Analysis of the curative effect of triple surgery under endoscope in the treatment of intractable heel pain / 中国骨伤

OBJECTIVE@#To investigate the clinical effect the treatment of arthroscopy-assisted calcaneal spur resection combined with plantar fascia release and calcaneal decompression in the treatment of the patients with intractable calcaneal pain.@*METHODS@#The clinical data of 50 patients with intractable heel pain from January 2016 to January 2019 were retrospectively analyzed, including 20 males and 30 females;aged from 40 to 68 years old with an average of (50.12±7.35)years old, the medical history ranged from 1 to 4 years. All patients underwent arthroscopy-assisted calcaneal spur resection combined with plantar fascia release and calcaneal decompression, and were followed up, the duration ranged from 24 to 60 months with an average of(42.00±3.28) months. All patients had obvious heel pain before surgery, and X-ray examinations often showed the presence of calcaneal spurs. In addition to the routine foot examination, the changes in the height and angle of the arch of the foot were also measured pre and post-operatively by X-ray, for the evaluation of clinical effect. The VAS system was used to evaluate the degree of foot pain;the AOFAS scoring system was used to comprehensively evaluate the foot pain, voluntary movement, gait and stability.@*RESULTS@#The VAS decreased from (8.75±1.24) before surgery to (5.15±2.35) at 3 months after surgery, (4.07±2.53) at 6 months after surgery, and (3.95±2.44) at the last fllow-up(P<0.05). The AOFAS score increased from (53.46±4.17) before surgery to(92.46±2.53) at 3 months after surgery, (96.33±2.46) at 6 months after surgery, and (97.05±2.37) at the last follow-up(P<0.05). The arch height was (41.54±1.15) mm before operation and (41.49±1.09) mm after the operation, the difference was not statistically significant(P>0.05). The internal arch angle of the foot arch was (121±6)° before operation and (122±7)° after operation. The difference was not statistically significant(P>0.05).@*CONCLUSION@#Arthroscopy-assisted calcaneal bone spurs resection combined with plantar fascia release and calcaneal decompression exhibited great clinical effect for treating intractable heel.

Controversy of subtalar arthroereisis in symptomatic flatfoot / 中国骨伤

Flatfoot could be divided into flexible flatfoot and rigid flatfoot. Flatfoot with symptoms is called symptomatic flatfoot, surgical treatment is required if conservative treatment is not effective. Subtalar arthroereisis is a minimally invasive procedure which has been used for many years with good results in flexible flatfoot, however, still has many controversial points. Controversial points focus on indications and contraindications, optimal age, subtalar arthroereisis alone or not, efficacy and safety of absorbable material implants, and implant removal. The paper reviewed and summarized the use and controversies of subtalar arthroereisis in symptomatic flatfoot as follows:the best indication for subtalar arthroereisis was pediatric flexible flatfoot syndrome and aged from 10 to 12 years old was optimal age for treatment;tarsal coalitions with flatfoot and adult flatfoot were relative indications. Stiff flatfoot, joint laxity, and subtalar arthritis were contraindications;obesity and neurogenic flexible flatfoot were relative contraindications. The correction ability of subtalar arthroereisis alone was limited, and it's combined with other procedures depending on patient's situation. The safety and efficacy of absorbable material implants had been reported. Routine removal of the implant was not necessary, the main reason of which was tarsal sinus pain.

Distally-based sural island flap for soft tissue coverage of ankle and heel defects

To determine the outcome of heel and ankle reconstruction with distally-based sural island flap. Case series. The study was carried out in Plastic Surgery Department, Chittagong Medical College Hospital, from January 2007 to April 2009. Twenty two subjects with soft tissue defect of heel and ankle requiring coverage were included in the study. The flap was first outlined on the posterior aspect of leg at the junction of upper and middle-third. Having incision made over the designed flap and along the line of the fascial pedicle, the vessels and the nerve were ligated at the proximal margin and severed. The skin island was elevated with the deep fascia. The sub-cutaneous fascial pedicle was then raised, with a width of 2.5 cm to include the sural nerve and vessels. The recipient defect was covered after tunneling the island flap. The donor site was closed directly when the wound was less wide and with a split skin graft when the wound was large. Results were analyzed in terms of graft acceptance and complications determined as percentage frequencies. Of the 22 patients, 15 had uneventful recovery with almost complete take of flaps. Although 5 patients showed marginal necrosis initially, they later on healed by secondary intention without requiring any secondary graft coverage. The rest two had a marked loss of flap in the peripheral part and required secondary graft coverage. Immediate venous congestion was commonly encountered which disappeared within a few days. There were no delayed complaints regarding sensation of the flaps. Distally-based sural island flap can be performed as a one-step procedure without sacrifice of any major artery. It is reliable, safe and should be the choice for reconstruction of ankle and heel defects

Lateral Calcaneal Artery Adipofascial Flap for Reconstruction of the Posterior Heel of the Foot

BACKGROUND: Soft tissue defects of the posterior heel of the foot present difficult reconstructive problems. This paper reports the authors' early experience of five patients treated with a lateral calcaneal artery adipofascial flap. METHODS: Between 2003 and 2007, five patients (3 males and 2 females) with soft-tissue defects over the posterior heel underwent a reconstruction using a lateral calcaneal artery adipofascial flap and a full-thickness skin graft. The flap sizes ranged from 3.5 x 2.5 cm to 5.5 x 4.0 cm. RESULTS: All five flaps survived completely with no subsequent breakdown of the grafted skin, even after regularly wearing normal shoes. The adipofascial flap donor sites were closed primarily in all patients. CONCLUSIONS: Lateral calcaneal artery adipofascial flaps should be included in the surgical armamentarium to cover difficult wounds of the posterior heel of the foot. These flaps do not require the sacrifice of a major artery to the leg or foot, they are relatively thin with minimal morbidity at the donor site, and leave a simple linear scar over the lateral aspect of the foot.

