[Lateral ligament injuries of the ankle joint]. / Die Verletzung des lateralen Kapsel-Band-Apparats des Sprunggelenks.

Lateral ligament injuries are the most common sports injury and have a high incidence even in non-sportive activities. Although lateral ligament injuries are very common there is still a controversial debate on the best management. The diagnosis is based on clinical examination and X-ray images help to rule out fractures. Further imaging, especially magnetic resonance imaging (MRI) is used to diagnose associated injuries. According to the recommendations of the various scientific societies the primary therapy of lateral ligament injuries is conservative. Chronic ankle instability develops in 10-20 % of patients and the instability can be a result of sensomotoric deficits or insufficient healing of the lateral ligament complex. If the patient does not respond to an intensive rehabilitation program an operative reconstruction of the lateral ligaments has to be considered. Most of the procedures currently performed are anatomical reconstructions due to better long-term results compared to tenodesis procedures.

[Problems in complex hindfoot corrections]. / Probleme bei Komplexen Rückfusskorrekturen.

This article discusses the intraoperative and postoperative problems seen in the treatment of posterior tibial tendon dysfunction. Problems associated with tendon transposition procedures, osteotomy and arthrodesis are discussed. The preoperative, intraoperative and postoperative problems and complications and how to avoid or treat them will be addressed. The individual procedures are often part of other complex hindfoot reconstructions. For this reason the general and special aspects of treating posterior tibial dysfunction can often be transferred to avoiding and resolving problems in hindfoot surgery.

[Closed reposition of an acute midfoot luxation fracture in Charcot arthropathy with the ring fixator]. / Geschlossene Reposition einer akuten Mittelfussluxationsfraktur im Rahmen einer Charcot-Arthropathie mit Hilfe des Ringfixateurs.

Diabetic neuropathic osteo-arthropathy (DNOAP; Charcot arthropathy) is a progressive disease characterized by joint luxation, fractures and excessive destruction of foot architecture. The operative therapy is indicated when conservative therapy fails, in progressive breakdown, in hindfoot Charcot and in spreading infections due to plantar ulcers. The complication rate of 10-20% in open surgery is high. We present a minimally invasive technique of closed reduction and application of a ring fixator for reconstruction of the foot architecture and arthrodesis of the involved joints.

[Principles of treatment for deep infections of the diabetic foot]. / Behandlungsprinzipien bei tiefen Infektionen beim diabetischen Fuss.

Infections are the typical complications of ulcers related to the neuropathic diabetic foot. The loss of the foot or sepsis is the consequence due to the progression of an untreated infection. Therefore, prophylaxis of ulcer formation is the key to lower the rate of amputation. If infection has occurred antibiotics and non-weight bearing are indicated. Abscesses and phlegmons can be localized by the clinical findings, ultrasound, x-rays, computer tomography and MRI and immediate surgical treatment is necessary to prevent further spreading. In the chronic phase dead tissue, necrotic tendons and bones need to be resected. Closure of the skin can be achieved by secondary healing or other methods of plastic surgery. Persistent bony prominences have to be removed and instabilities need fusion operations. In this way many amputations can be avoided or the extent of amputation can be noticeably reduced.

Calcaneus replacement after total calcanectomy via vascularized pelvis bone.

Because of loss of function and chronic pain total calcanectomy is a serious impairment for the patient. There are few reports concerning replacement procedures using ribs [Brenner P, Zwipp H, Rammelt S. Vascularized double barrel ribs combined with free serratus anterior muscle transfer for homologous restoration of the hindfoot after calcanectomy. J Trauma-Injury Infect Crit Care 2000;49(2):331-5; Lin CH, Wei FC, Levin LS, Su JI. Free composite serratus anterior and rib flaps for tibial composite bone and soft-tissue defect. Past Reconstr Surg 1997;99:1656-65; Moscona RA, Ullmann Y, Hirshowitz B. Free composite serratus anterior muscle-rib flap for reconstruction of severely damaged foot. Ann Plast Surg 1988;20:167-72] or homologeous bone graft [Mankin HJ, Gebhardt MC, Jennings LC, Springfield DS, Tomford WW. Long-term results of allograft replacement in the management of bone tumors. Clin Orthop 1996;324:86-97; Muscolo DL, Miguel AA, Aponte-Tinao A. Long-term results of allograft replacement after total calcanectomy. J Bone Joint Surg Am 2000;82(1):109-12; Ottolenghi CE, Petracchi LJ. Chondromyxosarcoma of the calcaneus; report of a case of total replacement of involved bone with a homogenous refrigerated calcaneus. J Bone Joint Surg 1953;35A(1):211-4]. We report a case of calcaneus replacement by vascularized iliac crest bone.

