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1.
Foot (Edinb) ; 57: 101960, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37898054

RESUMEN

BACKGROUND: Endoscopic calcaneoplasty (ECP) and gastrocnemius recession (GR) are procedures that have been described to effectively treat Haglund's deformity and insertional Achilles tendinopathy respectively. The purpose of our manuscript is to evaluate the efficacy and safety of ECP and GR with immediate weightbearing for the treatment of Haglund's deformity with mild to moderate insertional Achilles tendinopathy. METHODS: We performed ECP coupled with GR on 14 patients with an average age of 52 years. All patients demonstrated < 50% tendinous degeneration on MRI. All were allowed weightbearing as tolerated in a CAM boot within the first post-operative week. AOFAS scores and plain film radiographic findings were collected pre-operatively and post-operatively. RESULTS: The radiographic exam of the Fowler-Philip angle significantly improved from an average 60.1-40.7° (p < 0.001). The AOFAS ankle/hindfoot score significantly improved from an average 54.7-91.4 (p < 0.001). The average return to work was 7.5 weeks. There were two cases of temporary sural nerve paresthesia, and two cases of delayed wound healing. CONCLUSIONS: This is the first mid-term study evaluating the outcomes of ECP with GR. The results of our study suggest that ECP with GR followed by immediate weightbearing is a safe and effective procedure for the treatment of Haglund's deformity and mild to moderate insertional Achilles tendinopathy.


Asunto(s)
Tendón Calcáneo , Bursitis , Calcáneo , Espolón Calcáneo , Tendinopatía , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Calcáneo/diagnóstico por imagen , Calcáneo/cirugía , Tendón Calcáneo/diagnóstico por imagen , Tendón Calcáneo/cirugía , Tendinopatía/diagnóstico por imagen , Tendinopatía/cirugía , Pie , Síndrome
2.
Wounds ; 35(4): 80-84, 2023 04.
Artículo en Inglés | MEDLINE | ID: mdl-37023476

RESUMEN

INTRODUCTION: Plantar hallux wounds are common in patients with diabetic neuropathy. Several techniques, both surgical and nonsurgical, are designed to offload plantar wounds. However, controversy exists regarding which techniques are superior in terms of efficacy, safety, and longevity. OBJECTIVE: This manuscript presents a simple, minimally invasive technique to permanently offload the plantar IPJ of the hallux in the case of recalcitrant plantar ulcerations. The authors describe their surgical technique for and outcomes of medially based hallux IPJ arthroplasty for the management of recalcitrant hallux ulcerations. MATERIALS AND METHODS: Five patients (6 wound cases) were evaluated. All patients underwent the same surgical procedure and were subject to the same postoperative protocol of full weight-bearing as tolerated. RESULTS: All 5 cases healed, with an average time to healing of 15.5 days (range, 10-22 days) and no instances of recurrence. The average time to final follow-up was 83.17 weeks (range, 54-95 weeks). CONCLUSIONS: The medially based hallux IPJ arthroplasty approach has demonstrated ability to adequately offload hallux ulcerations, permits bone biopsy or resection for treatment of underlying bone infection, and allows for immediate weight-bearing.


Asunto(s)
Neuropatías Diabéticas , Úlcera del Pie , Hallux , Humanos , Hallux/cirugía , Úlcera del Pie/cirugía , Artroplastia/métodos , Cicatrización de Heridas , Estudios de Seguimiento , Resultado del Tratamiento
3.
J Foot Ankle Surg ; 61(1): 27-31, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-34253431

RESUMEN

Bone grafting is commonly used in reconstructive foot and ankle surgery. The calcaneus provides an excellent site for graft harvest due to its rich vascularity and access to corticocancellous or strictly cancellous bone. The relatively thin soft tissue envelope makes dissection easy compared to more proximal autograft sites. In this investigation we quantified cancellous autograft volume from the calcaneus while simultaneously defining anatomical safe zones and identifying anatomical structures at risk. Nine matched-pair (18 total) fresh-frozen cadaveric below-knee limbs were utilized. All limbs were thawed at room temperature prior to the procedure. Calcaneal autograft was harvested following the senior author's (D.J.E.) technique. Bone graft was packed and quantified by podiatric medical students (B.R. and J.T.). An independent investigator (K.S.) meticulously dissected the lateral calcaneal soft tissue envelope to determine rates of neurovascular compromise. Anatomical safe zones were defined by measurements of the harvest site compared to vital anatomical structures. Cancellous autograft averaging 0.85 cc was obtained through an average cortical opening of 0.77 cm. The stab incision is approximately 2.2 cm anterior to the posterior aspect of the calcaneus and 1.6 cm superior to the inferior aspect of the calcaneus. This incision is an average 1.8 cm from the main branch of the sural nerve. No neurovascular damage was found. This study details percutaneous harvest of calcaneal autograft for use in forefoot or midfoot surgeries with an emphasis on feasibility of this additional procedure. The technique proposed is valuable based on simplicity, wide anatomic safe zone, and potential improvement of surgical outcomes.


