RESUMO
Foot drop has many etiologies. One rarely mentioned and often neglected reason for foot drop is an acute inversion sprain of the ankle. Over the past 14 years, a collection of 32 cases of foot drop have been compiled in our orthopaedic and physiatric practices. All cases had appropriate evaluations, including electrodiagnostic studies (electromyography and nerve conduction studies) to determine the location and type of injury. Treatment and follow-up are also discussed. Of the 32 case studies, four were caused by a straightforward acute inversion sprain of the ankle. These cases are described with the electrodiagnostic evaluations, treatments, and outcomes. Proposed mechanisms for this type of foot drop are discussed, including traction and compression of the common peroneal nerve as it winds around the neck of the fibula, and possible compression by hematoma. Surgical versus conservative treatment is described. The functional impairment associated with foot drop is detailed.
Assuntos
Traumatismos do Tornozelo/complicações , Pé/inervação , Transtornos Neurológicos da Marcha/etiologia , Nervo Fibular/lesões , Neuropatias Fibulares/etiologia , Entorses e Distensões/complicações , Adulto , Idoso , Traumatismos do Tornozelo/fisiopatologia , Moldes Cirúrgicos , Descompressão Cirúrgica , Eletromiografia , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Masculino , Condução Nervosa , Aparelhos Ortopédicos , Nervo Fibular/fisiopatologia , Neuropatias Fibulares/fisiopatologia , Recuperação de Função Fisiológica , Entorses e Distensões/fisiopatologia , Resultado do Tratamento , Adulto JovemRESUMO
Contemporary methods of bone grafting osteochondral defects, in which the remaining overlying cartilage is relatively well preserved, have inherent problems. The bony defects are often saucer-shaped and the cylindrical graft may not fill the void, leaving areas of cartilage with no underlying scaffold and obviating early weight bearing. Furthermore, to obtain a proper fill of the defect, tamping of the graft can cause excessive pressure and disruption of the overlying cartilage. In an effort to address these concerns, the authors propose the use of a biological viscous paste of calcium sulfate that hardens within 5 minutes when injected in a retrograde fashion into the talus. This confers a mechanical advantage of complete cystic fill of the cyst which allows early weight bearing. Calcium sulfate acts as an osteoconductive material that incorporates into host bone within 8 weeks. Donor site morbidity is eliminated using this system.
