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1.
Orthop Clin North Am ; 51(2): 279-291, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32138865

RESUMO

Hansen disease remains a common problem worldwide with 750,000 new cases diagnosed each year. Nerve injury is a central feature of the pathogenesis because of the unique tendency of Mycobacterium leprae to invade Schwann cells and the peripheral nervous system, that can be permanent and develop into disabilities. The orthopedic surgeon has an important role in the management of neuropathy, performing surgical release of the tibial and common peroneal nerves in potentially constricting areas, thus providing a better environment for nerve function. In cases of permanent loss of nerve function with drop foot, specific tendon transfers can be used.


Assuntos
Doenças do Pé/cirurgia , Hanseníase/cirurgia , Doenças do Sistema Nervoso Periférico/cirurgia , Doenças do Pé/diagnóstico , Doenças do Pé/tratamento farmacológico , Doenças do Pé/microbiologia , Humanos , Hanseníase/diagnóstico , Hanseníase/tratamento farmacológico , Hanseníase/microbiologia , Transferência de Nervo , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Doenças do Sistema Nervoso Periférico/etiologia
2.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(12): 1498-1502, 2019 Dec 15.
Artigo em Chinês | MEDLINE | ID: mdl-31823547

RESUMO

Objective: To explore the effectiveness of modified internal fixation and fusion in treatment of type Ⅱ painful accessory navicular (PAN) in adults. Methods: Between January 2016 and December 2017, 29 patients (37 feet) with type Ⅱ PAN were treated with modified internal fixation and fusion. There were 12 males and 17 females with an average age of 41.4 years (range, 18-50 years). The injury caused by sprain in 24 cases and no obvious inducement occurred in 5 cases. All patients received conservative treatment for more than 6 months with no significant improvement. The effectiveness was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score before operation and at last follow-up. The inclination angle of calcaneus, the first metatarsal angle of talus, the inclusion angle of talonavicular joint, and the second metatarsal angle of talus were measured on X-ray films. Results: Superficial infection of incision occurred in 1 case after operation, and the incision healed after enhanced dressing change. The incisons of the other patients healed by first intention. There was no deep infection or osteomyelitis. All patients were followed up 12-33 months (mean, 25.1 months). X-ray films showed that the articular surfaces healed at 2-5 months after operation, with an average of 3.4 months. No loosening or rupture of internal fixator was found during the follow-up. At last follow-up, the pain, function, alignment scores, and total score of AOFAS were significantly improved when compared with those before operation (P<0.05). The inclusion angle of talonavicular joint, the first metatarsal angle of talus, and the second metatarsal angle of talus were also significantly improved when compared with those before operation (P<0.05). But there was no significant difference in the inclination angle of calcaneus between pre- and post-operation (t=1.097, P=0.276). Conclusion: Modified internal fixation and fusion in treatment of type Ⅱ PAN can effectively relieve the symptoms and obtain good recovery of feet function with less complications.


Assuntos
Calcâneo , Doenças do Pé , Fixação Interna de Fraturas , Ossos do Metatarso , Adolescente , Adulto , Calcâneo/cirurgia , Feminino , Doenças do Pé/cirurgia , Humanos , Masculino , Ossos do Metatarso/cirurgia , Pessoa de Meia-Idade , Dor , Resultado do Tratamento , Adulto Jovem
3.
J Am Podiatr Med Assoc ; 109(6): 451-454, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31755773

RESUMO

Soft-tissue chondroma is a rare, benign tumor. It is predominantly found in the hands and feet, but rarely in the toes. In this article, we report a digital soft-tissue chondroma that presented as a painful nodule of 5 years' duration in a 67-year-old man. Physical examination revealed a round, solid, movable nodule measuring 7 mm in diameter. Radiographs showed faint linear calcifications in the nodule under the right hallux proximal phalanx neck. The mass was completely excised, and pathologic observation revealed a mass composed of mature chondrocytes in a cartilaginous matrix, consistent with a chondroma. Even though this is a benign tumor, it needs to be differentiated from other tumors, including schwannoma, leiomyoma, chondrosarcoma, and others. Surgical excision is the preferred treatment.