Asunto(s)
Calcáneo , Autoinjertos , Trasplante Óseo , Cadáver , Calcáneo/cirugía , Humanos , Nervio Sural/anatomía & histología
4.
J Foot Ankle Surg ; 60(5): 990-993, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33985874

RESUMEN

Hammertoe deformity correction surgery is one of the most common procedures performed by foot and ankle surgeons. Recent foot and ankle medical literature presents conflicting opinions regarding the optimal intramedullary fixation device and techniques for use in digital deformity correction. There are a number of varying fixation constructs of intramedullary Kirschner wire fixation reported for proximal interphalangeal joint arthrodesis; however, there are no reports of relative loading strength of the fixations. In this study, 90 sawbone models were divided equally into 3 groups of different intramedullary Kirschner wire fixation techniques: Group A- single straight, Group B- single bent, Group C- double bent. Each fixation construct underwent controlled axial loading and failure points were observed. Results showed no significant difference in load failure from all 3 groups with mean maximum force of Group A = 20N, Group B = 19.1N, and Group C =17.5N. We conclude that all Kirschner wire fixation options for digital deformity correction, will provide similar resistance to sagittal plane axial loads.


Asunto(s)
Síndrome del Dedo del Pie en Martillo , Deformidades Congénitas de la Mano , Artrodesis , Hilos Ortopédicos , Síndrome del Dedo del Pie en Martillo/diagnóstico por imagen , Síndrome del Dedo del Pie en Martillo/cirugía , Humanos , Prótesis e Implantes
5.
J Foot Ankle Surg ; 60(2): 333-338, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33349538

RESUMEN

The modified Lapidus bunionectomy is a useful and highly powerful procedure for correcting hallux abducto valgus. Traditionally reserved for "severe" deformities, this procedure has seen a recent resurgence in the podiatric community for its unique ability to achieve tri-planar correction of this challenging deformity. Although this procedure has been extensively studied in both biomechanical labs and the clinical arenas, no clear consensus has been achieved regarding optimal fixation for this thought-provoking procedure. The current study examined the differences in strength between commercially available 5-hole locking plates with interfragmentary compression vs a crossed-screw with a third "transfixation" screw construct in a controlled setting. Ten fresh-frozen cadaveric match pair limbs (20 total limbs) were used to complete this study. Ten limbs were randomly assigned to a 3-screw construct. The other 10 contralateral limbs were assigned to a commercially available 5-hole locking plate (5 stainless steel and 5 titanium alloy) with an interfragmentary lag screw construct. The first rays were then isolated and potted into a 4-point bending device. The specimens were loaded to failure in a servohydraulic load frame at a controlled rate. Failure was defined as catastrophic or 3 mm of plantar gapping at the arthrodesis site. The mean maximal load to failure was 310.9 ± 109.4 N for the 3-screw construct. The mean maximal load to failure for the locking plate constructs was 264.1 ± 100.9 N. This difference was not statistically significant (p = .328). These results suggest that a 3-screw construct for Lapidus arthrodesis is as strong as commercially available locking plate constructs.


Asunto(s)
Hallux Valgus , Huesos Metatarsianos , Artrodesis , Fenómenos Biomecánicos , Placas Óseas , Tornillos Óseos , Cadáver , Hallux Valgus/diagnóstico por imagen , Hallux Valgus/cirugía , Humanos , Huesos Metatarsianos/cirugía
6.
J Am Podiatr Med Assoc ; 111(2)2021 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-33090212

