ABSTRACT
BACKGROUND: Achilles insertional tendon pathology is a common condition affecting a broad range of patients. When conservative treatments are unsuccessful, the traditional open resection, debridement, and reattachment of the Achilles tendon is a variably reliable procedure with significant risk of morbidity. Fasciotomy and surgical tenotomy using ultrasound-guided percutaneous microresection is used on various tendons in the body, but the efficacy has not been examined specifically for the Achilles tendon. METHODS: A retrospective review evaluated 26 procedures in 25 patients who underwent Achilles fasciotomy and surgical tenotomy. The Foot Function Index was used to quantify pain, disability, activity limitation, and overall scores. RESULTS: Mean Foot Function Index scores were as follows: pain, 8.53%; disability, 7.91%; activity limitation, 2.50%; and overall, 6.97%. Twenty index procedures were successful, and two patients repeated the procedure successfully for an overall 84.6% success rate in patients with chronic insertional pathology with mean surveillance of 16 months. There were no infections or systemic complications. CONCLUSIONS: Ultrasound-guided percutaneous microresection is a safe and minimally invasive percutaneous alternative that can be used before proceeding to a more invasive open procedure.
Subject(s)
Achilles Tendon/surgery , Fasciotomy , Tendinopathy/surgery , Tenotomy , Achilles Tendon/diagnostic imaging , Aged , Aged, 80 and over , Chronic Disease , Cohort Studies , Disability Evaluation , Female , Humans , Male , Middle Aged , Patient Satisfaction , Retrospective Studies , Ultrasonography, InterventionalABSTRACT
Phosphaturic mesenchymal tumor (mixed connective tissue variant) (PMT-MCT) are tumors that may cause tumor-induced osteomalacia and rarely appear intracranially. The authors describe the case of an 8-year-old girl who was found to have PMT-MCT with involvement of the cerebellar hemisphere and a small tumor pedicle breaching the dura mater and involving the skull. This was removed surgically in gross-total fashion without further complication. Histologically the tumor was confirmed to be a PMT-MCT. There was no evidence of tumor-induced osteomalacia. At the 42-month follow-up, the patient is doing well, has no abnormalities, and is free of recurrence. PMT-MCTs are rare tumors that may involve the brain parenchyma. A gross-total resection may be effective to cure these lesions.
Subject(s)
Ataxia/etiology , Biomarkers, Tumor/analysis , Cerebellar Neoplasms/surgery , Fibroblast Growth Factors/analysis , Hypophosphatemia, Familial/etiology , Mesenchymoma/surgery , Skull Neoplasms/surgery , Biomarkers, Tumor/genetics , Cerebellar Neoplasms/chemistry , Cerebellar Neoplasms/complications , Cerebellar Neoplasms/pathology , Child , Diagnosis, Differential , Female , Fibroblast Growth Factor-23 , Fibroblast Growth Factors/genetics , Gene Expression Regulation, Neoplastic , Humans , Hypophosphatemia/etiology , Magnetic Resonance Imaging , Mesenchymoma/chemistry , Mesenchymoma/complications , Mesenchymoma/pathology , Osteomalacia/etiology , Reverse Transcriptase Polymerase Chain Reaction , Skull Neoplasms/chemistry , Skull Neoplasms/complications , Skull Neoplasms/pathology , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Metatarsus adductus is a relatively common congenital foot deformity that is often unrecognized at birth. Thus, the adult foot with metatarsus adductus is prone to pathologic entities that have been theorized to result from lateral column overload. We present a descriptive study comparing plantar foot pressure distribution during gait in subjects with and without metatarsus adductus. A total of 65 subjects were recruited for the study: 28 subjects with and 37 subjects without metatarsus adductus. An EMED(®) pedobarograph was used to collect the data. The analysis of the peak pressure and pressure-time integral in each of the 8 regions of the plantar surface of the foot showed significant (p < .05) differences between each of the regions and a significant (p < .05) interaction effect between the 8 regions and the 2 groups. A series of independent Student's t tests were therefore performed to determine which of the plantar regions showed a significant difference between the 2 groups. The result of those t tests showed that the peak pressure and pressure-time integral were significantly different (p < .05) between the 2 groups for the "heel," "lateral midfoot," and "lateral forefoot." The results of the present study support the concept that during gait, the adult foot with metatarsus adductus has increased peak plantar pressures on the lateral side of the foot.