Assuntos
Condroma/patologia , Doenças do Pé/patologia , Hallux/patologia , Neoplasias de Tecidos Moles/patologia , Idoso , Condroma/diagnóstico por imagem , Condroma/cirurgia , Doenças do Pé/diagnóstico por imagem , Doenças do Pé/cirurgia , Hallux/diagnóstico por imagem , Humanos , Masculino , Radiografia , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/cirurgia
4.
J Am Podiatr Med Assoc ; 109(4): 322-326, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31762309

RESUMO

A schwannoma is a solitary benign tumor composed of Schwann cells occurring anywhere in the peripheral nervous system. The diagnosis of a schwannoma is often difficult to make by clinical presentation and advanced imaging modalities. We present a case report of a 61-year-old Hispanic woman with a left-foot, third-digit, soft-tissue mass. The diagnosis of a schwannoma of the proper digital nerve was made postsurgically by means of histopathologic and immunohistochemistry parameters. This is a rare location for a schwannoma, and neurogenic tumor should be included in the differential diagnosis of soft-tissue mass, as there have been prior case reports.


Assuntos
Doenças do Pé/patologia , Neurilemoma/patologia , Neoplasias do Sistema Nervoso Periférico/patologia , Dedos do Pé/inervação , Feminino , Doenças do Pé/diagnóstico por imagem , Doenças do Pé/cirurgia , Humanos , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/cirurgia , Dedos do Pé/diagnóstico por imagem , Dedos do Pé/cirurgia , Ultrassonografia
5.
J Am Podiatr Med Assoc ; 109(4): 334-337, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31762311

RESUMO

Osteoid osteoma is a benign tumor originating from osteoblasts, and it is mostly seen in long bones of lower limbs. The distal phalanx of the foot is an atypical location for an osteoid osteoma, and lesions occurring in this location may be a diagnostic challenge. A 22-year-old man presented with a complaint of severe pain on the second distal phalanx of his right foot. An osteoid osteoma was suspected after radiologic evaluation. The lesion was surgically excised and removed completely by curettage. Histopathologic evaluation confirmed the diagnosis of an osteoid osteoma. The patient was followed-up for a 9-month period without any symptoms or recurrence.


Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Doenças do Pé/diagnóstico por imagem , Osteoma Osteoide/diagnóstico por imagem , Dedos do Pé/patologia , Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Doenças do Pé/patologia , Doenças do Pé/cirurgia , Humanos , Masculino , Osteoma Osteoide/patologia , Osteoma Osteoide/cirurgia , Radiografia , Dedos do Pé/diagnóstico por imagem , Adulto Jovem
6.
Anticancer Res ; 39(11): 6175-6181, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704845

RESUMO

BACKGROUND/AIM: Acral lentiginous melanoma (ALM) is a rare entity on the foot. This study aimed to reveal its clinical presentations, histopathology and treatment options. MATERIALS AND METHODS: Seven cases of ALM involving foot were treated in our Institute in a 3-year period. RESULTS: The patients' age ranged from 38 to 84 years, with a mean of 65. The ratios of males to females and white to non-white were 4:3 and 5:2, respectively. Clinically, ALM presented as asymmetric, irregular shaped, black-brown, variegatedly discolored, papular, verrucoid, ulcerated or nodular lesions with or without pain. All ALMs were treated with either wide local excision (WLE) or toe amputation. Histologically, ALM was characterized by multiple single and nested atypical melanocytes growing along the dermal-epidermal junction, and extending into dermal layer in nodular growth pattern. CONCLUSION: ALM is a rare, asymmetric, irregularly bordered, variegatedly pigmented lesion. WLE or toe amputation is the standard treatment option.