RESUMEN

BACKGROUND: Hallux abducto valgus is a triplane deformity with recent attention given to the significance of correcting the coronal plane component. This study explored the accuracy of the forefoot axial (FFA) study as a standard radiographic assessment method compared with weightbearing computed tomography (CT). METHODS: Twelve feet with hallux abducto valgus from 12 individuals were included in this study. Three images of the affected foot were taken: FFA radiograph and weightbearing CT with the foot in maximum pronation (pronated CT) and maximum supination (supinated CT). Five investigators determined the sesamoid rotation angles (SRAs) from each of the images. The measurements from a single investigator were used to compare the SRA means from each of the image types, and those from all five investigators were used to determine reliability. RESULTS: The mean ± SD SRA was 22.1° ± 7.6° for pronated CT, 10.5° ± 5.0° for supinated CT, and 12.2° ± 9.4° for FFA images. The mean SRA from the pronated CT was significantly greater than the supinated CT (P < .001) and FFA (P < .005) SRAs. There were no significant differences in mean SRA between the FFA and supinated CT images (P > .99). Results indicated high reliability in measurements among investigators. CONCLUSIONS: Using weightbearing CT, these findings indicate that the sesamoids significantly alter their position in the coronal plane, as determined by the SRA, with changes in weightbearing subtalar joint position. Moreover, the affected foot positioning required for determining the SRA from the FFA radiograph seems to significantly underestimate the true SRA. Thus, use of this image in surgical hallux abducto valgus planning is called into question.


Asunto(s)
Hallux Valgus , Hallux , Adulto , Hallux Valgus/diagnóstico por imagen , Humanos , Reproducibilidad de los Resultados , Rotación , Tomografía Computarizada por Rayos X , Soporte de Peso
7.
J Foot Ankle Surg ; 59(1): 173-177, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31753568

RESUMEN

Coalitions of the hindfoot are a relatively rare but challenging condition encountered by foot and ankle surgeons. Those that manifest between the cuboid and navicular (cubonavicular coalitions) are seen even more infrequently and are estimated to comprise ∼1% of all tarsal coalitions. Treatment for cubonavicular coalitions parallels protocols for more common hindfoot coalitions. Typically, resection versus hindfoot arthrodesis procedures are used. The present study describes the case of a 34-year-old male with a painful cubonavicular coalition and early secondary signs of arthrosis. Despite the recommended guidelines of hindfoot arthrodesis, he elected for surgical resection. Autogenous adipose tissue and cryopreserved amniotic membrane were used for interposition at the resection site. This case demonstrates that surgical resection with interpositional grafting can be successful even in advanced disease states.


Asunto(s)
Tejido Adiposo/trasplante , Amnios/trasplante , Huesos Tarsianos/cirugía , Coalición Tarsiana/cirugía , Trasplante Autólogo/métodos , Adulto , Artroplastia de Reemplazo , Autoinjertos , Bioprótesis , Criopreservación , Humanos , Prótesis Articulares , Masculino , Osteotomía , Huesos Tarsianos/anomalías , Huesos Tarsianos/diagnóstico por imagen , Coalición Tarsiana/diagnóstico por imagen
8.
J Foot Ankle Surg ; 58(5): 974-979, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31266695

RESUMEN

Because of their inert character and desired biocompatibility, titanium implants have been universally accepted as safer alternatives to the conventional stainless steel orthopedic implants; however, recent emergence of type IV hypersensitivity reactions to titanium have included eczema, contact dermatitis, a prolonged febrile state, sterile osteonecrosis, and impaired fracture and wound healing. This report presents a patient with postoperative incision dehiscence and devascularization of surfaces in contact with titanium hardware after undergoing a double calcaneal osteotomy and a first metatarsal-cuneiform arthrodesis using titanium alloy implants. Titanium hypersensitivity was confirmed in this case through standard allergy patch testing by a board-certified immunologist. Complete healing occurred after diagnosis of the titanium allergy and hardware explant. To our knowledge, this is one of a few known allergies to titanium implants after foot and ankle surgery.


Asunto(s)
Artrodesis/efectos adversos , Artrodesis/instrumentación , Hipersensibilidad Tardía/etiología , Huesos Metatarsianos/cirugía , Titanio/efectos adversos , Adulto , Femenino , Pie Plano/cirugía , Humanos , Hipersensibilidad Tardía/diagnóstico , Hipersensibilidad Tardía/terapia , Osteotomía/efectos adversos , Huesos Tarsianos/cirugía
9.
Foot (Edinb) ; 39: 45-49, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30965226

RESUMEN

Often times, conservative treatment is unsuccessful in long-term resolution of recalcitrant verrucae plantaris lesions. In addition to being aesthetically displeasing, severe cases that are left untreated can be debilitating, often leading to chronic pain, gait abnormalities, and further cutaneous spread. Inoculation through implantation of verrucae plantaris into a muscle was previously postulated to provoke an immune response against the human papilloma virus, resulting in auto-immunization. The purpose of this study was to determine the rate of recurrence following two methods of treatment: A) Surgical removal and subsequent implantation of verruca plantaris into the contralateral abductor hallucis muscle belly and B) Surgical excision of verrucae plantaris. A retrospective chart review of 43 consecutive patients was performed. Group A was comprised of 25 patients who underwent surgical removal of verrucae plantaris followed by implantation of a biopsied specimen into the contralateral abductor hallucis muscle belly. Group B was comprised of 18 patients who underwent only surgical removal of the verrucae. The presence or absence of verrucous lesions was recorded at a post-operative follow-up at an average of 27.5 months. Correlations between recurrence of disease and age, sex, and medical comorbidities were evaluated. Our results suggest that implantation of verruca plantaris into the abductor hallucis muscle belly yields no significant difference in clinical recurrence rates when compared to surgical removal.