[Diagnosis and treatment of warts, corns, and clavi]. / Was Iässt die Hornhaut an den Füssen wuchern?

The term keratosis covers a variety of growths such as warts and pressure-induced callosities. Warts develop in the absence of pressure, and often clear up again after a certain period, usually without treatment. Clavi can develop as a result of wearing poorly fitting shoes, but also deformed toes or other anatomical deformities affecting the foot. The resulting non-anatomical stressing leads to the formation of pressure callosities and even to pressure sores.

[Management of acute wounds]. / Meist ist es mit ein paar Stichen getan.

Uncomplicated wounds can be treated immediately in the general practitioner's office. Management by a specialist is necessary only in the case of wounds involving the eyes, nose or mouth, or in the presence of other unusual features.

[Soft tissue infections treatable in the doctor's office]. / Kleine Schnitte in der Praxis.

A good number of infections requiring only minor surgery can be treated in the GP's office, simply and adequately. Of importance, however, is the physician's ability to recognize when a patient needs to be referred to a specialist. Provided the principles listed here are adhered to, treatment is usually successful. All other courses indicate a multifactorial pathology and belong in the hands of an experienced specialist.

[Diagnosis and treatment of paronychia]. / Wann schienen, wann schneiden?

Paronychia is a purulent infection of the lateral fingertip, and represents the most common infectious disease affecting the hand.The typical germ is Staphylococcus aureus, while a mixture of bacteria or pathogens of a different kind are usually seen in patients with immunodeficiency. Treatment ranges from bathing the finger in an antiseptic solution to lancing the abscess.

[Treatment of hindfoot instability in Charcot foot using a hybrid technique of internal and external fixation]. / Behandlung von Rückfußdestruktionen beim Charcot-Fuß durch Hybridtechnik mit interner Osteosynthese und Ringfixateur.

OBJECTIVE: The main problem of patients with Charcot foot is their inability to off-load. Therefore the risk of internal fixation failure is increased, especially in hindfoot instability (Sanders type IV) with osteonecrosis of the talus. Combination of internal and additional external fixation guarantees the reconstruction and improves surgical outcome. The main objective of this surgery is to obtain a resilient, plantigrade foot that is shoeable in custom-made orthopedic shoes. INDICATIONS: Charcot foot with instable collapse of the hindfoot with or without fragment dislocation, with or without (noninfected) ulceration not shoeable in custom-made orthopedic shoes. CONTRAINDICATIONS: Very poor general condition, non-reconstructible peripheral vascular disease, deep infection and defects in the region of surgery which makes amputation nescessary, and poor patient compliance. SURGICAL TECHNIQUE: Excision of the distal fibula and removal of the destroyed talus body using a lateral approach. Medial approach to remove the medial malleolus. Tibiocalcaneal fusion using screws for internal fixation. Fusion of the talus head to the anterior tibia. Ilizarov external fixateur to stabilize the internal fixation. POSTOPERATIVE MANAGEMENT: Off-loading for 3 months, then CT scan to verify bony fusion and according to the findings stepwise weight-bearing in a cast or walker over 4-6 weeks. Then custom-made orthopedic shoes with a high shaft and insoles for neuropathic patients and full weight-bearing. RESULTS: In a retrospective cohort study, 14 of 16 patients could be fitted in custom-made shoes after undergoing tibiocalcaneal fusion. During follow-up, 2 patients required below-knee amputation, 3 patients had stress fractures of the tibia, one related to a pin track infection. All patients had a bony fusion of calcaneus and tibia; 10 of 16 patients had fusion of midfoot/talus head and the distal tibia. The 10 patients who had an ulcer before surgery could be healed. In 1 patient, a heel ulcer developed due to talipes calcaneus.