Reversed sural flap for coverage of heel defect following marjolin's ulcer on frostbite

Marjolin's ulcer following frostbite is a rare occurrence. Our review of literature revealed that only 23 cases have been reported. In most instances heel is involved and the most common associated malignancy is squamous cell carcinoma. We present a 69-year-old male patient with squamous cell carcinoma arising over a frostbite scar in heel 45 years after cold injury. This case is unique with respect to the treatment modality performed: resection of tumor with free margins and reconstruction with pedicled reverse sural flap with good result and no evidence of recurrence during the follow up period

Liberacion endoscopica de la fascia plantar / Arthroscopic facial plantar release

Objetivo: Presentar nuestra experiencia con el tratamiento endoscopico de la fascitis plantar refractaria a tratamiento medico ortopedico. Metodo: Once pacientes con diagnostico de fascitis plantar tratados en forma incruenta por un periodo de 6 meses sin respuesta fueron intervenidos quirurgicamente entre abril de 2003 y agosto de 2006 con tecnica endoscopica. Diez de ellos fueron analizados en forma retrospectiva y los resultados evaluados con el Clinical Rating System para tobillo y retropie de AOFAS, el sistema otorga un maximo de 100 puntos, y los resultados son categorizados como muy bueno, bueno, regular y malo. El tiempo minimo de seguimiento fue 14 meses y el maximo 41 meses, con una media de 32,6 meses. Resultados: 8 fueron categorizados como muy buenos, 1 como bueno y 1 como regular. No se registraron complicaciones infecciosas ni hematomas. Dos pacientes refirieron sintomas neurologicos en el postoperatorio. Un caso con parestesias en la region plantar externa, el cuadro se resolvio espontaneamente a los 6 meses. El otro paciente refirio una zona de hipoestesia alrededor del portal medial, que a la fecha del ultimo control no se ha resuelto. Conclusiones: La liberacion endoscopica de la fascia plantar es una alternativa util para el tratamiento de los casos refractarios a tratamiento medico y segura en la medida que se respeten los detalles de tecnica quirurgica descriptos.

Alargamiento percutaneo del tendón de Aquiles en el pie esquino espastico: experiencia en los últimos 5 años del Hospital Ortopedico Infantil / Lengthening percutaneous elongation of the Aquiles tendon in spastic foot corner: experience over the past 5 years of the Hospital Ortopedico Infantil

El alargamiento subcutáneo del tendón de Aquiles en el tratamiento de la deformidad en equino del tobillo fue realizado por Delpech en 1.816 y modificado por numerosos autores a lo largo de la historia, sin embargo su utiliación fue descartada durante mucho tiempo hasta Hoke en 1947 la realizó en forma percutánea con exelentes resultados. Nosostros en el HOI la practicamso de manera rutinaria en los pacientes con PCI obteniendo resultados satisfactorios. En el presente trabajo revisamos en forma prospectiva los resultados obtenidos en 64 pacientes a quienes se les realizó la técnica quirúrgica.

Talalgias crónicas / Chronic plantar hindfoot pain

Se presenta una serie de 30 casos con talalgia crónica uni o bilateral con edad promedio de 45 años, que fueron tratados conservadoramente mediante infiltración de corticoides, antiinflamatorios, férulas, cambio de calzado por otro más blando y cómodo y rehabilitación durante 3 a 6 meses, en quienes fracasó dicho tratamiento, por lo que se sometieron a cirugía de fasciotomía plantar, con excelente resultado en el 90 por ciento de los casos y bueno en el 10 por ciento

Resurfacing of heel defects

Soft tissue coverage of the heel remain a difficult, challenging and often frustrating problem to patients and surgeons. Numerous techniques have been described to reconstruct skin defects of the heel. 20 patients with heel defects were treated using various available techniques. The indications, advantages and limitations and limitations of each technique were discussed

Tratamento das perdas cutaneas do calcanhar com retalho da arteria calcanea lateral / Treatment of cutaneous losses of the heel with lateral calcaneus artery flap

O retalho da arteria calcanea lateral tem padrao axial e em seu pediculo esta incluido o nervo sural e a veia safena parva. E utilizado para cobertura cutanea de defeitos da regiao do tornozelo; e de simples execucao e seguro. A area doadora do retalho e fechada com enxerto de pele de espessura parcial. No presente trabalho, relatamos experiencia com oito pacientes que foram submetidos a reconstrucao da regiao calcanea com retalho da arteria calcanea lateral. E, sete casos o retalho foi utilizado em ilha, com diametro de ate 4 cm. No presente, o retalho foi realizado em sua forma original, como descrito por Grabb e Argenta. A etiologia da perda de substancia foi o trauma em cinco casos e ulceras de pressao em tres pacientes paraplegicos. Os resultados mostraram que o retalho foi adequado para promover a cobertura de lesoes da regiao calcanea, pois e resistente a marcha normal e nao foram observadas ulceracoes.