The treatment of intermetatarsal neuromas with 4% alcohol sclerosing injections.

The cause of intermetatarsal neuromas or intermetatarsal neuritis is unclear; however, the most likely pathogenesis is either a mechanically induced degenerative neuropathy or entrapment of the intermetatarsal nerve as it passes under the transverse intermetatarsal ligament. Treatment of intermetatarsal neuromas includes the very simple method of changing shoe styles, more complex conservative treatments with functional orthotic devices, oral anti-inflammatory medications and cortisone injections, and surgical intervention. In this study, 100 adult patients with previously untreated intermetatarsal neuromas received three to seven injections of a 4% alcohol sclerosing solution every 5-10 days. No additional treatment was provided during the visits. The use of 4% alcohol sclerosing solution showed an 89% success rate. Of the 89 patients who were improved, 82 had complete resolution of symptoms. Eleven patients showed no improvement. The results of this prospective study indicate that the alcohol sclerosis treatment of intermetatarsal neuromas is a viable alternative to serial steroid injections or surgery for persistent symptoms.

Surgical treatment of mycotic toenails.

The authors present several options for the surgical treatment of painful and dystrophic mycotic toenails. The procedures include total and partial nail avulsion as well as chemical and excisional matrixectomies, both partial and total. Adjunctive treatment with topical and oral antifungal agents is also discussed.

The Romano drill: a new surgical curved drill system.

A new surgical curved drill system that drills curved holes into bone is presented, along with several examples of its use in foot and ankle surgery. The technical information involving soft tissue fixation, wiring, or suturing around a bone bridge, by drilling a curved tunnel for tendon, capsule, and ligament reconstruction is also reviewed.

Symptomatic juvenile flatfoot condition: surgical treatment.

This article presents the clinical findings of a particular form of flatfoot described as the "symptomatic flexible juvenile pes planovalgus" condition. A review and postoperative follow-up of the results from surgical treatment of symptomatic juvenile flatfoot condition is presented for 32 children (59 feet), ranging from 7 to 15 years of age. The author describes the indications and justifications of the procedures involved and reviews the long-term results obtained with this combined surgical approach.

V-Y plasty and its variants.

The authors present an overview of the V-Y plasty technique with a discussion of the basic underlying principles and a description of the surgical technique. The variations available and the direct application of this procedure are discussed with reference to the foot and ankle. Consideration is given for design, location, survival, and postoperative care of the V-Y plasty.

Use of Z-skin plasty in scar revisions and skin contractures of the lower extremity.

A discussion of the design and use of the Z-skin plasty to revise scars and lengthen skin contractures of the lower extremities is presented. One of the most commonly used rotational flaps to alter scar direction or relieve tension on the existing scar or skin, the Z-plasty can also be the most difficult to perform and carries a high risk of flap loss if inaccurately planned or poorly placed. Several variations of the standard procedure and examples of common usage are presented.

Single-lobe rotation flaps.

The basic principles of a single-lobe flap are discussed along with the description of a modified slide-swing rotational flap. This rotation flap is called the Schrudde flap, and it has many applications in the treatment of skin defects of the foot and ankle. This rotation skin flap procedure provides excellent end results with high patient acceptance.

Hypertrophic and keloid scars.

Scar formation is discussed along with definitions of the three most common types of scars: normal, hypertrophic, and keloid. Several current forms of therapy designed to reduce or eliminate scars are presented. The use of silicone gel sheeting is reviewed as a newer solution for the treatment of many types of lower extremity scars.

Diagnosis and treatment of digital mucoid cysts.

An analysis of treatment options and the results of various treatments is presented for the lower extremity digital mucoid cyst. The author reviews the retrospective results of 25 consecutive Schrudde rotation flap procedures which were performed on 24 patients with digital mucoid cysts. The long-term results (greater than one year) revealed a 94% success rate with this treatment option.

Adhesive lesions of the talocrural joint.

Iatrogenic and posttraumatic adhesive lesions of the ankle joint are rather common, although infrequently reported, clinical entities. Ankle arthroscopy has proved to be a valuable asset in the assessment and treatment of recalcitrant symptomatic cases of both localized adhesions and adhesive capsulitis. This article intends to broaden the reader's understanding of the clinical presentation and intra-articular derangements of these lesions.