Assuntos
Tornozelo/patologia , Doenças do Pé/patologia , Melanoma/patologia , Nevo/patologia , Neoplasias Cutâneas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Tornozelo/cirurgia , Feminino , Seguimentos , Doenças do Pé/cirurgia , Humanos , Masculino , Melanoma/cirurgia , Pessoa de Meia-Idade , Nevo/cirurgia , Prognóstico , Neoplasias Cutâneas/cirurgia
7.
J Am Podiatr Med Assoc ; 109(5): 397-400, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31599671

RESUMO

Angioleiomyomas are benign soft-tissue tumors that present painfully and are more commonly found in the extremities. Although benign soft-tissue tumors do not require excision, the clinician may not always know the type of tumor, and patient symptomatology may require removal of the offending body. In this article, we present our case findings of a 45-year-old man presenting with a subcutaneous angioleiomyoma subcalcis.


Assuntos
Angiomioma/cirurgia , Complicações do Diabetes/cirurgia , Doenças do Pé/cirurgia , Neoplasias de Tecidos Moles/cirurgia , Angiomioma/diagnóstico por imagem , Angiomioma/patologia , Diabetes Mellitus Tipo 2/complicações , Pé/diagnóstico por imagem , Pé/cirurgia , Doenças do Pé/diagnóstico por imagem , Doenças do Pé/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/patologia
8.
J Am Podiatr Med Assoc ; 109(5): 393-396, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31599673

RESUMO

Enchondroma is the most common benign cartilage bone tumor of the toes. In contrast, the foot is a rare region for chondrosarcoma, and the involvement of phalanges is extremely rare. In this article, we report an unusual case of intermediate chondrosarcoma involving the proximal phalanx of the great toe of a 52-year-old woman who was previously treated with curettage and bone grafting because of misinterpretation of enchondroma at a local hospital. She presented complaining of pain and swelling that she had experienced for a period of 1 year after the first operation. Radiography revealed a lytic lesion with a subtle punctuate calcification and endosteal scalloping in the proximal phalanx of the great toe. Gadolinium-enhanced magnetic resonance imaging confirmed soft-tissue involvement and cortical destruction. Staging evaluation with computed tomographic scan of the chest, abdomen, and pelvis was performed to ensure that there was no metastatic disease. Subsequently, a bone biopsy was performed, and the diagnosis was grade 2 chondrosarcoma. The patient was informed about the recurrence of the lesion and the clinical context on the basis of tumor biology of chondrosarcoma and was offered the option of either amputation or wide resection. She preferred the latter. The patient was treated with wide resection and underwent reconstruction with cement and Kirschner wire. She remains free of disease after 1 year of follow-up.


Assuntos
Neoplasias Ósseas/cirurgia , Condrossarcoma/cirurgia , Doenças do Pé/cirurgia , Hallux/diagnóstico por imagem , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/patologia , Condrossarcoma/diagnóstico por imagem , Condrossarcoma/patologia , Erros de Diagnóstico , Feminino , Doenças do Pé/diagnóstico por imagem , Doenças do Pé/patologia , Hallux/patologia , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva Local de Neoplasia , Radiografia
9.
Am J Vet Res ; 80(10): 943-949, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31556713

