ABSTRACT
The plantar plate is a critical structure involved in stabilizing the metatarsophalangeal joint. Its disruption can not only be painful for the patient but also may lead to subsequent structural deformities. There are several conservative treatment modalities available to help mitigate symptoms including splinting, offloading, and intraarticular injections. That being said, once the pathology progresses to advanced stages, these treatments are not efficacious. Reported success with conservative treatment modalities is limited to case studies and series with a low level of clinical evidence. As such, this represents an area where further investigation is needed to evaluate the true efficacy of conservative treatment and to allow for development of a more standardized approach.
Subject(s)
Joint Instability , Metatarsophalangeal Joint , Plantar Plate , Humans , Joint Instability/surgery , Metatarsophalangeal Joint/diagnostic imaging , Metatarsophalangeal Joint/surgery , Osteotomy , Plantar Plate/surgeryABSTRACT
Tarsal coalitions are recognized as a congenital anomaly whereby the two or more bones of the hindfoot and midfoot are fused resulting in limitation of foot motion and pain. Tarsal coalitions were found to be the cause of painful flatfeet in adolescents and young adults. Developing a clinical understanding of tarsal coalitions as well as developing a step-wise conservative and surgical approach for their treatment can alleviate patient symptomatology and provide excellent long-term benefits. Conservative treatment consists of immobilization, NSAIDs, and casting for symptomatic patients, and surgical treatment for symptomatic tarsal coalition consists of resection and/or arthrodesis.
Subject(s)
Flatfoot , Tarsal Bones , Tarsal Coalition , Adolescent , Arthrodesis , Conservative Treatment , Humans , Tarsal Bones/diagnostic imaging , Tarsal Bones/surgery , Tarsal Coalition/diagnostic imaging , Tarsal Coalition/surgery , Young AdultABSTRACT
INTRODUCTION: Esterified hyaluronic acid is part of a unique dressing that can be used for the treatment of difficult, nonprogressive wounds, including venous leg ulcers (VLUs) and diabetic foot ulcers (DFUs). OBJECTIVE: The data presented herein represent a small retrospective sample of the authors' clinical experience with this unique material. MATERIALS AND METHODS: Data were collected from 6 patients with DFUs and 3 patients with VLUs. Patients were assessed at regular intervals, and the change in wound size as well as the percentage of necrotic versus granular tissue were tracked. RESULTS: The average time for evaluation was 55.25 days (SD = 2.76 days). During this period, the average change in wound size decreased by 6.43 cm2 (SD = 7.55 cm2), from 7.93 cm2 (SD = 8.12 cm2) to 1.50 cm2 (SD = 0.92 cm2), and developed an increase of 74.38% (SD = 32.01%) coverage with granulation tissue from 46.11% (SD = 22.05%), representing about a 50% increase in granulation tissue over the 55 days of evaluation. CONCLUSIONS: The presented literature supports the contention that hyaluronic acid is a critical component in the complex cascade of wound healing and most likely is responsible for the clinical wound improvement in the case series presented.
Subject(s)
Diabetic Foot/therapy , Hyaluronic Acid/therapeutic use , Varicose Ulcer/therapy , Wound Healing/drug effects , Animals , Bandages , Clinical Trials as Topic , Diabetic Foot/pathology , Granulation Tissue/drug effects , Granulation Tissue/pathology , Humans , Hyaluronic Acid/pharmacology , Models, Animal , Retrospective Studies , Treatment Outcome , Varicose Ulcer/pathology , Wound Healing/physiologyABSTRACT
Placental membrane grafts have long been used in the realms of wound care and ophthalmology to assist in the healing cascade. Recently, surgeons have started to implant placental membrane grafts in a wide variety of foot and ankle surgeries to take advantage of their many touted benefits. The application of placental membrane grafts for cases of lower extremity tendinopathy is detailed in this article.
Subject(s)
Placenta/transplantation , Tendinopathy/surgery , Adult , Allografts , Female , Foot , Humans , Male , Pregnancy , Transplantation, Homologous , Wound HealingABSTRACT
Adult acquired inferior calcaneal heel pain is a common pathology seen in a foot and ankle practice. A literature review and expert panel discussion of the most common findings and treatment options are presented. Various diagnostic and treatment modalities are available to the practitioner. It is prudent to combine appropriate history and physical examination findings with patient-specific treatment modalities for optimum success. We present the most common diagnostic tools and treatment options, followed by a discussion of the appropriateness of each based on the published data and experience of the expert panel.