Treatment of hypertrophic and keloid scars with SILASTIC Gel Sheeting.

An evaluation of the results of treatment of both fresh and long-standing hypertrophic and keloid scars on the lower extremities using topical SILASTIC Gel Sheeting was performed in 94 patients ranging in age from 11 to 73 years. In the total of 94 patients, there were 80 with true hypertrophic scars. Of this group, 74 patients (92.5%) were greatly improved with treatment, five patients (6.25%) were somewhat improved, and one patient (1.25%) was not improved. The remaining 14 patients in the study had true keloid scars, and their results were poorer with five patients (35.7%) greatly improved, five patients (35.7%) somewhat improved, and four patients (28.6%) showing no improvement. When all patients were totalled together, there were 79 patients (84%) greatly improved, 10 patients (11%) somewhat improved, and only five patients (5%) with no improvements. Overall, the success rate (somewhat improved to greatly improved) for the treatment of hypertrophic and keloid scars is high (95%).

Giant keratoacanthoma of the plantar foot: a report of two cases.

KA develops from a rapidly growing, firm, smooth nodule into a mature dome-shaped lesion with a central core filled with keratin that usually degenerates into an involuting keratinous mass. KAs must be differentiated from squamous cell carcinoma. Classically, KA is a benign tumor that is self-limiting. However, there is controversy concerning the aggressiveness of the tumor. Some authors believe there is no way to determine the aggressiveness of the tumors and they should be classified as low grade squamous cell carcinomas (3). Others feel that the risk of malignant transformation is not a serious consideration but misdiagnosis is, due to the histopathologic similarities (31, 33). Overall, the literature shows that solitary and giant lesions should be excised. Excisional biopsy yields a more cosmetic scar and increases the chance for an accurate biopsy diagnosis. Multiple and multinodular lesions should be excised if they have the potential for causing a mutilating deformity but are otherwise treated systematically. If a solitary or multiple lesion which is left to spontaneously resolve shows signs of aggressiveness, even with a biopsy indicating that it is a KA, it should be immediately excised. Solitary and giant KA are usually not considered to be located on the palms and soles. However, with the cases presented here, there are now a total of 4 cases in the literature. Therefore, KA should be included in the differential diagnosis when dealing with rapidly growing tumors on the plantar aspect of the foot.

Lateral ankle stabilization using bovine collagen material: xenograft bioprosthesis, model GR.

This is a combined research study including use of a reproducible technique for ankle stress x-ray examinations (both preoperatively and postoperatively) and the use of the bovine bioprosthesis tendon implant for stabilization and augmentation of the lateral ankle ligaments. The surgical technique is fully described and the follow-up results indicate that there is long-term ankle stability, and that patient acceptance is very high.

An autogenous free graft technique for lateral ankle stabilization.

A recent advancement in the surgical treatment of chronic lateral ankle instability is presented. The authors have collected data from 401 surgical stabilizations of the lateral ankle performed at the Waldo Podiatric Residency Program. A data summary is presented to provide the reader an appreciation of the evolution in treatment of ankle instability at this institution. The free tendon graft method of lateral ankle ligament reconstruction is also presented as performed on 37 patients with chronic unstable ankles.

Complications following traumatic incidents with STA-peg procedures.

The authors describe use of a Silastic plug to limit subtalar joint motion in symptomatic pediatric flatfeet. Three patients sustained postoperative injury resulting in pedal complications. Successful resolution of these cases is discussed.

Bovine tendon lateral ankle stabilization procedure: xenograft bioprosthesis model GR 6 mm.

A surgical technique utilizing a bovine xenograft bioprosthesis has been developed for stabilizing a chronically unstable lateral ankle. With this new technique, minimal dissection of adjacent soft tissue is required, and the method allows for tissue ingrowth for strength and anastomosis to bone. However, a longer period of non-weightbearing is required to prevent inadequate incorporation of the graft.

Dermatology flow sheet.

This article presents an organized and relatively easy mechanism for the diagnosis of dermatologic problems by using an algorithmic flow sheet. Once this technique is understood, the practitioner may find it much easier to categorize, diagnose, and manage skin conditions of the lower extremities.