[Management of midfoot instability in Charcot foot with the ring fixator : Use of a hybrid technique with internal and external stabilization]. / Behandlung von Fußwurzelinstabilitäten bei Charcot-Fuß mit dem Ringfixateur : Anwendung der Hybridtechnik mit interner und externer Stabilisierung.

OBJECTIVE: Combination of external and internal fixation for improvement of stabilization in midfoot arthrodesis. INDICATIONS: Charcot foot of the midfoot with/without (infection-free) ulceration. CONTRAINDICATIONS: Severe anesthesiological risks in multimorbid patients; untreated symptomatic peripheral arterial occlusive disease; severe soft tissue infection and defect with the necessity of amputation. SURGICAL TECHNIQUE: Performing subtractive resection arthrodesis of the midfoot with locking plates and screws combined with an external ring fixator of the foot and lower leg. POSTOPERATIVE MANAGEMENT: Postoperative partial weight bearing with sole contact and walking frame for 3 months. Then removal of external fixator, CT scan and based on the result, staged increasing of stress load with short-leg cast over a period of 4-6 weeks. Podomechanotherapy with full weight bearing. RESULTS: With this surgical procedure, sufficient stabilization with fully load bearing, plantigrade foot with podomechanotherapy with the help of a combined internal and external fixation is possible. Complications (pin-tract infection or dislocation) exist, but they can be controlled. High healing rate of ulceration was achieved by bony position correction and stabilization.

Reconstruction of focal cartilage defects in the talus with miniarthrotomy and collagen matrix.

SURGICAL PRINCIPAL AND OBJECTIVE: Treatment of focal cartilage defects (traumatic or osteochondrosis dissecans) of the talus using a collagen matrix. The goal is to stabilize the superclot formed after microfracturing to accommodate cartilage repair. The procedure can be carried out via miniarthrotomy, without medial malleolus osteotomy. INDICATIONS: International Cartilage Repair Society (ICRS) grade III and IV focal cartilage defects of the talus > 1.5 cm(2). CONTRAINDICATIONS: Generalized osteoarthritis, inflammatory joint disease, gout, neuroarthropathy. SURGICAL TECHNIQUE: Miniarthrotomy to open the ankle joint. Debridement of unstable cartilage and necrotic bone, curettage of cysts. Filling of the bone defects with autologous cancellous bone. Sealing of reconstructed bone with fibrin glue and attachment of a collagen matrix shaped to precisely fit the defect. POSTOPERATIVE REGIMEN: Immobilization for 48 h. Partial weight bearing of 10 kg for 6 weeks, with continuous passive motion. Increasing weight bearing from 7 weeks onwards. RESULTS: Follow-up of at least 30 months in 14 patients showed improvement in the Score of the American Orthopedic Foot and Ankle Society (AOFAS) from 50 to 89 points, with equal mobility on both sides of the upper ankle joint.

[Technical aspects in the provision of orthopedic shoes for athletes]. / Orthopädieschuhtechnische Versorgung beim Sportler.

From the technical point of view different groups must be distinguished in the provision of orthopedic shoes for athletes. The one group encompasses athletes who are provided with insoles in the hope of improved comfort or better performance. The other group includes athletes with diseases or injuries of the lower limbs for whom the provision of appropriate shoes and insoles makes it possible for them to participate again actively in their chosen sport. In such cases one has to differentiate between the purely physical disorder of the foot and biomechanical disorders. For the first group the correct fitting of the shoe is the most important factor whereas in the second group attempts are made to correct and/or compensate for the deficit by means of insoles and wedges as well as supporting or bedding elements. The particular challenge for all such measures is to achieve an as small as possible impairment on the sport activity or, in the ideal cases, even to support it.

[The case of a patient with multiple superinfected necrosis of both legs caused by vasculitis disease]. / Fallbericht einer Patientin mit multiplen superinfizierten Nekrosen beider Ober- und Unterschenkel auf dem Boden einer Vaskulitis.

Vasculitis can lead to skin necrosis, which typically shows decayed recovery tendency and is able to lead to local as well as systemic inflammation. By repeated necrosectomy, vacuum therapy, split skin graft transplantation as well as simultaneous immunosuppression and systemic antibiotics, the cutaneous manifestations of vasculitis where cured.