Latex allergy and the podiatric surgeon.

Latex allergy in recent years has become a more visible problem in the medical community. There are certain populations found to be at greater risk for this problem. Those with myelodysplasia, congenital urinary anomalies, and a history of a significant number of prior surgeries are particularly at risk, followed less commonly by health care workers and the general population. A detailed patient history is the most reliable predictor of latex sensitivity. There are various immunological and serological screening tests on the market, which are not always reliable predictors of allergy or readily available to the physician. This article reviews the current literature on latex allergy and provides insight into populations at risk, the type of allergic response seen, predictors of sensitivity, management of patients with latex allergy, and measures to prevent it.

Long-term efficacy of total SILASTIC implants: a subjective analysis.

A retrospective analysis of the long-term efficacy of total SILASTIC implant arthroplasty performed before 1986 is presented. A total of 50 patients responded to subjective questionnaires regarding pain, function, complications, and overall patient satisfaction. The average age of the patients at the time of surgery was 55.1 years with an average follow-up of 13.4 years (range 10.7 to 16.9 years). Ninety-seven percent of patients reported relief from pain, and the overall success rating was 90.7%. Results were calculated based on a modification of the American Orthopaedic Foot and Ankle Society clinical rating system; the mean rating was 87.3. Attention must be directed at realigning the joint via appropriate osteotomies and soft tissue balancing procedures for increased success. Although radiographic deterioration of the implant was demonstrated in all implants, this deterioration did not correlate with patient satisfaction and should not be the sole criterion for implant removal. We conclude that total implant arthroplasty is a proven procedure for long-term relief of pain in selected patients with degenerative joint disease of the first metatarsophalangeal joint.

Our fixation with fixation: are screws clinically superior to external wires in distal first metatarsal osteotomies?

The purpose of this study was to evaluate the immediate postoperative morbidity, the structural correction attained, and the long-term range of motion following fixation with a single external Kirschner wire and an internal cortical screw. We abstracted records for 69 patients undergoing, distal unicorrectional chevron osteotomies. Thirty-three patients received percutaneous 0.062-inch K-wire fixation and 36 patients received single 2.7-mm. cortical screw fixation. Among these age- and sex-matched subjects, there was not a significant difference between any of the correctional or morbid outcomes measured in this study on the basis of type of fixation employed. Patients with rigid internal screw fixation did not return to shoe gear sooner, develop fewer postoperative infections, or have increased long-term range of motion than the group receiving external fixation with a single K-wire. Surgical time was significantly longer for those patients undergoing rigid internal fixation with a screw (42.5 +/- 9.5 vs. 35.1 +/- 6.6 minutes, p < 0.001). We conclude that there is no significant difference in postoperative infection, dehiscence, long-term structural correction attained, or range of motion achieved between rigid internal screws and external K-wires used to fixate distal metatarsal osteotomies.

Calcaneonavicular bar resection. A retrospective review.

The authors present a retrospective study evaluating the results of calcaneonavicular bar resection with interposition of the extensor digitorum brevis in ten patients with painful calcaneonavicular coalition. All operative procedures were supervised by one of the authors to ensure consistency in preoperative evaluation, surgical technique, and postoperative care. Results obtained from questionnaires showed significant improvement of preoperative symptoms with increased activity levels noted in all patients.

Talectomy for diabetic Charcot foot. An alternative to amputation.

A talectomy was performed because of Charcot degeneration during recovery from a hallux amputation. The patient was treated conservatively but Charcot degeneration continued, resulting in ulceration and dorsomedial dislocation of the talar head. The patient was hospitalized, and the talectomy was performed. The patient returned to normal activities.

Ankle dislocation without fracture: an unusual case report.

Complete dislocation of the ankle joint without associated fracture is considered a rare injury. Few cases are reported in the literature. A case report is presented, and a review of the etiological factors and treatment principles are discussed.

Stenosing tenosynovitis of the flexor hallucis longus at the ankle joint.

The discussion of stenosing tenosynovitis of the flexor hallucis longus at the level of the ankle joint is not found in the literature with frequency. A thorough understanding of the involved anatomy is necessary when considering this condition. A strong clinical suspicion, coupled with appropriate diagnostic tests, is necessary to arrive at a proper diagnosis. Various treatment options may be considered. However, surgical decompression of the stenosed sheath ultimately is recommended by the authors.

Stenosing peroneal tenosynovitis.

The etiology, diagnosis and surgical treatment of stenosing tenosynovitis of the peroneal tendons is presented. The authors stress the need for thorough understanding of this clinical entity as its symptomatology can mimic several more frequently encountered podiatric pathologies. This could result in delayed or missed diagnosis and, thus, improper management.

Complete rupture of the Achilles tendon: a new modification for primary surgical repair.

Appropriate surgical repair of ruptured Achilles tendon will decrease the complications commonly associated with conservative therapy, this is particularly true with respect to rerupture. A literature review of complete ruptures of the Achilles tendon and a new modification of the Lindholm surgical procedure is presented.

Aneurysmal bone cysts with emphasis on roentgenologic diagnosis.

This paper was written to bring about an awareness of aneurysmal bone cysts--the etiology, signs and symptoms, and clinical manifestations. Emphasis is placed upon the roentgenologic appearance of bone tumors and the differentiation of aneurysmal cysts from other relatively common bone tumors. Treatment and pathologic interpretation are discussed briefly.