Asunto(s)
Úlcera del Pie/cirugía , Terapia por Láser , Láseres de Gas/uso terapéutico , Verrugas/cirugía , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
10.
Clin Podiatr Med Surg ; 36(1): 21-35, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30446043

RESUMEN

Although rare, deep vein thrombosis (DVT) and pulmonary embolism remain a concern for foot and ankle surgeons. Most prophylactic measures against DVT formation are synthesized from orthopedic hip and knee data, and therefore the routine use of these recommendations may place patients at risk for complications associated with unnecessary prophylaxis. In this article we review and present the most current literature specific to venous thromboembolism (VTE) in foot and ankle surgery. It is clear that, given our current literature, a case-by-case approach for VTE prophylaxis should be used following foot and ankle surgery.


Asunto(s)
Tobillo/cirugía , Fibrinolíticos/uso terapéutico , Pie/cirugía , Complicaciones Posoperatorias/prevención & control , Trombosis de la Vena/prevención & control , Femenino , Estudios de Seguimiento , Humanos , Masculino , Podiatría/métodos , Cuidados Posoperatorios/métodos , Prevención Primaria/métodos , Medias de Compresión/estadística & datos numéricos , Resultado del Tratamiento
11.
J Foot Ankle Surg ; 57(4): 844-849, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29661673

RESUMEN

Fibular fractures in the setting of an unstable ankle joint require surgical fixation; however, several factors contradict open surgical correction. Severe soft tissue compromise can delay adequate fracture reduction and preclude the standard incisional approach. The soft tissue envelope in the setting of obesity, diabetes, and/or peripheral vascular disease further complicates definitive treatment. Poorly timed open fixation can lead to delayed healing of the incision site, with wound breakdown and the potential for hardware failure. Proximal fibular fractures are also at unique risk of neurovascular compromise with open reduction and internal fixation. Surgical fixation has now focused on minimizing the soft tissue insult using percutaneous techniques in the comorbid patient. We present a case that highlights a minimally invasive technique that provides dynamic stable internal fixation of fibular fractures with the use of flexible pediatric intramedullary nails, typically used in long bone fractures of children.


Asunto(s)
Clavos Ortopédicos , Peroné/lesiones , Fijación Interna de Fracturas/instrumentación , Fijación Intramedular de Fracturas/instrumentación , Fracturas Óseas/cirugía , Anciano de 80 o más Años , Femenino , Fijación Interna de Fracturas/métodos , Fracturas Óseas/diagnóstico por imagen , Humanos , Radiografía
12.
J Foot Ankle Surg ; 56(6): 1305-1311, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28807380

RESUMEN

Reports of ballistic injures to the extremities typically include those involving gunshot wounds. However, high-pressure washer injuries frequently lead to equally damaging injuries. These injuries should not be overlooked, because they can result in high morbidity and complication rates. Similar to the open fracture protocol, these injuries require prompt debridement and irrigation with administration of antibiotics to avoid limb loss. The present case report identified a delay in the treatment protocol that left limited options for the patient. However, the patient agreed to undergo staged reconstruction consisting of serial debridement, implantation of a polymethylmethacrylate antibiotic spacer, and eventual interpositional iliac crest arthrodesis of the midfoot. At a follow-up point >5 years from the initial injury, the patient was walking with minimal pain and no limitations in his daily activities.


Asunto(s)
Traumatismos del Tobillo/cirugía , Fijadores Externos , Traumatismos de los Pies/cirugía , Fijación de Fractura/efectos adversos , Osteomielitis/cirugía , Procedimientos de Cirugía Plástica/métodos , Accidentes de Trabajo , Traumatismos del Tobillo/diagnóstico por imagen , Artrodesis/métodos , Trasplante Óseo/métodos , Estudios de Seguimiento , Traumatismos de los Pies/diagnóstico por imagen , Fijación de Fractura/métodos , Curación de Fractura/fisiología , Humanos , Ilion/trasplante , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Osteomielitis/diagnóstico por imagen , Osteomielitis/etiología , Medición de Riesgo , Tomografía Computarizada por Rayos X/métodos
13.
J Foot Ankle Surg ; 54(1): 82-8, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25441270

