Squamous cell carcinoma complicating chronic osteomyelitis in a toe: a case report and review of the literature.

Squamous cell carcinoma arising from chronic osteomyelitis is uncommon. Although the majority of cases occur in the lower extremity, incidence in the foot is relatively rare, and in the toe, exceptional. This report illustrates a particularly unusual incidence of squamous cell carcinoma complicating chronic osteomyelitis of the hallux. Guidelines for early diagnosis, recommendations for treatment, and prognostic data are included.

Effectiveness of orthotic shoe inserts in the long-distance runner.

Five hundred questionnaires were distributed to long-distance runners who had used, or who were using orthotic shoe inserts for symptomatic relief of lower extremity complaints. Three hundred forty-seven (69.4%) responded (males, 71%; females, 29%). The mean age of the respondents was 36 years (range, 15 to 61). The average distance run per week was 39.6 miles (range, 5 to 98). The mean duration for use of the orthotic inserts was 23 months (range, 1 to 96). The predominant (63%) type of orthotic device used was flexible. The presumed diagnoses in the population studied were excessive pronation (31.1%), leg length discrepancy (13.5%), patellofemoral disorders (12.6%), plantar fasciitis (20.7%), Achilles tendinitis (18.5%), shin splints (7.2%), and miscellaneous (4.9%). Of the runners responding, 262 (75.5%) reported complete resolution or great improvement of their symptoms. Results of treatment with orthotic shoe inserts were independent of the diagnosis or the runner's level of participation. A high degree of overall satisfaction was demonstrated by the finding that 90% of the runners continued to use the orthotic devices even after resolution of their symptoms. Orthotic shoe inserts were most effective in the treatment of symptoms arising from biomechanical abnormalities, such as excessive pronation or leg length discrepancy. Along with other conservative measures, orthotic shoe inserts may allow the athlete to continue participation in running and avoid other treatment modalities that are more costly and time consuming, and therefore less acceptable to them.

A comparison of shoe insole materials in plantar pressure relief.

A clinical study was performed to evaluate the effectiveness of seven shoe insole materials and their ability to relieve areas of high plantar pressure. The following materials were tested: Latex foam, Plastazote, Dynafoam, Ortho felt, PPTR, Spenco, and Molo. Twenty-six patients with areas of high plantar pressure were tested using each of these materials. The Harris and Beath footprinting technique was used to measure plantar pressure. It was found that the average pressure of a clinically painful plantar area was 398.15kN/m2. All insole materials tested decreased this pressure, with averages ranging from 186.33kN/m2 to 286.35kN/m2. PPT, Plastazote and Spenco were the most effective products tested.

Bilateral simultaneous achilles tendon ruptures. A case report and review of the literature.

Bilateral simultaneous Achilles tendon ruptures are rare, with only ten cases reported in the English literature. Our case is that of a 44-year-old woman, along with a review of the literature. Affected persons usually are on chronic steroid treatment and in the fifth to seventh decades of life. The patient may have concomitant systemic disease, and the injury occurs with relatively mild trauma. The goals of treatment are mainly preventative, i.e., cessation of steroids as soon as possible and protective bracing of the remaining intact Achilles tendon.

The Harris and Beath footprinting mat: diagnostic validity and clinical use.

Pain on the plantar aspect of the forefoot is a common malady whose specific cause is often difficult to diagnose. Using the Berkemann Laboratory version of the original mat of Harris and Beath, and a calibration curve, the patterns on a footprint can be translated into their actual pressure values withhin the range of 0.27 kg/cm2 to 4.80 kg/cm2. Using the procedure presented here, inexperienced subjects were able to estimate the pressure values of random prints of unknown pressure within a standard deviation of 0.28 kg/cm2 from their actual values. The mat is valuable for diagnosis of pressure metatarsalgia and other disorders of the foot. The specificity was 0.77, sensitivity was 0.57, with the sum being equal to 1.34. These results indicate that there is a relatively large population of normal people wit excessive localized pressure under their metatarsal heads who do not complain of pain. The apparently low sensitivty of the mat in this study does not seem to be a limitation, but is an indication of the haziness involved in the differential diagnosis of forefoot pain. Pressure metatarsalgia can be quantitated by analysis of the Harris footprint.

The predictive utility of the orthopedic examination in identifying the low back pain patient with hysterical personality features.

Physical examination of the patient with low back pain routinely includes a number of tests which are useful clinically to the orthopedist as suggestive of the presence of hysteria or malingering. These include tests of light touch differences medially and laterally in the same foot or leg, vibratory sensation in the lower extremities, forward flexion, straight-leg raising differences between the supine and sitting positions, and the Burns' bench test. The present study examined the specific predictive utility of these tests individually and as a composite battery in identifying low back pain patients with hysterical personality features. Twenty-five postoperative lumbar laminectomy and diskectomy patients were administered the MMPI and evaluated by physical examination. Silight to moderate correlations were found for each of the subtests with a Composite Hysteria Index derived from the MMPI. The predictability was improved by the use of a weighted combination of the individual tests obtained by multiple regression analysis. The results lend empirical support to: the predictive value of these clinical tests in definitively identifying 60% of those low back pain patients with hysterical personality features; decision rules for use in clinical practice were also developed.

The Burns' test in low back pain: correlation with the hysterical personality.

