Posterior tibial tendon dysfunction. Diagnosis, evaluation, and treatment.

Posterior tibial tendon dysfunction (PTTD) is a complex multifaceted condition that can affect the lower extremity. Rarely mentioned 20 years ago, today it is the subject of numerous articles, books, and is a topic at most scientific seminars relating to the foot and ankle. It is a muscle imbalance initiated by a rupture, avulsion, or chronic inflammation of the tibialis posterior tendon. With time, it progresses from a flexible to rigid flatfoot deformity. Left untreated, peritalar dislocation and degenerative joint disease may develop. This article discusses the diagnosis, evaluation, and treatment of PTTD.

Isolated medial cuneiform fracture: review of the literature and report of two cases.

The authors present two unusual cases of isolated medial cuneiform fracture. Both fractures were difficult to see on plain films and therefore diagnosed with ancillary tests (computed tomography and magnetic resonance imaging). Treatment was nonweightbearing cast immobilization, in which both patients healed within twelve weeks of treatment without complication and returned to full work related activities.

Is glass visible on plain radiographs? A cadaver study.

Eighteen randomly selected pieces of nonleaded glass from a collection of 30 pieces from broken bottles of four known color types found on the streets of Houston were sorted into four sets with one control. The purpose of this study was to determine if regular glass is visible on plain radiographs and whether color, location, or volume of these fragments had any effect on the detection of nonleaded glass. These sets were then placed into a fresh-frozen cadaver foot and ankle with a history of insulin-dependent diabetes and peripheral vascular disease. This foot was radiographed utilizing four standard foot projections. Five examiners read these five sets of radiographs twice and recorded the number seen. Overall sensitivity for all of the examiners was 90% with an overall false-positive rate of 10%. Intraobserver and interobserver Pearson's correlation coefficients showed that there was reliability between the first and second readings and between observers. The authors concluded that regular nonleaded glass is radiographically visible and that factors such as color and location of the glass have no effect on its detection, while a volume of less than 15 mm3 may have an effect on the detection of glass.

Bilateral intraosseous cystic formation in the talus: a complication of subtalar arthroeresis.

Intraosseous cystic formation in the talus is a complication of subtalar joint arthroereisis which has not been previously reported. The authors present a case whereby STA-peg implants were utilized to correct a bilateral flatfoot deformity in an adolescent girl. The surgical procedure was successful in treating the structural deformity of the foot; however, the formation of talar cysts occurred. A review of the literature and the treatment of this previously undescribed complication is presented.

Morton's neuroma. Update on diagnosis and imaging.

The diagnosis of Morton's neuroma is usually made from evaluation of a patient's subjective complaints, clinical findings, and exclusion of other differential diagnoses. Occasionally, when other neurological conditions exist or when the clinical findings are atypical, various imaging techniques may be helpful in the diagnosis of interdigital neuromas. This article will discuss these techniques and briefly review this common lower extremity disorder.

The use of bone grafts in the management of nonunions.

Nonunions can be frustrating complication for the lower extremity surgeon. The cessation of bone healing requires an understanding of its etiology before it may be treated appropriately. This article will review nonunions and, in the context of this special issue, discuss the role of bone grafts in their treatment.

Repair of neglected Achilles tendon ruptures with a triceps surae muscle tendon advancement.

Neglected Achilles tendon ruptures, although rare, can be a surgical challenge for the lower extremity specialist. These injuries often present with large defects which require special reconstructive techniques and principles. This paper presents an overview of this problem, various treatment strategies, and two case reports utilizing a triceps surae muscle tendon flap advancement.

Compartment syndromes causing neuropathy.

Compartment syndromes of the lower extremity can cause significant mobidity when appropriate treatment is not rendered. Paramount to the management of a compartment syndrome is a timely diagnosis. The physician must be intimately familiar with the anatomy as well as the signs and symptoms that a compartment syndrome presents. This familiarity can provide the opportunity for early diagnosis and treatment to prevent debilitating sequalae.

Giant cell tumor of the first metatarsal bone en bloc resection with autogenous middle fibular strut graft.

Giant cell tumors of bone are tumors of somewhat obscure origin. Clinically, they often do not present until late in their development. Radiographically, they can appear quite aggressive. However, most are intermediate-type lesions. Curettage has shown a tendency toward recurrence with en bloc resection becoming more popular when located in a long bone. The following is a brief review and a case report of an aggressive giant cell tumor of the first metatarsal. An en bloc resection of the proximal two-thirds of the metatarsal with an autogenous middle fibular strut graft is presented.

The tarsal tunnel syndrome and its surgical decompression.

This article addressed the tarsal tunnel syndrome. Its etiology, symptomatology, diagnosis, treatment, and surgical decompression were discussed.

Surgical treatment of posterior tibial tendon dysfunctions.

Ruptures and dysfunctions of the tibialis posterior tendon are often overlooked or misdiagnosed and can cause considerable loss of function to the patient. This article reviews the etiology, clinical as well as radiologic diagnosis, classification, and alternative surgical approaches. Case reports and photography of magnetic resonance imaging examples are included as well as a description of flexor digitorum longus tendon transfer in the treatment of this disorder.

Tibialis posterior dysfunction: an overview with a surgical case report using a flexor tendon transfer.

Tibialis posterior dysfunction, a syndrome that leads to a progressive, unilateral, acquired flat foot, can be missed easily by the podiatric specialist. This paper discusses various etiologies, its clinical presentation, and varying treatment regimes. A case report using the flexor digitorum longus tendon transfer for its repair is presented.