Traumatic injuries of the first ray.

Injuries involving the first ray are common and can lead to significant pain and disability. The management of these injuries, both conservative and surgical, is discussed in this article. Treatment goals include recreating a uniformly plantigrade weight-bearing surface under all the metatarsal heads, preserving functional anatomy, and preventing traumatic arthritis while maintaining a supple, pliable foot. Many of these injuries can be prevented by use of proper, protective shoegear.

Congenital idiopathic talipes equinovarus (clubfoot). Current concepts.

Congenital idiopathic talipes equinovarus (clubfoot) is a complex and challenging entity. This article reviews its history, incidence, and classification as well as the current controversies regarding its causes, pathologic anatomy, evaluation and diagnostic techniques, surgical intervention, and treatment assessment methods.

Comparative radiographic analysis of congenital idiopathic talipes equinovarus (clubfoot) in infancy: a retrospective study.

Controversy exists regarding the quantitative use and predictive value of standard radiographs in the evaluation of talipes equinovarus in infancy. To address this issue, a comparative study of the three most commonly utilized quantitative radiographic assessment methods has been conducted. This study is retrospective in nature and consists of 56 congenital idiopathic clubfeet resistant to conservative treatment that required surgical correction. The results of this study indicate that the "Simons' standardized method of analytical radiography" of the infant clubfoot is the most clinically accurate in evaluating the type and degree of articular malalignments present, as well as predicting the status of the talonavicular joint prior to the ossification of the navicular. With this knowledge, it is then possible to institute the appropriate treatment regimen at an earlier age.

Management of the resistant idiopathic clubfoot: the Kaiser experience from 1980-1990.

Sixty-three congenital idiopathic clubfeet were clinically and radiographically evaluated following a single Turco-type complete posteromedial soft tissue release with internal fixation. Average age at the time of surgery: 12.4 months; average postoperative follow-up: 67.2 months. A new rating system that weighs dynamic functional results more heavily was used to compare our findings. The results were rated as excellent in 29 feet (46%), good in 15 feet (24%), fair in 8 feet (13%), and poor/failures in 11 feet (17%). Ninety-five percent of the parents were satisfied with the current results, although 59% felt that their child would have physical limitations in the future. Clinical complications included the following residual deformities: hindfoot varus (3.2% or two feet), equinus (3.2% or two feet), cavus (22.2% or 14 feet), and forefoot adductus (41.3% or 26 feet). The bimalleolar axis in the 63 clubfeet averaged 74.9 degrees. No calcaneus gaits were present. Radiographic complications included both over-correction (1.6% or one foot) and under-correction (4.8% or three feet) of the talonavicular joint articulation, avascular necrosis of the navicular, (14.3% or nine feet), talus (4.8% or three feet), and calcaneus (1.6% or one foot). Thirty-three feet (52.4%) revealed some degree of abnormal talar dome flattening, 22 feet (34.9%) revealed navicular dorsal subluxation or "wedging." Only 37 (58.7%) exhibited normal talonavicular joint congruity.