Prevention of ulceration, amputation, and reduction of hospitalization: outcomes of a prospective multicenter trial of tibial neurolysis in patients with diabetic neuropathy.

This is the first multicenter prospective study of outcomes of tibial neurolysis in diabetics with neuropathy and chronic compression of the tibial nerve in the tarsal tunnels. A total of 38 surgeons enrolled 628 patients using the same technique for diagnosis of compression, neurolysis of four medial ankle tunnels, and objective outcomes: ulceration, amputation, and hospitalization for foot infection. Contralateral limb tibial neurolysis occurred in 211 patients for a total of 839 operated limbs. Kaplan-Meier proportional hazards were used for analysis. New ulcerations occurred in 2 (0.2%) of 782 patients with no previous ulceration history, recurrent ulcerations in 2 (3.8%) of 57 patients with a previous ulcer history, and amputations in 1 (0.2%) of 839 at risk limbs. Admission to the hospital for foot infections was 0.6%. In patients with diabetic neuropathy and chronic tibial nerve compression, neurolysis can result in prevention of ulceration and amputation, and decrease in hospitalization for foot infection.

A positive Tinel sign as predictor of pain relief or sensory recovery after decompression of chronic tibial nerve compression in patients with diabetic neuropathy.

Predictive ability of a positive Tinel sign over the tibial nerve in the tarsal was evaluated as a prognostic sign in determining sensory outcomes after distal tibial neurolysis in diabetics with chronic nerve compression at this location. Outcomes were evaluated with a visual analog score (VAS) for pain and measurements of the cutaneous pressure threshold/two-point discrimination. A multicenter prospective study enrolled 628 patients who had a positive Tinel sign. Of these patients, 465 (74%) had VAS >5. Each patient had a release of the tarsal tunnel and a neurolysis of the medial and lateral plantar and calcaneal tunnels. Subsequent, contralateral, identical surgery was done in 211 of the patients (152 of which had a VAS >5). Mean VAS score decreased from 8.5 to 2.0 (p <0.001) at 6 months, and remained at this level for 3.5 years. Sensibility improved from a loss of protective sensation to recovery of some two-point discrimination during this same time period. It is concluded that a positive Tinel sign over the tibial nerve at the tarsal tunnel in a diabetic patient with chronic nerve compression at this location predicts significant relief of pain and improvement in plantar sensibility.

Postoperative cryotherapy: risks versus benefits of continuous-flow cryotherapy units.

Continuous-flow cryotherapy units have been proved to decrease pain, inflammation, swelling, blood loss, and narcotic usage in the postoperative setting. Complications related to cryotherapy are extremely rare (estimated at 0.00225%) but can be devastating. Complications include frostbite, chronic pain, and loss of digits. Caution should be exercised when prescribing continuous-flow cryotherapy units to patients with known risk factors for cold injury. All members involved with care of the patient, including the physician, nursing staff, patient, and patient's family and caregivers, should take an active roll in monitoring the foot for signs and symptoms of cold injury. Continuous-flow cold therapy should be discontinued when capillary refill time is greater than 5 seconds.

Progressive post-traumatic ankle arthrosis treated with total ankle joint replacement: a case review.

This article discusses the joint degeneration progression associated with post-traumatic arthrosis of the ankle. A representative case study of this debilitating condition was outlined, and treatment with total ankle joint replacement was presented. Although ankle arthrodesis continues to be a standard option following the progression of severe post-traumatic osteoarthritis, total ankle replacement is maturing as a viable option for this condition.