The Use of Decellularized Human Placenta in Full-Thickness Wound Repair and Periarticular Soft Tissue Reconstruction: An Update on Regenerative Healing.

Prolonged or incomplete healing of the foot and ankle can pose significant challenges. Therefore, investigators have begun searching for alternative treatment strategies. With advances in tissue engineering, decellularized human placental connective tissue matrix has been suggested as a means to achieve more rapid and complete healing for various soft tissue and bone procedures. Basic science and clinical studies have shown that decellularized human placental connective tissue matrix can support regenerative healing through cellular migration, accelerated tissue remodeling, and the establishment of functional tissue. Additional research is needed to fully explore and evaluate clinical applications within the foot and ankle.

Complex Total Ankle Arthroplasty.

Total ankle arthroplasty is a viable surgical technique for the treatment of end-stage degenerative joint disease. With continued advancement in prosthetic design, refined surgical techniques, and improved outcomes, the indications for total ankle replacement have expanded to include cases of increasing complexity. With meticulous preoperative planning and exacting execution, many frontal plane deformities and cases of avascular necrosis can now be successfully addressed at the time of prosthesis implantation or in a staged procedure.

Accessory Soleus: A Case Report of Exertional Compartment and Tarsal Tunnel Syndrome Associated With an Accessory Soleus Muscle.

An accessory soleus muscle is a rare anatomic variant that frequently presents as an asymptomatic soft tissue swelling in the posteromedial ankle. Less frequently, the anomalous muscle can cause pain and swelling with activity. We present the case of a 17-year-old male with exertional compartment syndrome and associated tarsal tunnel syndrome secondary to a very large accessory soleus muscle. After surgical excision, the patient was able to return to full activity with complete resolution of symptoms.

The association of metatarsus adductus to the proximal fifth metatarsal Jones fracture.

This retrospective study aimed to determine if a transverse plane forefoot relationship exists in patients with Jones fractures. Anteroposterior radiographs of 30 acute Jones fractures were compared with radiographs of 30 asymptomatic control subjects. Radiographic metatarsus adductus angle measurements were analyzed with a digital software program. The reliability of the measurements was evaluated with an intra-rater study. An independent t test was used to compare the metatarsus adductus angle between the Jones fracture group and the control group. Radiographic analysis revealed the mean metatarsus adductus angle for the Jones fracture group to be 20.22° (± 6.79°) compared with a mean of 14.27° (± 4.60°) for the control group. This difference between the groups was found to be statistically significant (p < .005). The intraclass reliability coefficient (ICC = 0.9396) confirmed there was no bias in the radiographic measurements. The metatarsus adductus angle in this group of patients with Jones fractures was increased compared with the nonpathologic control group. The Jones fracture mechanism of injury and resultant lateral column overload may be intensified with an increased metatarsus adductus. This relationship should be considered a risk factor for Jones fractures and taken into consideration with respect to bone healing, treatment, and prevention.

Management of pedal puncture wounds.

Puncture wounds of the foot are a common injury, and infection associated with these injuries may result in considerable morbidity. The pathophysiology and management of a puncture wound is dependent on the material that punctures the foot, the location and depth of the wound, time to presentation, footwear, and underlying health status of the patient. Puncture wounds should not be treated lightly, so accurate diagnosis, assessment, and treatment are paramount. Early incision and drainage, vaccination, and the use of proper antibiotics can lead to positive outcomes and prevent limb-threatening circumstances.

Workflow characterization in a busy urban primary care clinic.

We are examining the workflow processes within a large, urban general internal medicine practice in order to understand task inefficiencies that can lead to medical errors. We are performing a time-motion study looking at task management of check-in, check-out clerks, nurses, nurse's aides and physicians. Our pilot data suggests that there is significant variability in the task burden at different times of the day due to several factors, including patient-show rates, time allotted to late arrivals, multi-tasking by check-in clerks and inefficient intra-clinic communication processes. Our initial data suggests that a streamlined check-in process, more effective communication strategies and better time-task utilization can improve patient flows in this clinic.