Radiofrequency Ablation for the Treatment of Painful Neuroma.

Mechanical compression of interdigital nerves beneath the deep transverse intermetatarsal ligament and between the metatarsal heads leads to painful irritation and possible fibrosis. Conservative measures of padding and injections often fail to provide long-term relief. Surgical excision provides definitive relief, but the procedure is not without risk. Incomplete excision and stump neuroma formation are a few of the possible complications associate with open excision. This retrospective cohort study was performed to provide a review of the available literature on the identification and treatment of interdigital neuromas and to examine the overall incidence of patient satisfaction after radiofrequency ablation as definitive treatment for interdigital neuroma formation. This study population consisted of 32 patients (25 females and 7 males with 1 patient having bilateral procedures) with a mean age of 46.3 ± 17 (range 31 to 65) years. For all procedures, the median patient satisfaction score was 92.5 (interquartile range 50 to 100) of 100, with a mean follow-up period of > 2.5 years. Only 1 patient in the study population reported no relief after 3 total procedures. Radiofrequency ablation offers a minimally invasive alternative with a short postoperative recovery course and considerably fewer complications compared with surgical excision of the intermetatarsal neuroma as described in prior reports.

Long-Term Follow-Up of the Cheilectomy for Degenerative Joint Disease of the First Metatarsophalangeal Joint.

Cheilectomy is the surgical resection of 20% to 30% of the dorsal metatarsal head and proximal phalanx. The present retrospective study evaluated the long-term efficacy of aggressive cheilectomy to address degenerative joint disease of the first metatarsophalangeal joint. To our knowledge, this is the second longest duration study to date to evaluate the long-term efficacy of the cheilectomy procedure, with a mean follow-up period of 7.14 years (range 39 weeks to 14.87 years). The mean patient age was 55.71 ± 9.51 years, and 37 (65%) of the patients were female. Age, sex, foot type, and preoperative radiographic parameters of hallux rigidus were also evaluated and correlated. The mean percentage of success with this operation was 87.69%. Of the 58 patients, 51 (87.93%) experienced no limitations in their daily activities. Only 2 patients (3.33%) subsequently required subsequent arthrodesis. The results of the present study suggest that cheilectomy offers long-term satisfaction for patients with hallux rigidus and is an acceptable alternative to the joint destructive procedure of first metatarsophalangeal arthrodesis.

Intrinsic Fixation of the Tibial Sesamoid in First Metatarsophalangeal Joint Arthrodesis: A Cadaveric Study.

Nonunion rate of first metatarsophalangeal joint (MTP) joint arthrodesis is reportedly less than 6%, regardless of fixation type. Robust modern plating constructs aim to decrease incidence of nonunion while also allowing early postoperative weight-bearing. Quicker transition to weight-bearing postoperatively increases patient adherence, decreases adjacent joint stiffness, and reduces risk of deep vein thrombosis in the postoperative period. The purpose of this study was to investigate the effect tibial sesamoid fixation has on first MTP joint arthrodesis.

Effect of Surgical Weight Loss on Plantar Fasciitis and Health-Care Use.

BACKGROUND:: Plantar fasciitis (PF) is one of the most common causes of heel pain. Obesity is recognized as a major factor in PF development, possibly due to increased mechanical loading of the foot due to excess weight. The benefit of bariatric surgery is documented for other comorbidities but not for PF. METHODS:: A retrospective medical record review was performed for patients with PF identified from a prospectively maintained database of the Cleveland Clinic Bariatric and Metabolic Institute. Age, sex, surgery, excess weight loss, body mass index (BMI), and health-care use related to PF treatment were abstracted. Comparative analyses were stratified by surgery type. RESULTS:: Two hundred twenty-eight of 10,305 patients (2.2%) had a documented diagnosis of PF, of whom 163 underwent bariatric surgery and were included in the analysis. Eighty-five percent of patients were women, mean ± SD age was 52.2 ± 9.9 years, and mean ± SD preintervention BMI was 45 ± 7.7. Postoperatively, mean ± SD BMI and excess weight loss were 34.8 ± 7.8 and 51.0% ± 20.4%, respectively. One hundred forty-six patients (90%) achieved resolution of PF and related symptoms. The mean ± SD number of treatment modalities used for PF per patient preoperatively was 1.9 ± 1.0 ( P = .25). After surgery, the mean ± SD number of treatment modalities used per patient was reduced to 0.3 ± 0.1 ( P = .01). CONCLUSIONS:: We present new evidence suggesting that reductions in BMI after bariatric surgery may be associated with decreasing the number of visits for PF and may contribute to symptomatic improvement.

A practical guide for examining and treating the diabetic foot.

Physicians can perform a quick, complete examination of the feet of patients with diabetes to prevent serious complications. The examination should focus on circulation, nerve function, musculoskeletal problems, and the skin. All patients should be urged to wear supportive, comfortable shoes, and to wash, moisturize, and examine their feet every day.

Sesamoid disorders of the first metatarsophalangeal joint.

The sesamoid complex is located centrally and plantar to the first metatarsal head, where they are imbedded within the plantar plate, which transmits 50% of body weight and more than 300% during push-off, is susceptible to numerous pathologies. These pathologies include sesamoiditis, stress fracture, avascular necrosis, osteochondral fractures, and chondromalacia, and are secondary to these large weight-bearing loads. This article discusses sesamoid conditions and their relationship with hallux limitus, and reviews the conditions that predispose the first metatarsophalangeal joint to osteoarthritic changes.