RESUMO

OBJECTIVE: To determine the holding capacity of a 5.5-mm-diameter cortical bone screw when placed in the third phalanx (P3) of horses and assess whether screw placement through the dorsal hoof wall into P3 would be tolerated by clinically normal horses and would alleviate signs of pain and prevent P3 rotation in horses with oligofructose-induced laminitis. ANIMALS: 40 limbs from 10 equine cadavers and 19 clinically normal adult horses. PROCEDURES: In part 1 of a 3-part study, a 5.5-mm-diameter cortical bone screw was inserted by use of a lag-screw technique through the dorsal hoof wall midline into P3 of 40 cadaveric limbs and tested to failure to determine screw pullout force. In part 2, 6 horses had 5.5-mm-diameter cortical bone screws placed in both forefeet as described for part 1. Screws were removed 4 days after placement. Horses were monitored for lameness before and for 2 weeks after screw removal. In part 3, 13 horses were randomly assigned to serve as controls (n = 3) or undergo screw placement without (group 2; 6) or with (group 3; 4) a washer. Following the acquisition of baseline data, horses were sedated and administered oligofructose (10 g/kg) via a stomach tube. Twenty-four hours later, screws were placed as previously described in both forefeet of horses in groups 2 and 3. Horses were assessed every 4 hours, and radiographic images of the feet were obtained at 96 and 120 hours after oligofructose administration. Horses were euthanized, and the feet were harvested for histologic examination. RESULTS: The mean ± SD screw pullout force was 3,908.7 ± 1,473.4 N, and it was positively affected by the depth of screw insertion into P3. Horses of part 2 tolerated screw placement and removal well and did not become lame. All horses of part 3 developed signs of acute lameness, and the distance between P3 and the dorsal hoof wall increased slightly over time. The change in the ratio of the dorsal hoof wall width at the extensor process of P3 to that at the tip of P3 over time was the only variable significantly associated with treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Placement of a 5.5-mm-diameter cortical bone screw through the dorsal hoof wall into P3 had sufficient holding power to counteract the pull of the deep digital flexor tendon in approximately 500-kg horses, and placement of such a screw was well tolerated by clinically normal horses but did not alleviate signs of pain in horses with oligofructose-induced laminitis. Further research is necessary before this technique can be recommended for horses with naturally occurring acute laminitis.


Assuntos
Parafusos Ósseos/veterinária , Doenças do Pé/veterinária , Casco e Garras/cirurgia , Doenças dos Cavalos/cirurgia , Coxeadura Animal/cirurgia , Animais , Feminino , Doenças do Pé/cirurgia , Membro Anterior , Doenças dos Cavalos/induzido quimicamente , Cavalos , Masculino , Oligossacarídeos/efeitos adversos , Distribuição Aleatória , Rotação
10.
Vet J ; 250: 63-70, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31383422

RESUMO

Laminitis is associated with failure of the suspensory apparatus of the distal phalanx (SADP) connecting the distal phalanx to the hoof wall. The specific aim of this study was to examine in vitro whether thinning of the hoof wall leading to increased deformability influences the damage of the laminar tissue created by loading of the hoof. Paired cadaver forelimbs from twelve horses were used. For each pair, the hoof wall from one hoof was thinned by 25%; this was ascertained by radiography. The contralateral hooves were used as controls. In a material testing machine, hooves were loaded in a proximodistal direction at 0.5mm/s until a cut-off value of 8kN or 14mm was reached. Afterwards, samples of the SADP were taken for histology. Image-based evaluation of the destruction of the SADP was performed using quantitative histogram analysis. Additionally, three examiners masked to treatment (trimmed/untrimmed) qualitatively evaluated SADP destruction. During hoof loading with forces from 0.5 to 1.8 times the body mass of the donor horses, hooves with thinned hoof wall underwent significantly more deformation (P<0.05). Quantitative histogram analysis detected a shift to higher brightness values and a higher pixel intensity in control hooves, representing disruption in the histologic analysis. Qualitative evaluation of histology sections showed significantly more disruption of the SADP in untrimmed hooves (P=0.03). These results confirm the hypothesis that reduced hoof wall thickness can decrease disruption of laminar tissue in vitro, thus supporting the evaluation of hoof wall reduction as a prophylactic measure in horses at imminent risk of SADP failure.


Assuntos
Doenças do Pé/veterinária , Casco e Garras/patologia , Doenças dos Cavalos/patologia , Falanges dos Dedos do Pé/patologia , Animais , Cadáver , Feminino , Doenças do Pé/patologia , Doenças do Pé/cirurgia , Membro Anterior/patologia , Membro Anterior/cirurgia , Casco e Garras/cirurgia , Doenças dos Cavalos/cirurgia , Cavalos , Técnicas In Vitro/veterinária , Masculino , Falanges dos Dedos do Pé/cirurgia
11.
Foot Ankle Clin ; 24(3): 515-531, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31371001