Twenty-five postoperative lumbar laminectomy and diskectomy patients were administered the MMPI and evaluated by physical examination which included the Burns' Bench Test. In this test the patient is asked to kneel on a bench with knees and hips flexed and place his fingers on the floor. The kneeling position relieves stress on the low back and tension on the siatic nerve, so that patients with organic causes of low back pain are able to perform the test. Conversely, inability to perform the test is indicative of functional symptoms as in hysteria. All patients were males and the average age was 54. The average interval from surgery was 2 1/2 years. Sixty-seven per cent of those patients unable to perform the Burns' test were classified as hysterical on the basis of the MMPI, while 73% of patients classified as hysterical using the MMPI criteria failed to perform the Burns' test. The correlation between the Burns' test and hysteria as determined by the MMPI was 0.48. In terms of sensitivity and specificity, the sensitivity of the Burn's test in distinguishing patients with an hysterical MMPI was 73%. The specificity for normal subjects was 71%. The Burns' test is a useful clinical test for differentiating between organic and non-organic causes of low back pain. However, the test by itself should not be construed as an unequivocal measure of hysteria as defined psychologically by the MMPI. Failure to perform the test indicates a need for further psychological study.

Chondrosarcoma of the talus: a case report.

Although malignant cartilage tumors of the foot and especially of the talus are uncommon, the treating physician must become suspicious when a "simple ankle sprain" is resistant to standard treatment. In such a case, the comparison of serial radiographs may reveal subtle changes and the use of a radioactive bone scan may be of diagnostic value.

The unreducible Lisfranc fracture. Case report and literature review.

In a lateral dislocation that is unreducible by closed methods, one should suspect that the tendon of the tibialis anterior muscle may be preventing reduction because of its interposition. In such a situation an open reduction is mandatory.

Primary coccidioidal synovitis of the knee: a report of four cases and review of the literature.

Primary coccidioidal synovitis of the knee is a rare disorder and controversy exists in the literature over the efficacy of treatment with synovectomy and Amphotericin B therapy. Four cases are presented illustrating features of the natural history, diagnosis, and treatment of the disease.

Body type and rotational laxity of the knee.

Forty young adult males were somatotyped according to the Health-Carter Modified Method and were separated into 2 groups. One group was a meso-endomorphic body type (5-6-1) and the other was ectomorphic body type (3-2-4). Measurement of rotational laxity of the knee in 90 degrees flexion showed a statistically significant increase (p less than .001) in external rotation and total rotation in ectomorphs compared to meso-endomorphs. Rotational laxity of the knee is associated with body type. Lateral radiographs were used to measure patellae alta in each group. No statistical difference was found, and patellae alta does not appear to be associated with body type.

Anaerobic infection after total hip replacement. Report of three cases.

In a series of 387 consecutive total hip replacements there were nine infections (2.3% infection rate). Three of the infections were caused by an anaerobic gram positive cocci, Peptococcus. This is an increased incidence of infection for this previously rare pathogen. The anaerobic infections occurred despite prophylactic antibiotic coverage with Keflin. No causative factors such as hospital, operating time, operating personnel, medical disease, or blood loss could be associated with the observed anaerobic infections. Two of the anaerobic infections appeared late. This is consistent with other reports of anaerobic infections in implants. Drainage after total hip arthroplasty operation must be cultured for anaerobes as well as aerobes, especially late infections in patients on prophylactic antibiotics. Drainage which is sterile to aerobic culture should alert the physician to a possible anaerobic infection.

Gluteal compartment syndrome: case report.

A compartmental syndrome can occur in any space limited by fascia or skin. A case of a gluteal compartment syndrome is reported, apparently from prolonged pressure after a drug overdose. Clinical features were a painful expanding gluteal mass with sciatic nerve dysfunction. Fasciotomy of the tensor fascia lata and the overlying fascia of the gluteus maximus resulted in rapid relief of symptoms.

UCI knee replacement.

Between March 9, 1972 and December 31, 1973, a total of 103 UCI knee replacements were performed. Follow-up data are available on 83 knees with an average follow-up of 33 months. Patient evaluation of the end results indicates that 78.3 per cent were better, 9.6 per cent unchanged, and 12.1 per cent worse. Patient evaluation of their own knee function averaged 55 per cent preoperatively and 79 per cent postoperatively. Patients were also evaluated on a 100 point Modified Larson Analysis Form. The average preoperative score was 46, and the average postoperative score was 70. There were six (5.8%) biological complications in the 103 knee replacement. Biological complications included infections, wound healing problems and unexplained pain. Mechanical complications were seen in 18 (17.4%) knees, and included knee instability, tibial component loosening or deformation, and patellar problems. Additional surgery was required in 18 (17.4%) knees. Failure of the procedure eventually requiring removal of the prosthesis and fusion or amputation occurred in 4 (3.9%) knees. The intermediate-term results of UCI knee replacement have been clinically satisfactory. We currently recommend consideration of this procedure for patients with disabling arthritis of the knee.

Irvine ankle arthroplasty. Prosthetic design and surgical technique.

A total ankle arthroplasty (IAA) design is presented for highly selected cases. The design stems from investigations on the anatomical and biomechanical characteristics of the human ankle joint. The prostheses are inserted through an anterior approach. Full weight-bearing is well tolerated within a few days. The immediate results on 20 ankles are most encouraging.