ABSTRACT
The pediatric flatfoot can include multiple planes of deformity and concomitant concerns such as metatarsus adductus and equinus. Each aspect of the deformity must be carefully evaluated before any surgical planning. The goal of surgery should be an improvement in symptoms by creating a controllable foot with a reduction of deforming forces. There are multiple procedures that can be used for the pediatric flatfoot, including the Evans calcaneal osteotomy, the Cotton medial cuneiform osteotomy, the medial calcaneal slide osteotomy, and arthroereisis implants. Each contributes in a specific way to the overall deformity correction. Multiple options exist for grafts and hardware.
Subject(s)
Calcaneus , Flatfoot , Metatarsal Bones , Tarsal Bones , Humans , Child , Flatfoot/surgery , Foot , Tarsal Bones/surgery , Osteotomy/methods , Calcaneus/surgery , Retrospective StudiesSubject(s)
Bunion , Hallux Valgus , Hallux Valgus/diagnostic imaging , Hallux Valgus/surgery , Humans , OsteotomyABSTRACT
This clinical consensus statement of the American College of Foot and Ankle Surgeons focuses on the highly debated subject of the management of adult flatfoot (AAFD). In developing this statement, the AAFD consensus statement panel attempted to address the most relevant issues facing the foot and ankle surgeon today, using the best evidence-based literature available. The panel created and researched 16 statements and generated opinions on the appropriateness of the statements. The results of the research on this topic and the opinions of the panel are presented here.
Subject(s)
Consensus , Flatfoot/surgery , Orthopedic Procedures/methods , Orthopedics , Societies, Medical , Adult , HumansSubject(s)
Podiatry/education , Universities/trends , Curriculum/trends , History, 20th Century , History, 21st Century , Humans , PhiladelphiaSubject(s)
Analgesics, Opioid/adverse effects , Drug Utilization/statistics & numerical data , Opioid-Related Disorders/epidemiology , Pain Management/methods , Prescription Drug Overuse/mortality , Analgesics, Opioid/administration & dosage , Humans , Inappropriate Prescribing/prevention & control , Inappropriate Prescribing/statistics & numerical data , Needs Assessment , Opioid-Related Disorders/physiopathology , Pain Management/adverse effects , Prescription Drug Overuse/statistics & numerical data , Public Health , Survival Analysis , United StatesABSTRACT
Melorheostosis is a rare disorder marked by increased bony sclerosis on radiographs. In addition to bone changes, the skin and soft tissues overlying affected bone often demonstrate increased fibrosis, which can create joint contracture. These can all affect surgical planning for a patient with melorheostosis. This article reviews the literature and describes the surgical intervention and 4-year follow-up of a 10-year-old boy with melorheostosis.
Subject(s)
Foot Deformities, Congenital/surgery , Melorheostosis/surgery , Activities of Daily Living , Child , Contracture/etiology , Contracture/surgery , Foot Deformities, Congenital/diagnostic imaging , Foot Deformities, Congenital/etiology , Hallux/surgery , Humans , Ilium/transplantation , Male , Melorheostosis/complications , Melorheostosis/diagnostic imaging , Metatarsal Bones/surgery , Osteotomy , Postoperative Complications , Radiography , Tendons/surgeryABSTRACT
Two randomized, double-blind, placebo-controlled studies assessed the analgesic efficacy of valdecoxib in patients with moderate-to-severe pain after bunionectomy. Study 1 (N = 374) assessed the efficacy of two regimens of valdecoxib on the day after surgery (valdecoxib, 40 mg, with a 20-mg redose [n = 127]; valdecoxib, 40 mg, with a placebo redose [n = 122]; and placebo/placebo [n = 125]), and study 2 (N = 478) examined the efficacy of two different multiple-dose regimens on postoperative days 2 through 5 (valdecoxib, 20 mg, twice daily [n = 160]; valdecoxib, 20 mg, once daily [n = 159]; and placebo [n = 159]). Valdecoxib provided significant pain relief and reduced the use of opioid rescue medication. This efficacy was accompanied by improved global scores, decreased pain interference with function, and increased patient satisfaction.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Hallux Valgus/surgery , Isoxazoles/therapeutic use , Pain, Postoperative/drug therapy , Pain, Postoperative/etiology , Sulfonamides/therapeutic use , Adolescent , Adult , Aged , Aged, 80 and over , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Humans , Isoxazoles/administration & dosage , Male , Middle Aged , Sulfonamides/administration & dosage , Treatment OutcomeABSTRACT
Digital surgery is one of the most common types of surgery performed by foot and ankle surgeons. Flail toe is a complication that may occur after overaggressive resection arthroplasty of the proximal interphalangeal joint of the lesser toes. Correction of flail toe deformity has received little attention and has predominantly involved soft-tissue procedures. The authors' preferred technique for the surgical correction of flail toe is to place a unicortical autogenous bone graft (harvested from the ipsilateral calcaneus) within the revised proximal interphalangeal joint of the lesser toes to create a distraction arthrodesis. This technique allows restoration of digital length, stability, and purchase. A retrospective review of 22 such procedures in 13 patients is presented, along with a literature review of other procedures and a description of the authors' current surgical technique and postoperative management protocol. Overall success using the authors' procedure was 82%. Complications occurred in three patients, with one of the grafts showing complete resorption and two requiring additional surgical intervention owing to nonunion and malunion of toes.