RESUMO

Haglund syndrome is a triad of posterosuperior calcaneal prominence (Haglund deformity), retrocalcaneal bursitis, and insertional Achilles tendinopathy. The sources of pain include the posterior calcaneal wall cartilage, retrocalcaneal and subcutaneous adventitial bursa, and the Achilles tendon. Resection of the posterosuperior calcaneal tubercle, bursectomy, excision of the Achilles tendon pathology, reattachment of the Achilles tendon, gastrocnemius aponeurotic recession, and flexor hallucis longus transfer have been proposed as surgical treatment options. All of them can be performed endoscopically or under minimally invasive approaches.


Assuntos
Tendão do Calcâneo/cirurgia , Bursite/cirurgia , Calcâneo/anormalidades , Endoscopia/métodos , Deformidades do Pé/cirurgia , Doenças do Pé/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Tendinopatia/cirurgia , Humanos , Síndrome
12.
J Foot Ankle Surg ; 58(4): 632-640, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31256897

RESUMO

Compartment syndrome of the foot (CSF) is a surgical emergency, with high risk of morbidity and poor outcome, including persistent neurologic deficits or amputation. Uncertainty remains regarding surgical approaches, pressure monitoring values, and the extent of surgical treatment. This review provides a summary of the current knowledge and reports evidence-based diagnostic and therapeutic management options for CSF. Articles describing CSF were identified from MEDLINE, PubMed, and Cochrane databases up until February 2018. Experimental and original articles, systematic and nonsystematic reviews, case reports, and book chapters, independent of their level of evidence, were included. Crush injuries are the leading cause of CSF, but CSF can present after fractures of the tarsal or metatarsal bones and dislocations of the Lisfranc or Chopart joints. CSF is often associated with persistent neurologic deficits, claw toes, amputations, and skin healing problems. Diagnosis is made after accurate clinical evaluation combined with intracompartmental pressure monitoring. A threshold value of <20 mmHg difference between the diastolic blood pressure and the intracompartmental pressure is considered diagnostic. Management consists of surgery, whereby 2 dorsal incisions are combined with a medioplantar incision to the calcaneal compartment. The calcaneal compartment can serve as an "indicator compartment," as the highest-pressure values can regularly be measured within this compartment. Appropriately powered studies of CSF are necessary to further evaluate and compare diagnostic and therapeutic options.


Assuntos
Síndromes Compartimentais/cirurgia , Fasciotomia/métodos , Doenças do Pé/cirurgia , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/fisiopatologia , Medicina Baseada em Evidências , Pé/fisiopatologia , Pé/cirurgia , Doenças do Pé/diagnóstico , Doenças do Pé/fisiopatologia , Humanos , Pressão
13.
J Foot Ankle Surg ; 58(5): 1019-1024, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31345760

RESUMO

Multiple accessory navicular bones is an extremely rare condition. To the best of our knowledge, only 8 cases in 2 imaging studies have been published. We report a case of a patient with flat foot with 2 accessory navicular bones. This patient needed to be treated surgically, and the surgery was successful, with short-term follow-up. We believe this is the first case of multiple accessory navicular bones to be treated surgically in English literature. The incidence of multiple accessory navicular bones might be higher. There is a risk to remaining ossicles without resection or fixation during surgery; therefore, we strongly recommend using not only radiographs, but also 3-dimensional computed tomography scans or magnetic resonance imaging scans to confirm the type of accessory navicular bone, at least before surgery, for both painful accessory navicular bone and flat foot with accessory navicular bone.


