Mycobacterium chelonae-abscessus Complex Infection After Flatfoot Reconstruction.

Mycobacterium infections involving tuberculosis in the foot are rare but cases are readily available in published studies. Atypical or nontuberculosis mycobacterium foot infections are rare, especially those involving the soft tissue and bone, and have been infrequently reported. To date, no case reports involving atypical mycobacterium infection after elective foot surgery have been reported. We present the case of a 49-year-old female who underwent flatfoot reconstruction, with a resultant Mycobacterium chelonae-abscessus infection and osteomyelitis postoperatively. The patient ultimately underwent hardware removal with multiple debridements. The patient was treated ultimately with a 6-week course of intravenous antibiotics and 5 months of oral antibiotics for the mycobacterium infection and osteomyelitis. At the last follow-up examination, the patient remained healed with a satisfactory outcome. We also provide a literature review of mycobacterium infections in the foot.

Narrowing the normal range for lateral ankle ligament stability with stress radiography.

Stress radiographs are commonly performed to evaluate lateral ankle ligament stability; however, little agreement exists on the physiologic limits obtained from the anterior drawer and talar tilt stress tests. Published studies have reported the normal range for the anterior drawer test to be 3 to 10 mm and the normal range for the talar tilt test to be 0° to 23° for the uninjured ankle, leading to inconsistent interpretation. The primary objective of the present study was to narrow the threshold for the diagnosis of ankle ligament injury using stress radiographs by refining the values seen in the normal ankle. An improved understanding of normal ankle motion could allow for a more accurate determination of ligament injury using stress imaging. Conducted in a simplified, yet reproducible, manner, we hoped the present study would draw a parallel with generalized use in an office setting and would allow physicians the ability to more effectively diagnose ankle ligament injury. Bilateral radiographic images of anterior drawer and talar tilt stress tests were taken of 50 participants (100 ankles) with no history of ankle fracture or surgical intervention for ankle instability. Participants with a previous ankle sprain were later excluded from the result computations. Factors such as patient age and gender were evaluated. In the final analysis, 46 participants (76 ankles) were included, with a mean anterior drawer test result of 2.00 mm ± 1.71 mm and talar tilt test result of 3.39° ± 2.70° in the normal ankle. The results of the present study suggest that stress radiographs for lateral ankle stability can be performed in a simple and reliable manner. These results also support a much lower threshold for the diagnosis of lateral ankle injury than previously reported.

Average depth of tarsometatarsal joint for trephine arthrodesis.

The trephine arthrodesis technique has been shown to be an effective method for various foot and ankle fusion procedures, with acceptable rates of fusion reported. The tarsometatarsal joints are an excellent example for this procedure because of the joint shape and soft tissue stability. The success of this procedure depends on many factors, but a large consideration is adequate joint resection. A cadaveric study to examine the joint depth of the Lisfranc complex was undertaken, allowing for improved understanding of the resection needed to maintain a stable plantar cortex while removing all apposing joint surfaces. A statistical analysis was then performed to determine the significance of the joint depth to available demographic data. A total of 51 limbs were evaluated for the depth of the first, second, and third metatarsal-cuneiform joints. The average joint depth for the first through third metatarsal-cuneiform joints was 32.3, 26.9, and 23.6 mm, respectively. The plantar cortex depth was less than 2 mm for the first through third metatarsal-cuneiform joints. The correlation between the length of the foot and the joint depth was statistically significant. Subgroups stratified by shoe size were analyzed for differences in joint size and were also statistically significant. A better understanding of the tarsometatarsal joint anatomy would benefit the trephine technique for Lisfranc arthrodesis.

Synovial Chondromatosis Surrounding the First Metatarsophalangeal Joint: A Case Report.

UNLABELLED: Synovial chondromatosis is a benign synovial tumor that rarely occurs in the foot. We present a case of a 36-year-old male who underwent surgical excision of primary synovial chondromatosis of the first metatarsophalangeal joint. This report also presents a review of the literature related to synovial chondromatosis of the foot. Currently in the literature, this pathology has been described as occurring in multiple locations in the foot and ankle. Synovial chondromatosis can occur primarily or secondarily in diseased joints. Treatment is based on the phase of disease, with a goal to decrease pain and arthritis, and increase mobility. Surgical techniques used for foot and ankle synovial chondromatosis have been adapted from larger joints where the condition is more prevalent. Further case studies are needed to formulate a treatment protocol for foot and ankle synovial chondromatosis, but successful surgical excision was found in this case report. LEVELS OF EVIDENCE: Therapeutic, Level IV: Case study.

Histologic evaluation of intermetatarsal Morton's neuroma.

BACKGROUND: The present study was conducted in an attempt to obtain consistent similarities among histologic findings of surgically excised neuromas. Secondly, we looked for a correlation between the presence of a neuroma with certain comorbidities. METHODS: A total of 22 specimens with a preoperative diagnosis of Morton's neuroma were sent to the pathology laboratory, and evaluation was performed by a single pathologist. RESULTS: Degenerative changes were seen in 59% of the specimens. Patient age showed trends toward affecting nerve fibrosis, nerve diameter, vessel obstruction, and degenerative changes. The most frequent comorbidity was hypertension, seen in 44% of the participants. CONCLUSIONS: Significant histologic similarities among results were not seen; however, certain trends were discovered. Degenerative changes were appreciated in most specimens. Definite histologic findings of neuroma recur, but difficulty in consistent reproducibility may be related to factors such as age, sex, and comorbidities.