower extremity surgery. METHODS: Retrospectively, a busy orthopedic foot and ankle practice performed a chart review examining for postoperative neuropathic complications possibly related to the popliteal nerve block. The 1014 patients who had undergone a popliteal block for foot and/or ankle orthopedic surgery were analyzed for short and long-term neuropathic complications. The collected data consisted of tourniquet time, pressure, and location as well as the method of finding the fossa nerve, adjuncts used, and patient medical history. Data were analyzed using chi-square, Fisher's exact, and t tests for analysis with a significance value of P < .05. RESULT: Of these 1014 patients, 52 patients (5%) developed deleterious symptoms likely resulting from their popliteal block, and 7 (0.7%) of these were unresolved after their last follow-up. No immediately apparent underlying causes were determined for these complications. CONCLUSION: The frequency of a neuropathic complication following a popliteal nerve block was notably higher in the early postoperative period than indicated in the past. The proportion of patients with unresolved neuropathic symptoms at last follow-up is comparable to that previously reported in the literature. LEVEL OF EVIDENCE: Level IV, retrospective case series.