Assuntos
Pé Chato/complicações , Pé Chato/cirurgia , Doenças do Pé/complicações , Doenças do Pé/cirurgia , Ossos do Tarso/anormalidades , Adulto , Feminino , Pé Chato/diagnóstico , Doenças do Pé/diagnóstico , Humanos , Ossos do Tarso/cirurgia
14.
Pediatr Blood Cancer ; 66(11): e27935, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31339226

RESUMO

Spindle cell and sclerosing rhabdomyosarcoma (ssRMS) is a rare variant of rhabdomyosarcoma, which includes three distinct subtypes. In infants, these tumors are commonly associated with recurring fusions involving VGLL2 or NCOA2 and have a favorable prognosis. We present four cases of ssRMS and 16 additional cases from the literature, which show that these patients present with localized disease and have an excellent prognosis regardless of surgical margin or lack of radiation therapy. Molecularly defined spindle cell rhabdomyosarcoma in infants is likely a biologically distinct entity which may not require the aggressive multimodal treatment used for other subtypes of rhabdomyosarcoma.


Assuntos
Rabdomiossarcoma Embrionário/congênito , Neoplasias de Tecidos Moles/congênito , Amputação , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante , Terapia Combinada , Ciclofosfamida/administração & dosagem , Dactinomicina/administração & dosagem , Extremidades/patologia , Feminino , Doenças do Pé/congênito , Doenças do Pé/tratamento farmacológico , Doenças do Pé/genética , Doenças do Pé/cirurgia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/tratamento farmacológico , Doenças do Prematuro/genética , Doenças do Prematuro/cirurgia , Masculino , Proteínas de Fusão Oncogênica/genética , Indução de Remissão , Rabdomiossarcoma Embrionário/tratamento farmacológico , Rabdomiossarcoma Embrionário/genética , Rabdomiossarcoma Embrionário/cirurgia , Neoplasias de Tecidos Moles/tratamento farmacológico , Neoplasias de Tecidos Moles/genética , Neoplasias de Tecidos Moles/cirurgia , Coxa da Perna , Neoplasias Torácicas/congênito , Neoplasias Torácicas/tratamento farmacológico , Neoplasias Torácicas/genética , Neoplasias Torácicas/cirurgia , Parede Torácica/patologia , Vincristina/administração & dosagem
16.
Int J Infect Dis ; 85: 127-131, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31096056

RESUMO

OBJECTIVES: Daptomycin has shown clinical efficacy in diabetic foot infections (DFI). However, only limited data are available on its bone penetration in this particular population. The aim of this study was to determine daptomycin bone concentrations in patients with DFI undergoing surgery after multiple daptomycin infusions and to determine bone daptomycin inhibitory quotients (IQs) for the predominant gram-positive species involved in DFI. METHODS: Fourteen adult patients hospitalized with DFI treated with daptomycin and requiring surgical bone debridement and amputation were included in this single-centre prospective study. Daptomycin concentrations in serum and bone were determined by HPLC at steady state. Bone IQs were then calculated according to different minimum inhibitory concentrations (MICs; range 0.25-4mg/l) that are representative of the main MICs for Staphylococcus aureus, coagulase-negative staphylococci (CoNS), and Enterococcus sp populations. RESULTS: Residual and peak concentrations varied from 4.5mg/l to 39.9mg/l and from 31.8mg/l to 110.9mg/l, respectively. Bone daptomycin concentrations at the moment of surgery varied from 1.2mg/l to 17mg/l. Up to a MIC of 1mg/l, which is the epidemiological cut-off value (ECOFF) and breakpoint value for S. aureus and CoNS, all bone daptomycin IQs were positive. The highest bone IQs were observed with Staphylococcus species. Calculated bone IQs for Enterococcus species were often weak at MIC values near the ECOFF. CONCLUSIONS: Daptomycin penetrates bone well in patients treated for DFI. At an initially recommended dosage of 6mg/kg, bone concentrations are likely to be effective against staphylococcal infections and infections due to low-MIC Enterococcus.


