Results of shortened program of Ponseti technique for congenital clubfoot.

OBJECTIVE: To study the results and complications of congenital clubfoot treatment using a shortened (twice a week) program of serial casting using Ponseti technique. MATERIAL AND METHOD: Sixteen patients with congenital clubfoot (26 feet) were treated by serial manipulation and casting twice a week until acceptable deformity correction (60 degrees of abduction with or without equinus deformity) were achieved RESULTS: Seventeen patients (65%) required less than three weeks in treatment to improvement in the deformity, while eight patients (30%) required more than three weeks of treatment. This period of treatment is at least two weeks shorter than the conventional Ponseti technique. One patient did not complete treatment due to hospital-acquired pneumonia. Four patients who developed pressure ulcers from the castings were continued in treatment and all achieved successful correction. CONCLUSION: A shortened program of clubfoot correction using the Ponseti technique can be effective for correcting uncomplicated clubfoot without serious complications.

Chronic irreducible dislocation of the proximal interphalangeal joint of the fifth toe: a case report.

BACKGROUND: Traumatic dislocation of the interphalangeal of the fifth toe is an unusual foot injury. CASE PRESENTATION: We report the case of a 47-year-old woman who sustained a minor foot injury for more than 30 years, resulting in chronic, irreducible dislocation of the proximal interphalangeal joint of the fifth toe. The affected proximal interphalangeal joint was accessed via a dorsal incision over the unstable interphalangeal joint. It was found that the interposed interphalangeal joint capsule and attenuated lateral collateral ligament were reconstructed, and it was stabilized by temporary insertion of a Kirschner wire. The affected joint was found to be stable, well-positioned and pain-free at the 12-month post-surgical check-up. CONCLUSION: This unusual presentation of a chronic joint dislocation responded favorably to open reduction, soft tissue reconstruction and restabilization of the affected joint. It is suggested that this approach will provide a good and functional outcome even in cases of very long-standing joint injury.

Extraskeletal chondroma on the sole of the foot.

UNLABELLED: A 47-year-old female presented with a solitary mass located in the plantar region of her left foot. The mass, which she noticed 2 years ago, grew gradually and caused increasing pain when bearing weight. Physical examination showed a 3.5-cm diameter tender nonmobile mass with firm consistency in the midplantar region. Radiographs showed a ring-like calcification compatible with cartilage tissue. Magnetic resonance imaging revealed a lobulated mass with a hypointense signal on T1-weighted images and a hyperintense signal on T2-weighted images in the mid-substance of the plantar fascia. After a skin incision was performed, the mass was dissected from the skin and subcutaneous tissue. Then, a marginal excision was performed. The histological assessment reported chondrocytes within lacunae embedded in a chondroid matrix with focal calcification. The definitive diagnosis was extraskeletal chondroma. Plantar pain resolved within 3 months and no recurrence was found at the 1-year follow-up. LEVEL OF EVIDENCE: Therapeutic Level IV, Case Report.

Off-loading total contact cast in combination with hydrogel and foam dressing for management of diabetic plantar ulcer of the foot.

BACKGROUND: The total contact cast is considered to be an effective method of off-loading a diabetic non-infected pressure ulcer. However complications have been reported in 1 to 15% of cases, e.g. prolonged healing of the ulcer. Debridement with modern dressings has been reported to be effective in promoting wound healing; however there have been few reported studies of the combination of modern dressings with the cast. OBJECTIVE: To evaluate the effectiveness of a combination of treatments on healing rates in diabetic non-infected plantar ulcer of the foot. MATERIAL AND METHOD: This retrospective study with prospective data collection was conducted between September 2010 and August 2012. Twenty diabetic patients with plantar neuropathic ulcer were treated using a combination of a contact cast plus hydrogel andfoam dressings. The size and location of the ulcer, ulcer healing, foot deformities and complications were evaluated. RESULTS: Of 21 ulcers, 20 (95.2%) healed completely in a mean time of 30.1 days (range 14 to 70 days). Healing times for forefoot and midfoot ulcers were 22.6 and 26.8 days, respectively, which is significantly shorter than the 51.7 days for heel ulcers. One patient who had an unhealed ulcer developed a severe infection two months after treatment, which necessitated below the knee amputation. There were three cases of recurrence of the ulcers after casting. CONCLUSION: Off-loading casting combined with modern dressings had a high rate of healing in short-term treatment of diabetic non-infected pressure ulcers. Recurrence of ulcers and new site abrasions were common complications; those complications may have been caused by association with bone deformity or improper footwear.