Sesamoid disorders of the first metatarsophalangeal joint.

The sesamoid complex is located centrally and plantar to the first metatarsal head, where they are imbedded within the plantar plate, which transmits 50% of body weight and more than 300% during push-off, is susceptible to numerous pathologies. These pathologies include sesamoiditis, stress fracture, avascular necrosis, osteochondral fractures, and chondromalacia, and are secondary to these large weight-bearing loads. This article discusses sesamoid conditions and their relationship with hallux limitus, and reviews the conditions that predispose the first metatarsophalangeal joint to osteoarthritic changes.

The cheilectomy and its modifications.

Hallux rigidus occurs in 10% of persons aged 20 to 34 years but in as much as 44% of people older than 80 years. Surgical intervention has been suggested for cases of hallux rigidus that have failed using conservative methods. The modified cheilectomy is considered by many the first-line treatment for this disease, given the procedure's inherent ability to eliminate degenerate bone and cartilage and decompress the intra-articular space, while sparing considerable cubic content of bone. Once the cheilectomy has been performed, there remains a sufficient volume of bone to perform a more definitive reconstruction if necessary.

Technique and pearls in performing the first metatarsal phalangeal joint arthrodesis.

When there is a considerable loss of first metatarsal phalangeal joint (MTPJ) motion and/or ankylosis is apparent then a joint preservation procedure may not be feasible. For end-stage degenerative change within the MTPJ, nonreducible joint incongruity, or instability of the first MTPJ, an arthrodesis can provide the most predictable and, arguably, the most definitive correction of the deformity, especially in patients with higher functional demands. This article discusses principles of techniques with an emphasis on the procedure to prepare a successful arthrodesis, and expounds on technical nuances including those associated with fixation devices.

Vesiculobullous syphilis: a case involving an unusual cutaneous manifestation of secondary syphilis.

The recent resurgence of syphilis mandates that clinicians maintain a heightened suspicion for Treponema infection, and that they be aware of the variety of cutaneous presentations that may mimic eczema, psoriasis, drug eruption, erythema multiforme, lichen planus, tinea versicolor, seborrheic dermatitis, mycosis fungoides, or other lichenoid lesions. In this report, we describe an unusual case of secondary syphilis in an adult woman, and briefly review the wide array of syphilitic dermopathy that could present to the foot and ankle surgeon.

Pigmented villonodular synovitis of the ankle-radiation therapy as a primary treatment to reduce recurrence: a case report with 8-year follow-up.

Pigmented villonodular synovitis (PVNS) is a rare, benign, idiopathic proliferative disorder of the synovium that results in villous and or nodular formations that have been reported to manifest within joints, tendon sheaths, and bursae. The overall incidence includes 2% to 10% that occur within the foot and ankle joints. PVNS has a high rate of recurrence and up to a 45% recurrence rate has been reported despite surgical intervention. Although traditional treatment for PVNS includes synovectomy with arthroplasty of the affected joint, radiation therapy is now suggested as an adjunctive therapy that is believed to reduce recurrence of the disease. We present a case of PVNS where the patient was treated in 2 stages: surgical resection of the tumor with arthroplasty of the ankle joint followed by radiation therapy. A retrospective review of the chart, radiographs, and MRIs was conducted for a 36-year-old, African American female who had been treated and followed for 8 years. Pathologic examination of the tumor confirmed the diagnosis of PVNS. No evidence of recurrent PVNS was identified in the long-term postoperative MRI examination. The fact that ancillary imaging examinations failed to reveal evidence of recurrence and that the patient expresses a very high patient satisfaction supports the potential benefit of adjunctive radiation therapy for this condition.

Malignant transformation of a chronic venous stasis ulcer to basal cell carcinoma in a diabetic patient: case study and review of the pathophysiology.

The degeneration of chronic wounds into basal cell carcinoma is rare. We present an atypical case of basal cell carcinoma diagnosed by soft tissue biopsy in a long-standing wound that had been treated for 3 years as a chronic venous stasis ulcer. In addition to the case report, we review the biomedical literature describing malignant transformation of long-standing wounds. Foot and ankle specialists should be on the lookout for changes that signal malignant transformation in long-standing ulcers.

Vessel loop closure technique in open fractures and other complex wounds in the foot and ankle.

A gaping wound of the foot and ankle can be difficult to close. In cases in which wound margin mobility is suitable, the use of a vessel loop, or loops, to provide sufficient tension for wound margin reapproximation can be a useful adjunct to the surgical management of wounds that would otherwise be very difficult to close without the use of a skin graft or flap coverage. In this report, we describe the use of a vessel loop, or loops, for reapproximation of the margins of gaping wounds of the foot or ankle.

Resection and reconstruction of an osteochondroma of the hallux: a review of benign bone tumors and a description of an unusual case.

UNLABELLED: Osteochondroma, which is also known as exostosis, is the most common benign bone tumor. Although foot and hand surgeons frequently encounter the subungual exostosis, exostoses commonly localize to other areas of the skeleton as well. In this review, we describe the clinical and diagnostic imaging characteristics of benign bone tumors and, in particular, the osteochondroma and its surgical management. We also report the case of a patient who experienced an unusual pedal digital osteochondroma-like lesion. LEVEL OF CLINICAL EVIDENCE: 4.