Lesser Digit Implants.

Lesser digit deformities that require surgical intervention may be corrected by interphalangeal arthrodesis. The traditional fixation device used to stabilize an interphalangeal arthrodesis is a smooth Kirschner wire (K-wire). Its use, however, has been associated with risks. The K-wires are known to migrate and break, and there are increased risks of pin tract infection. Choices for digital implants include nonresorbable, resorbable, and allograft. There are more than 60 newer intramedullary fixation devices available for use in digital surgery. Intramedullary implants also have their own inherent risks. Further research into patient outcomes and cost-effectiveness of these new devices is still needed.

Joint Clinical Consensus Statement of the American College of Foot and Ankle Surgeons® and the American Association of Nurse Practitioners®: Etiology, Diagnosis, and Treatment Consensus for Gouty Arthritis of the Foot and Ankle.

Gout is a condition that commonly affects the foot and ankle, and practitioners who treat these structures should be aware of the methods to diagnose and treat this form of arthritis. Practitioners also need to recognize extra-articular manifestations of the disease. Although the acutely red, hot, swollen joint is a common presentation, chronic tophaceous gout can be associated with pain, nodule formation, and cutaneous compromise. Since the underlying causes that lead to excessive monosodium urate deposition may be treatable, early and accurate diagnosis can be very beneficial and may even prevent articular degeneration.

American College of Foot and Ankle Surgeons® Clinical Consensus Statement: Perioperative Management.

A wide range of factors contribute to the complexity of the management plan for an individual patient, and it is the surgeon's responsibility to consider the clinical variables and to guide the patient through the perioperative period. In an effort to address a number of important variables, the American College of Foot and Ankle Surgeons convened a panel of experts to derive a clinical consensus statement to address selected issues associated with the perioperative management of foot and ankle surgical patients.

Staphylococcus lugdunensis: A Rare Pathogen for Osteomyelitis of the Foot.

Staphylococcus lugdunensis is an aggressive gram-positive bacteria that can lead to devastating infections in humans. S. lugdunensis has been associated with rare cases of osteomyelitis of the vertebra, prosthetic implants, and endocarditis. Reports of this organism associated with osteomyelitis of the foot or ankle have been infrequent. We present a unique case of acute osteomyelitis of a foot caused by S. lugdunensis after a patient stepped on a thorn. Our case is unique, because the radiographic changes were noted within 4 days, despite normal plain films and magnetic resonance images on the day of admission. This finding suggests the aggressiveness and virulence of S. lugdunensis. In addition, we report the first case of foot osteomyelitis as a result of isolated S. lugdunensis that involved 2 distinct specimens with 2 different antibiotic sensitivity reports.

Prevalence and Role of a Low-Lying Peroneus Brevis Muscle Belly in Patients With Peroneal Tendon Pathologic Features: A Potential Source of Tendon Subluxation.

A peroneus brevis low-lying muscle belly (LLMB) is a rare anomaly. A few published studies have supported the presence of this anomaly as an etiology for a peroneal tendon tear. However, the association between a peroneus brevis LLMB and tendon subluxation has not been well explored. In the present retrospective study, the magnetic resonance imaging (MRI) and intraoperative findings of 50 consecutive patients undergoing primary peroneal tendon surgery during a 5-year period were assessed. The sensitivity and specificity of MRI compared with the intraoperative findings for identifying peroneal tendon disease were investigated. The presence of associated peroneal tendon pathologic features in patients with and without a peroneus brevis LLMB was also compared. The sensitivity of MRI was high for identifying peroneal tenosynovitis (81.58%) and tear (85.71%). Although the sensitivity of MRI for detecting a peroneus brevis LLMB (3.23%) and tendon subluxation (10.00%) was low, MRI had high specificity at 94.74% and 100%, respectively. Intraoperatively, a peroneus brevis LLMB was seen in 62.00% of the patients with chronic lateral ankle pain and was associated with 64.52% of the patients with tenosynovitis, 29.03% of those with tendon subluxation, and 80.65% of those with a peroneus brevis tendon tear. Although the presence of a peroneus brevis LLMB did not show any statistically significant association with peroneus brevis tendon subluxation, of the 10 patients with intraoperatively observed tendon subluxation, 9 had a concomitant peroneus brevis LLMB. More studies with larger patient populations are needed to better investigate the role of a peroneus brevis LLMB as a mass-occupying lesion resulting in peroneal tendon subluxation.

Retrospective analysis of the rate and interval to union for joint arthrodesis of the foot and ankle.

Arthrodesis is a common procedure indicated for surgical treatment of end-stage degenerative joint disease of the foot and ankle. Many published studies have reviewed the union rate, focusing on specific technique or fixation. However, studies reporting on the average period required to achieve fusion, irrespective of the type of fixation or surgical method used, have been lacking. We report on the union rate and interval to fusion in patients who had undergone primary arthrodesis of various joints of the foot and ankle. A retrospective review of the medical records of 135 patients was performed. The specific joints studied were ankle, and the subtalar, triple, first tarsometatarsal, first metatarsophalangeal, and hallux interphalangeal joints. Our results showed that the average interval for complete fusion was significantly less for the joints in the forefoot, with the subtalar joint, ankle, and triple arthrodesis requiring a longer period to achieve complete fusion. The nonunion rate was also greater when the fusion involved the joints of the rearfoot. Our results have refuted the idea that 6 weeks is the minimum period required to achieve fusion in the foot and ankle. The results of our study support the need for additional education of the patients and surgeons that the interval required for recovery after foot and ankle fusion depends on the location and surface area that has been fused.

Non union of an epiphyseal fibular fracture in a pediatric patient.

There are few reports on delayed or nonunion in the pediatric ankle fracture. The authors present a case of a nonunion of a mid-epiphyseal fracture of the distal fibula, described as a type 7 pediatric fracture. Both the occurrence of this injury pattern and a nonunion has not been reported in the same patient. Operative reduction of the nonunion resulted in a satisfactory outcome.

Tendon interpositional arthroplasty of the fourth-fifth metatarsocuboid joint.

The most common complaints of patients with tarsal-metatarsal arthritis are severe loss of function and painful ambulation. In cases of failed conservative management, the recommended treatment is arthrodesis of the affected joint(s). This article presents a report of three cases of fourth-fifth metatarsocuboid arthritis treated with a fourth-fifth metatarsocuboid interposition alarthroplasty. Follow-up evaluation of all three patients demonstrated satisfactory pain relief. No postoperative complications were noted in any of the patients. Although more study is needed to evaluate the use of fourth-fifth metatarsocuboid tendon interpositional arthroplasty, the procedure offers promise and a suitable alternative to arthrodesis.