Assuntos
Antibacterianos/farmacocinética , Osso e Ossos/metabolismo , Daptomicina/farmacocinética , Pé Diabético/complicações , Doenças do Pé/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Idoso , Antibacterianos/uso terapêutico , Daptomicina/uso terapêutico , Enterococcus/efeitos dos fármacos , Feminino , Doenças do Pé/complicações , Doenças do Pé/metabolismo , Doenças do Pé/cirurgia , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/metabolismo , Infecções por Bactérias Gram-Positivas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Staphylococcus/efeitos dos fármacos , Staphylococcus aureus/efeitos dos fármacos
17.
J Foot Ankle Surg ; 58(4): 762-765, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30962105

RESUMO

Benign fibrous histiocytoma (BFH) is a rare benign primary bone lesion that occurs most frequently in the nonmetaphysis region of the long bones and the pelvic bones. The talus is a rare location for a BFH, which has not been reported previously in the literature. We report the case of a 19-year-old male patient with BFH of the talus, who was treated with curettage, followed by filling of the bone defect with calcium phosphate cement. The patient was free of pain and without local recurrence 5 years after the surgery. We describe the detailed radiographic findings of this rare lesion and discuss the differential diagnosis of such talar lesions.


Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Doenças do Pé/diagnóstico por imagem , Histiocitoma Fibroso Benigno/diagnóstico por imagem , Tálus/diagnóstico por imagem , Adolescente , Atletas , Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Diagnóstico Diferencial , Doenças do Pé/patologia , Doenças do Pé/cirurgia , Histiocitoma Fibroso Benigno/patologia , Histiocitoma Fibroso Benigno/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Radiografia , Tálus/patologia , Tálus/cirurgia
18.
Rev Assoc Med Bras (1992) ; 65(3): 370-374, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30994835

RESUMO

OBJECTIVE: The objective of this study is to report the results of arthroscopic debridement of the subtalar joint in eight patients with Sinus Tarsi Syndrome (STS) refractory to conservative treatment. METHODS: This is a retrospective study of eight patients with STS who underwent subtalar arthroscopy for debridement of the sinus tarsi between January 2015 and January 2017 after six months of conservative treatment. All patients answered an epidemiological questionnaire and underwent functional evaluation with the Visual Analogue Pain Scale (VAS) and the American Orthopedic Foot and Ankle Society Score (AOFAS) in the preoperative and in the last evaluation (average of 12 months - 6-24 months). RESULTS: All patients showed severe synovitis in the region. Seven patients had remnants of the talocalcaneal ligaments and six of the cervical ligament. AOFAS increased by 30 points on average (51.75 in the preoperative period to 82.62 in the last follow-up) and the VAS decreased on average by 5 points (7.37 preoperatively to 2.12 in the last follow-up). These results were statistically significant with p = 0.043 and p = 0.032 respectively. Six patients described the result as excellent and two as good. No complications were reported. All patients returned to sports after six months of follow-up. CONCLUSION: The arthroscopic debridement of the subtalar joint is an effective and safe alternative in the treatment of STS refractory to conservative treatment. More studies, with a prospective methodology, are necessary to prove the results of this technique.


Assuntos
Artroscopia/métodos , Desbridamento/métodos , Doenças do Pé/cirurgia , Articulação Talocalcânea/cirurgia , Adulto , Tornozelo/fisiopatologia , Tornozelo/cirurgia , Articulação do Tornozelo/fisiopatologia , Articulação do Tornozelo/cirurgia , Feminino , Doenças do Pé/fisiopatologia , Humanos , Instabilidade Articular/cirurgia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Reprodutibilidade dos Testes , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do Tratamento
19.
Rev Esp Cir Ortop Traumatol ; 63(3): 165-172, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30922598

