Flexible pediatric and adolescent pes planovalgus: conservative and surgical treatment options.

Pediatric and adolescent flexible flatfoot is a pathomechanically complex deformity. Conservative and surgical treatment is directed at realigning the foot and alleviating symptoms. When surgical intervention is considered, there are various methods and techniques that may be performed to realign the foot. The treatment goals are directed first at resolution of pain, and second at the realignment of the foot. A specific treatment algorithm does not exist, although planal dominance influences direct the surgeons when considering surgical intervention. Open physis often dictates the direction of the reconstruction. Attempts at essential joint preservation should be strongly considered in this young patient population. This article provides an overview of the common treatment pathways that highlight methods to structurally realign the pediatric and adolescent flatfoot.

Desyndactylization of the first and second toes using full-thickness autologous skin graft from the ankle.

We present a unique case of congenital bilateral simple syndactyly of the first and second toes that was surgically treated using a full-thickness skin graft harvested from the same foot at the lateral aspect of the ankle. This surgical approach eliminates the potential need to involve another surgical team to harvest a donor graft from above the ankle, saving operating room time, anesthesia time, and overall cost to the patient. Cosmetically, scar formation above the ankle is also eliminated.

Surgical considerations in the geriatric patient.

The geriatric patient has a high incidence of foot deformities and may be considered a good surgical candidate if healthy and psychologically ready for the surgical procedure. Foot problems in the geriatric population that may require surgical intervention can be grouped into approximately five categories, including (1) localized orthopedic disorders (ie, bunions, hammer toes, and so on); (2) skin and nail problems (ie, onychomycosis); (3) degenerative and inflammatory arthritis; (4) diabetic foot disorders; and (5) neuromuscular disease. However, age-related changes in cardiovascular, pulmonary, and renal function increase the risk of perioperative complications. The higher rates of complications seen in the older surgical patients result in part from existing comorbidity and age-associated changes in organ function. Extensive procedures depending on good bone healing for success should usually not be attempted on older patients. Office surgery for the geriatric patient should involve only the simplest procedures and should be kept to a minimum because of the increased possibility of postoperative complications. In the hospital there is better preoperative evaluation, operating room conditions, and postoperative care.