Making Things Easier: A Simple Novel Method to Fix a Dorsiflexion Osteotomy of the First Metatarsal.

A first ray dorsiflexion osteotomy is commonly performed for cavovarus foot correction. There are multiple techniques to fix this osteotomy, ranging from wires, screws, and plates or a combination of these. We present our results using a varisation staple (Biomet©) as an alternative fixation device. We performed a retrospective outcome analysis of a consecutive series of 10 cavovarus feet that underwent a dorsiflexion osteotomy (dorsal closing wedge) of the first metatarsal fixed with two varisation staples. The results were measured at a mean three monthly follow-ups and included union and complication rates, as well as clinical and radiographic assessment of cavus deformity correction. There was a 100% union rate with no complications or cases of delayed union. No metalwork removal was requested in any case at follow-up. First ray dorsiflexion osteotomies are most commonly fixed using a 3.5mm cortical screw. We demonstrate that our alternative and novel technique using varisation staples achieved a 100% union rate while avoiding the prominent hardware complications known to occur with cortical screws or plates.

Exploring Lived Experiences of Married Pakistani Women Post-Mastectomy.

OBJECTIVE: This qualitative descriptive exploratory study aimed to explore the lived experiences of married Pakistani women, 2 years post-mastectomy. METHODS: Twelve participants were recruited through purposive sampling from outpatient oncology clinic from a tertiary care hospital in Pakistan. Interviews were audio-taped and transcribed, and then themes and sub-themes were identified. RESULTS: Women verbalized a range of their experiences throughout the span from diagnosis to mastectomy. One over arching theme, quality of life and four main themes and their subthemes emerged from the data. Following are the themes; from history to diagnosis, worries, coping strategies, and recommendations. CONCLUSIONS: The study findings revealed that effective coping strategies were beneficial for these women, as these women coped well after being diagnosed with breast cancer. Strong recommendations were made by the participants for the formulation of support groups, which could help them reduce their anxiety through information exchange.

The management of dorsal peroneal nerve compression in the midfoot.

The foot and ankle specialist will frequently encounter patients with dorsal midfoot pain in clinic. In the presence of midfoot pain and/or paraesthesia, nerve entrapment must be considered. The authors report the outcome of a case series of patients who underwent surgical release of the DPN. Between 2011-2017, a single surgeon operated on seven patients with a diagnosis of DPN entrapment. A retrospective review of the patient's clinical notes was performed, including the operative findings. The average age at presentation was 47 years (range, 31-70 years), and the left foot was affected in four cases. In all cases the patient presented with dorsal midfoot pain, with three cases associated with paraesthesia. The mean follow up was 25 months (range, 4-70 months), with six of the patients discharged with their pre-operative symptoms settled. One patient who had good immediate pain relief following DPN neurolysis, EHB tendon resection and reduction of exostosis developed recurrence of the neuropathic pain at five years. Despite non-operative management the symptoms did not settle and exploration of the DPN was performed. The anatomical position of the DPN, and its site of compression, may vary however it can be localised by a positive Tinel's sign and targeted injection with local anaesthetic. All the patients that underwent surgical exploration and decompression had a good outcome, with one patient requiring further neurolysis for impingement.

Exploring the meaning of childhood disability: perceptions of disability among mothers of children with disabilities (CWD) in Kuwait.

The purpose of this exploratory research was to examine perceptions of mothers with children with disabilities (CWD) in Kuwait in order to understand the meaning of disability from their perspective and to explore the extent to which such perceptions influence rehabilitative services that their children receive. Ten semi-structured interviews were conducted with mothers of CWD receiving services at a large pediatric facility in Kuwait. Four themes emerged from the interviews: (1) mother's perceptions of disability, (2) mother's extended caregiver role, (3) religious beliefs as a coping strategy, and (4) perception of rehabilitation services. Our findings suggest that despite a traditional acceptance of disability as divine intervention or a challenge sent to them by God, mothers were motivated to maximize rehabilitation services in order to improve the functional capacity of their children. Kuwaiti mothers may hold both the fatalistic view of disability, and the belief that the course of disability can be altered through a rehabilitative intervention, in tension. An appreciation of this phenomenon might move toward a rehabilitation delivery model that integrates and harmonizes such beliefs.