Economic outcomes analysis from an ambulatory surgical center.

In the competitive healthcare marketplace, foot surgeons are being placed under pressure to demonstrate the economic value of surgical care. The management methodology of "fiscal outcomes review" is one tool being used to evaluate such care. Initially developed for internal corporate management as an executive decision support system, the process is being used an an external cost control technique to "economically credential" providers of surgical care. Consequently, the economic outcomes analysis of a single surgical procedure represents a first attempt to gather, allocate, analyze, and interpret meaningful charge information relative to the podiatric Ambulatory Surgery Center setting. When compared with the traditional outpatient hospital setting, charge reductions are documented without compromising quality. The long-held belief that Ambulatory Surgery Center surgery is more efficient than traditional outpatient surgery, can then be corroborated.

Grand rounds: first metatarsophalangeal joint replacement.

For approximately 30 years foot and ankle surgeons have been using a variety of techniques and devices to replace the first metatarsophalangeal joint. During this time there have been a multitude of implant designs and modifications, most attempting to anatomically and functionally replace the natural joint surfaces. The advantages and disadvantages of these many designs and various biomaterials has long been debated in scientific meetings and publications. Surgical technique, implant design, materials, and patient selection remain areas of heated debate and ongoing research. With this in mind, we asked leading foot and ankle surgeons to give their opinions on indications and utilization for joint replacement of the first metatarsophalangeal joint.

Structural metatarsus adductus deformity, surgical case report.

Structural metatarsus adductus deformity may be corrected through the use of closing abductory base wedge osteotomies of all five metatarsals. Although technically demanding, surgical precision is increased through the use of oblique wedges and a combination of screw and cerclage wire fixation. In the severe case, an opening wedge osteotomy of the inner cuneiform (Fowler procedure), with homogenous bone implantation, may be concomitantly used. Both techniques are described in this brief case presentation.

Peritalar dislocation without fracture.

The case report of a 28-year-old male who sustained a pure peritalar dislocation, without fracture, is presented. The injury is potentially devastating and seldom seen in clinical practice. In this discussion, the etiology and treatment protocol is reviewed to alert the practitioner for prompt evaluation and treatment.

Pediatric aneurysmal bone cyst of the ankle.

The case report of a large aneurysmal bone cyst of the ankle is presented, as it occurred in a 10-year-old male. Radiographic and histologic characteristics are illustrated. Treatment was by surgical curettment and autogenous bone grafting.

Enigma of pediatric vertical talus deformity.

Vertical talus is an unusual pediatric deformity that often is unrecognized at birth. Its treatment is necessarily surgical and not typically addressed by the podiatric medical profession. In this case report, the enigmatic deformity is reviewed, along with a detailed photographic assay of useful techniques for its surgical reduction.

Unilateral renal hypoplasia as an incidental finding in a patient with a ruptured heel cord.

A report of unilateral renal hypoplasia in an 11-year-old patient, admitted to the hospital for surgical repair of a ruptured Achilles tendon, is presented. The condition was incidentally discovered because of an elevated blood pressure level. The case demonstrates that screening for hypertension, even in the pediatric population, should be an essential part of the routine podiatric physical examination.

Plastic surgery in podiatry (simplified illustrated techniques).

Soft-tissue loss in the foot is often a perplexing, time consuming, and frustrating treatment dilemma for both patient and surgeon. Fortunately, several plastic surgical techniques may be used to successfully deal with this clinical situation. These techniques are presented through an illustrated essay format.

Reconstruction of soft tissue defects about the great toe.

Successful reconstruction of soft tissue defects about the great toe require careful consideration. Principles that must be evaluated prior to wound coverage include biomechanics of the hallux and location of tissue loss with regard to plantar weightbearing. This is important in order to acquire a functional as well as cosmetically acceptable outcome. Therefore, two examples are presented in this discussion to illustrate these principles.

Lower extremity limb salvage.

In this discussion, the case report of a fetid diabetic right foot infection is presented. Although definitive major limb amputation was initially contemplated, aggressive treatment efforts were used to prevent this catastrophe. Photographs illustrate state-of-the-art treatment techniques and document a satisfying clinical outcome.

Fractured anterior calcaneal process.

The case report of an intra-articular calcaneal fracture is presented. The case is noteworthy because the entire anterior process was fractured and dislocated into the subtalar joint. Treatment consisted of open reduction and internal fixation with good results. The literature was reviewed and an aggressive treatment posture adopted in order to prevent the long-term disability often associated with this type of injury.

Cysticus cruris giganticus.

A case report of epidermal inclusion cyst formation is presented as it occurred in a young male patient. The mass is noteworthy because of its location, rapid growth and bizarre size. Treatment consisted of surgical excision without recurrence.

Resistant metatarsus adductus deformity (illustrated surgical reconstructive techniques).

The dilemma of metatarsus adductus was reviewed in this clinically illustrated essay. A modification of the traditional Berman-Gartland procedure was also reported, along with 5 methods of osseous fixation. A retrospective analysis of 17 surgical cases, performed at Atlanta Hospital, revealed adherence to published indications and guidelines.

Physical and mechanical properties of joints (the pathomechanics of articular cartilage degeneration).

A review of the literature was performed to determine current theories regarding the physiology of human articular cartilage. The process of chondrodegeneration in rheumatoid arthritis and osteoarthritis was then discussed. Clinical pedal pathology was used to emphasize important but abstract concepts.