[Primary cutaneous mucormycosis: a case report]. / Mucormycose cutanée primaire: à propos d'un cas.

The authors report the clinical history of a patient having presented a cutaneous mucormycosis at the waning of a traumatic dilapidation post of the left lower limb. Mucormycosis is an opportunistic fungal infection due to fungi of the group of mucorales present in the environment. There are various clinical forms of the disease; it occurs generally in a predisposed environment. The diagnosis is based on the mycologic and pathologic examination. The therapeutic approach must be multidisciplinary; the vital and functional prognosis depends on early diagnosis and treatment.

[Ankle instability with involvement of the subtalar joint demonstrated by MRI. Results with the Castaing procedure in 45 cases]. / Instabilité de cheville avec lésion de l'articulation sous-talienne démontrée par l'IRM. Résultats de l'intervention de Castaing dans une série de 46 cas.

The authors report 46 cases of instability of the hindfoot involving the subtalar joint, with or without combined involvement of the tibiotalar ligaments, which were treated using Castaing's technique of ligament plasty between 1988 and 1999. Preoperatively, the patients complained of instability, recurrent sprains and pain. A tarsal sinus syndrome was present in 39%. Forty six patients underwent NMR examination which demonstrated capsuloligamentous lesions in every case. The results were evaluated using Kitaoka's score. With an average follow-up of 5.7 years after operation, instability was no more present in 80% and 63% were painfree. Clinical examination showed a reduction in the range of inversion of the hindfoot in 43%, with values between 50 and 70% of the contralateral foot, but without any significant clinical repercussion. Incipient osteoarthritis was noted on xrays in three patients. The overall results were very good in 82%, fair in 11% and poor in 7%. Eighty seven percent of the patients were satisfied with the result of the operation. The authors found a significant correlation between fair or poor results and a body mass index above 26 kg/m2 or constitutional laxity. Besides, results got worse as the time interval between the first sprain and the operative treatment increased. Comparison of these results with those of other techniques shows that they are essentially similar. Ligament plasty using Castaing's technique is a reliable operation but direct repair of ruptured ligaments at the subtalar joint should be preferred for primary treatment, leaving the possibility for secondary ligament plasty if necessary.

[Equinovarus of the foot in adults treated with tibiocalcaneal arthrodesis. Review of 18 cases]. / Pied varus équin de l'adulte traité par arthrodèse tibiocalcanéenne. Revue de 18 cas.

The authors have retrospectively studied 18 cases of tibiocalcaneal arthrodesis performed to treat a fixed equinovarus deformity of the foot in 13 adult patients. The operations were performed between 1981 and 1998; there were 9 neurologic and 9 post-traumatic deformities. The mean calcaneal varus deformity was 50 degrees and the mean equinus deformity was 75 degrees. The results were evaluated using Kitaoka's criteria. We noted one postoperative cutaneous necrosis, two nonunions, one of which was reoperated by bone freshening and osteotomy of the midfoot. All rearfeet were in neutral alignment and were stable. Shortening was on average 2.8 cm. Plantar support was achieved in 10 feet, with improved autonomy, walking capacity and footwear. Overall, there were 10 good, 2 fair and 1 poor result. In the group with neurologic deformities there were 4 good, 1 fair and 1 poor result. In the group with post-traumatic deformities, there were 6 good and one fair results. Other series published also showed satisfactory results comparable to or better than those obtained with triple arthrodesis, which generates severe stiffness of the rear- and midfoot, disturbing gait. Fixed equinovarus deformity of the foot in the adult is a good indication for tibiocalcaneal arthrodesis, allowing in the majority of cases to achieve stable and painless plantar support.

[Triple arthrodesis in the management of acquired flatfoot deformity in the adult secondary to posterior tibial tendon dysfunction. A retrospective study of 20 cases]. / L'arthrodèse médio-tarsienne et sous-talienne dans le traitement du pied plat valgus de l'adulte par insuffisance du tendon du tibial postérieur. Résultats d'une série de 20 cas.

The authors have reviewed 20 cases of valgus flatfoot deformity in the adult, secondary to insufficiency of the tibialis posterior tendon, which were treated by triple arthrodesis from 1983 to 1998. The longitudinal arch was flat grade 3 in 18 cases and grade 2 in two. The rearfoot was in valgus in all cases. Dorsal flexion of the ankle was limited to 5 degrees with a short Achilles tendon in 10 cases Djian-Annonier's angle was 134 degrees on average. The talocalcaneal divergence was 32 degrees. Diffuse osteoarthritis was present preoperatively in 14 cases. Fusion of the arthrodesis was achieved in 18 cases. There were two nonunions: one affecting the talonavicular joint, and the other, the talonavicular and calcaneocuboid joint. Results evaluated according to Kitaoka's criteria were excellent in 35%, good in 35%, fair in 20% and poor in 10%. Xrays showed progression of osteoarthritis. These results were not as good as in Fortin and Waling's series but we did not use iliac grafts. There was no instance of talus necrosis. The nonunion rate was higher than in other series at the talonavicular level. In order to improve the results, we now believe that bone resection must be kept minimal and bone grafts should be used, in addition to internal fixation. Triple arthrodesis was found to give good result in the treatment of acquired flat foot deformity due to insufficiency of the tibialis posterior tendon. However on the long term it promotes degenerative changes in neighbouring joints.