Fluoroquinolone-mediated Achilles rupture: a case report and review of the literature.

Fluoroquinolone use for the treatment of bacterial infections is a common practice for foot and ankle surgeons because of its rather broad-spectrum coverage against common pathogens, good tissue penetration, and high bioavailability. An associated risk of tendinopathy has been reported in published studies, although tendon rupture has been much less frequent. In addition, tendinopathy has been more commonly reported with earlier generations of fluoroquinolones. We present a case of levofloxacin-mediated Achilles rupture that was complicated by the presence of an infected hematoma and abscess and subsequent long-term postoperative follow-up data, with a review of the literature.

Autologous split peroneus longus lateral ankle stabilization.

Lateral ankle instability is a common clinical entity, and a variety of surgical procedures are available for stabilization after conservative management fails. Herein the authors reviewed outcomes after performing autologous split peroneus longus lateral ankle stabilization, using a previously described surgical technique to anatomically recreate the anterior talofibular and calcaneofibular ligaments. Twenty-five consecutive patients from 2 surgeons' practices underwent reconstruction between March 2007 and January 2011 with a minimum follow-up of 12 (range 12 to 51) months (mean 29.5 months). Follow-up interviews demonstrated 92.0% good or excellent outcomes with only 8.0% rating the outcome as fair and none as poor; 92.0% had no recurrent sprains or difficulty going up or down hills; 88.0% related no difficulty with uneven ground. The authors conclude that the autologous split peroneus longus lateral ankle stabilization results in a stable ankle with a low rate of complications and high patient satisfaction.

The opening base wedge osteotomy and subsequent lengthening of the first metatarsal: an in vitro study.

UNLABELLED: Traditionally, the opening base wedge osteotomy has been indicated in a moderate to severe hallux abducto valgus deformity with a short first metatarsal. This in vitro study aimed to address the question of how much lengthening is inherent to the geometric design of an opening wedge in the first metatarsal. The preosteotomy length of a first metatarsal segment was compared with postosteotomy length after performing transverse and oblique basilar osteotomies while maintaining the opening wedge with a prefabricated spacer. In the current bench study, it was found that the opening base wedge osteotomy does indeed lengthen the first metatarsal, albeit a small percentage of the total length (1%-2.8%), and there was no significant difference between the lengths achieved through a transverse or oblique osteotomy based on a confidence interval of 95%. LEVEL OF CLINICAL EVIDENCE: 5.

Analysis of radiographic classifications for rotational ankle fractures.

The acute ankle fracture has been often cited as one of the most commonly treated orthopedic injuries. As such, significant research has been conducted, along with many clinical studies, aiming to evaluate conservative versus surgical management, as well as radiographic classification and long-term outcomes. Because these clinical outcomes are pertinent to practicing physicians, this article aims to examine studies that assess the reliability and reproducibility of familiar classification systems for rotational ankle fractures.

Chondromyxoid fibroma.

Chondromyxoid fibroma is an uncommon benign cartilaginous tumor accounting for less than 1% of all bone tumors. The classic site of involvement is the metaphyseal region of long tubular bones, usually presenting in the second to third decades of life with nonspecific pain and swelling of the affected part. This case is an interesting incidental finding in a juvenile hallux abductovalgus deformity with no prodrome, eccentrically located in the diaphysis of the first metatarsal. Early detection and complete surgical resection are valuable in preventing recurrence in the affected bone. ACFAS Level of Clinical Evidence: 4.

Naviculocuneiform arthrodesis.

The adult acquired flatfoot is a challenging clinical entity with numerous procedures available to the surgeon for correction of the deformity. In a supple stage II flatfoot, naviculocuneiform arthrodesis with appropriate ancillary soft tissue augmentation and other adjunctive osseous procedures has proven effective with reproducible success. It may be used to balance a symptomatic flatfoot, re-establishing medial column stability and alignment while maintaining essential tri-tarsal joint motion. In addition to a review of the evidence-based medicine regarding this procedure, a detailed surgical technique is provided.

A compression force comparison study among three staple fixation systems.

Traditional staples have recently been redesigned with both new materials and engineering techniques to facilitate interfragmentary compression in theory, resulting in greater friction between bone fragments to counteract shearing forces. In the current study, the biomechanical properties of 3 different staples were investigated. The interfacial force at 2 different sites within a calcaneal bone model was measured after insertion and activation of the OSStaple, the UNI-CLIP, and the Smith and Nephew Standard Large Staple after precompression with the SYNTHES Small Distractor. Additionally, the ability of each staple to maintain compression over a short period of time was investigated. In the current bench study, the OSStaple consistently generated the greatest and most uniform compression across the bone model osteotomy and was also capable of sustaining the compression over the duration of all of the trials.

Elephantiasis nostras verrucosa.

Swelling of the leg is a frequent finding in podiatric medicine. Unless the patient draws notice to the condition or the physician is diligent in asking questions and examining the extremity, the condition may be viewed as minor and given little attention. Swelling of the leg can be a clinical sign of certain systemic diseases, lymphatic and venous disorders, or other miscellaneous causes. Dermatologic consequences linked to many of these causes of swelling are well documented. What is not as well chronicled is a dramatic skin alteration associated with chronic lymphedema. This article provides an overview and a case presentation of the unusual and debilitating skin condition related to chronic lymphedema of the lower extremity known as elephantiasis nostras verrucosa.

The physician's attire and its influence on patient confidence.

Although physician appearance has been a topic of discussion in the medical literature for many years, no objective research has been performed on this topic in the field of podiatric medicine. Our primary objective was to examine patient confidence in physicians as it relates to professional clinic attire versus casual or scrub outfits. We also assessed the influence of other variables, such as white coat, name tag, age, and sex, on patient confidence. We surveyed 155 podiatric medical patients from a private practice and a hospital-based clinic. The results indicate that 68% of patients surveyed felt that professional attire inspired the most confidence. Ninety-six percent of all patients either preferred white coats or were indifferent to their presence. We conclude that professionally dressed podiatric physicians may inspire more confidence in a significant percentage of their patients.