RESUMEN

First ray function and hallux misalignment after isolated tibial sesamoidectomy have been topics of debate. Although sesamoidectomy has been proved to be effective in the relief of sesamoid pain, many foot and ankle surgeons remain hesitant to perform the procedure fearing a possible joint perturbation. To our knowledge, the present study is the first to evaluate both laboratory and clinical evidence of the association between isolated tibial sesamoidectomy and hallux abducto valgus deformity. The bench study consisted of 10 cadaveric limbs that were dissected and prepared for testing. Controlled valgus loads were applied before and after tibial sesamoidectomy. No significant difference was found in the joint position after sesamoidectomy in both the rectus (p = .36) and the dorsiflexed (p = .062) positions. The clinical evaluation consisted of a retrospective cohort of 5 females; all of whom underwent isolated tibial sesamoidectomy. The pre- and postoperative radiographs and self-reported pain scores (visual analog scale) were compared. None of the patients developed a postoperative hallux abducto valgus deformity. Neither the hallux abductus angle (p = .180) nor the intermetatarsal angle 1-2 (p = .180) changed significantly in the postoperative setting. The visual analog scale pain scores changed from a mean of 6.8 to 1, a significant difference (p = .042). Based on our observations and clinical experience, we believe that isolated tibial sesamoidectomy does not have a significant effect on the position of the first metatarsophalangeal joint when meticulous surgical technique is used to excise the sesamoid. Isolated tibial sesamoidectomy can provide substantial pain relief and appears to be a safe treatment for a variety of conditions affecting the tibial sesamoid.


Asunto(s)
Hallux Valgus/etiología , Huesos Sesamoideos/cirugía , Cadáver , Femenino , Hallux Valgus/diagnóstico por imagen , Humanos , Enfermedad Iatrogénica , Procedimientos Ortopédicos/efectos adversos , Radiografía , Estudios Retrospectivos , Huesos Sesamoideos/diagnóstico por imagen
14.
J Foot Ankle Surg ; 53(6): 817-24, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24846156

RESUMEN

Lesser digital arthrodesis has become one of the most widely used techniques in foot and ankle surgery. When performing digital arthrodesis, surgeons have an abundance of options for implantable devices. We provide information on a simple method of achieving successful arthrodesis. An intramedullary Kirschner wire is implanted into the proximal phalanx with the intermediate phalanx compressed over the wire for rigid internal fixation to avoid the use of an external device. We have had results similar to those from the published data of more expensive implants.


Asunto(s)
Artrodesis/métodos , Fijación Intramedular de Fracturas/métodos , Síndrome del Dedo del Pie en Martillo/cirugía , Articulación del Dedo del Pie/cirugía , Hilos Ortopédicos , Humanos
15.
J Foot Ankle Surg ; 51(5): 669-74, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22704789

RESUMEN

Management of failed first metatarsophalangeal joint implant arthroplasty, especially in the face of infection, is an area of debate without a clear consensus. The purpose of the present report was to explore a new option of reconstructing the joint with an acellular dermal matrix substance in a single case study during a 12-month follow-up period. A staged approach that began with removal of the failed 2-component great toe implant, Koenig(®), excisional debridement of the wound with resection of the necrotic bone (proximal phalanx and distal portion of the first metatarsal bones), and culture-specific antibiosis therapy. The final stage included incorporating the acellular dermal matrix, Graftjacket(®) into the joint in an accordion-type fashion, and reconstruction of the joint capsule. Postoperative radiographs revealed a more rectus joint with some improvement in length. At 6 months postoperatively, magnetic resonance imaging revealed incorporation of the graft material into the joint. Finally, at the 1-year mark, the patient was pain free with satisfactory function at the first metatarsophalangeal joint during gait. This is the first reported case of salvaging failed and infected first metatarsophalangeal joint implant arthroplasty with incorporation of the acellular dermal matrix and provides a new option to consider in the future.


Asunto(s)
Dermis Acelular , Artroplastia/efectos adversos , Hallux Rigidus/cirugía , Articulación Metatarsofalángica , Infecciones Relacionadas con Prótesis/cirugía , Infecciones Estafilocócicas/cirugía , Staphylococcus aureus/aislamiento & purificación , Anciano , Desbridamiento , Remoción de Dispositivos , Femenino , Humanos , Prótesis Articulares , Falla de Prótesis , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Infecciones Relacionadas con Prótesis/etiología , Reoperación , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/etiología
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