RESUMO

OBJECTIVES: 1) to set a reminder of the diagnostic approach to osteoid osteomas (OOs) of the foot; 2) to define the indications of treatment for hindfoot OOs. MATERIAL AND METHOD: 5 OOs were checked (3 cases located in the talus and two cases in calcaneus). The diagnosis was established by clinical and imaging data. In all cases, a calcified nidus was identified on CT, perilesional bone oedema on MRI and focal scintigraphic uptake. Two cases were treated with radiofrequency ablation (RFA) and 3 cases with surgical resections: two open surgeries and one arthroscopic surgery. Clinical and oncological outcomes were evaluated at the end of the follow-up. RESULTS: No complications were reported. The clinical outcome was excellent in all cases. One patient was initially treated with open surgery and then subsequently with RFA due to failure of the procedure. There were no recurrences after an average follow-up time of 4 years and 8 months (range, 1-12 years). DISCUSSION: Hindfoot OOs are uncommon and their diagnosis is based on clinical data in conjunction with characteristic imaging findings. Their treatment choices depend on the location of the nidus and relationships with nearby anatomical structures. CONCLUSIONS: The diagnosis of an OO of the hindfoot can be ensured when the epidemiological, clinical and imaging data are compatible with this pathological entity. RFA is indicated for intracortical or cancellous cases in which the nidus is more than 1cm off the skin and significant neurovascular structures. For all other cases an open surgical resection or arthroscopic resection would be the first choice.


Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/cirurgia , Doenças do Pé/diagnóstico por imagem , Doenças do Pé/cirurgia , Osteoma Osteoide/diagnóstico por imagem , Osteoma Osteoide/cirurgia , Adolescente , Adulto , Artroscopia , Calcâneo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ablação por Radiofrequência , Tálus , Tomografia Computadorizada por Raios X , Adulto Jovem
20.
Foot Ankle Int ; 40(5): 506-514, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30776926

RESUMO

BACKGROUND: Various operative procedures have been reported for the treatment of Müller-Weiss disease (MWD). This study reports the midterm operative treatment results for stages II to V MWD with derotation of the talus and arthrodesis. METHODS: Thirty-four patients (36 feet) with MWD were treated by talonavicular (TN) or talonavicular-cuneiform (TNC) arthrodesis in our center from 2008 to 2015. The affected feet were staged according to the Maceira staging system (stage II: 9; stage III: 10; stage IV: 9; stage V: 8). The American Orthopaedic Foot & Ankle Society (AOFAS) midfoot scale, the visual analog scale (VAS), and relative radiologic parameters were evaluated preoperatively and also during follow-up. The mean follow-up duration was 38.2 (range, 25-113 months). RESULTS: The final follow-up showed satisfactory outcomes. Overall, the AOFAS scores improved from 41.5 (range, 20-56) to 85.3 (range, 68-100) points ( P <.001), and the VAS score decreased from 5.7 (range, 3-8) to 0.9 (range, 0-4) points ( P <.001). The Tomeno-Méary angle decreased from -6.7 (range, -26.4 to 17.7) to 0.7 (range, -5.3 to 7) degrees ( P=.001). The calcaneal pitch angle increased from 13.7 (range, 4.1-26.2) to 22.0 (range, 13.3-28.9) degrees ( P < .001). The anteroposterior (AP) talar-first metatarsal angle decreased from -15.8 (range, -30.1 to -13.7) to -7.0 (range, -25.9 to -8.9) degrees ( P < .001), and the AP talocalcaneal angle increased from 14.7 (range, 4.7-22.3) to 22.1 (range, 13.4-29.5) degrees ( P=.005). The AP talonavicular coverage angle decreased from -27.0 (range, -40.4 to -13.3) to -7.8 degrees (range, -20.7 to -1.8) degrees ( P < .001). CONCLUSION: The midterm results found that the TN or TNC joint fusion could achieve a favorable clinical and radiologic outcome for patients with MWD. Even for the patients with severe deformities (stages IV-V), this treatment strategy could also achieve satisfactory deformity correction and functional improvement. Intraoperative restoration of talus rotation was the key to normal alignment of the subtalar joint/TN joint. LEVEL OF EVIDENCE: Level IV, retrospective case series.


Assuntos
Artrodese , Doenças do Pé/cirurgia , Tálus/cirurgia , Articulações Tarsianas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Doenças do Pé/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Radiografia , Estudos Retrospectivos , Inquéritos e Questionários , Tálus/diagnóstico por imagem , Tálus/fisiopatologia , Articulações Tarsianas/diagnóstico por imagem , Articulações Tarsianas/fisiopatologia
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