Triple arthrodesis for adult acquired flatfoot.

The primary goal of triple arthrodesis for stage III and IV adult acquired flatfoot is to obtain a well-aligned plantigrade foot that will support the ankle in optimal alignment. Ancillary procedures including posterior muscle group lengthening, medial displacement calcaneal osteotomy, medial column stabilization, peroneus brevis tenotomy, or transfer and harvest of regional bone graft are often necessary to achieve adequate realignment. Image intensification is helpful in confirming optimal realignment before fixation. Results of triple arthrodesis are enhanced with adequate preparation of joint surfaces, bone graft/orthobiologics, 2-point fixation of all 3 tritarsal joints, and a vertical heel position.

Cutaneous myoepithelioma in the foot: case report.

Cutaneous myoepithelioma is a very rare, benign, subcutaneous and dermal tumor. It usually presents as a slow-growing and painless mass on the extremities. We report a case of cutaneous myoepithelioma that was located on the foot. A 68-year old woman presented with a slowly growing pain-free mass on the right third toe measuring 0.8 × 0.7 × 0.4 cm(3). We performed an elliptical excision, with histological and immunohistochemical analysis. The lesion showed dermis with cords of cytologically uniform ovoid cells with moderate amount of pale cytoplasm. No pleomorphism, mitotic activity, or necrosis was visualized. The tumor cells were positive for S-100 protein, epithelial membrane antigen and negative for smooth-muscle actin. From these findings, the tumor was diagnosed as a cutaneous myoepithelioma extending to the deep resection margin. To our knowledge, there are only 2 documented cases in the literature in English, and none have been reported in the foot and ankle literature.