Anterior ankle abutment.

Anterior ankle abutment can be problematic for both athletes and for persons whose occupations require repeated loading of the anterior ankle joint. Nonoperative care is often not satisfactory for the individual who demands painfree activity. Because the presence of anterior osteophytes has been shown to represent the early stages of degenerative disease of the ankle joint, operative intervention may provide the best option to decelerate the arthritic process. Open ankle débridement or arthroscopic débridement can be used to remove the osteophytes and inspect the ankle joint. Care must be taken to examine the joint adequately to ensure that the impingement is not caused by lateral ankle instability. Failure to recognize the cause of anterior ankle impingement will result in an unsatisfactory result. When the proper diagnosis is made, surgery can result in pain-free motion that allows the individual to return to painfree activity.

Stress fractures of the foot and ankle.

Stress fractures of the foot and ankle are common injuries that require a high index of suspicion to make the appropriate diagnosis. If required, advanced imaging modalities should be used to establish the diagnosis. When developing a treatment plan for the runner, the sports medicine physician must keep the athlete informed as to the nature of the injury and the necessity of the treatment. A fitness plan must be developed with the runner to ensure that strength, flexibility, and cardiovascular conditioning are maintained during this period. Ideally the physician should develop this plan with the runner and not dictate the type of activity that is used to obtain these goals.

Hypertrophic scars and keloids.

Excessive scarring caused by pathologically overabundant collagen deposition is a problem known by all surgeons. Complications to wound healing, such as hypertrophic scars and keloids, can lead to an aesthetically unacceptable result or even lead to anatomic dysfunction. An overwhelming amount of hypotheses concerning treatment of these problems is available. There seems to be no absolutely effective treatment for hypertrophic scars and keloids and the number of treatment modalities illustrate the lack of understanding concerning this kind of pathologic scar healing. Most studies reported have not been well controlled and have produced conflicting results.

Puncture wounds of the foot. Evaluation and treatment.

Puncture wounds of the foot are a common injury, often occurring in the warmer months. Various objects have been described as the penetrating source in these wounds; however, nails and glass are the most common cause of pedal puncture wounds. All puncture wounds should be evaluated thoroughly and treated aggressively to reduce the risk of complications. Viewing this injury lightly may cause complications, and is often a source of litigation. A systematic approach to the evaluation and treatment of puncture wounds limits complications and results in a satisfactory outcome for the patient and physician.

A new fixation technique for metatarsal fractures.

Intramedullary nail fixation is an excellent option for open reduction and internal fixation of metatarsal neck and shaft fractures. In the authors' experience, the reduction of these fractures with Steinmann pin fixation provided excellent stability, required minimal soft-tissue dissection, and allowed for preservation of the periosteal tissue. Minimal disruption to the periosteum protects the osteoprogenitor cells located in the cambium layer. These cells stimulate osteoblastic activity, allowing for excellent secondary bone healing. Intramedullary nail fixation is the authors' chosen procedure for reduction of lesser metatarsal fractures.

Evaluation and surgical management of the arthritic midfoot secondary to rheumatic disease.

RA is a common disorder that has significant destructive effects on the midfoot portion of the foot. When these degenerative joint changes occur, any motion at the involved joints causes severe pain and disability, and limits the patient in his or her attempt to perform daily activities. These changes have a significant social and economic impact, and cause unwanted lifestyle changes. Arthrodesis, when used judiciously, can offer pain relief and a restoration of normal activity for the patient with RA.

Off-loading techniques in the treatment of diabetic plantar neuropathic foot ulceration.

In the individual with diabetes mellitus, foot ulceration represents the single most important risk factor in lower-extremity amputation. The goal of treatment is to obtain a healed and closed wound that (1) eliminates a portal of entry for bacterial invasion and development of limb-threatening infection, and (2) allows for tissue loading. This manuscript reviews current off-loading approaches to the treatment of plantar neuropathic foot ulcers, along with advantages and disadvantages of those techniques.

Cigarette smoking and bone healing: implications in foot and ankle surgery.

Despite the known health risks associated with cigarettes, millions of Americans continue to smoke. Much has been reported on the adverse effects of cigarette smoke on wound healing. Recent experimental work and clinical observation have demonstrated the risk of impaired bone healing associated with cigarette smoking. The authors review the biological aspects of bone healing and analyze how the chemical components of cigarette smoke affect the bone healing process. Laboratory and clinical data are also reviewed. Cessation of cigarette smoking before foot and ankle surgery is recommended by the authors.

Ankle arthrodesis following avascular necrosis of the talus in a patient with lupus.

Avascular necrosis of bone is a common manifestation of systemic lupus erythematosus, particularly in those patients receiving corticosteroids. The authors review the pathogenesis and diagnosis of avascular necrosis and describe an ankle arthrodesis in a patient with systemic lupus erythematosus who developed avascular necrosis of the talus.

Considerations of prescription medications for the pregnant podiatric patient.

Prescription medications are thought to cause less than 1% of all congenital abnormalities. However, prescribing a medication to treat the foot disorder of a pregnant patient can be a source of anxiety for the physician. The authors review some of the medications commonly prescribed in podiatric medical practice and evaluate their use and safety during pregnancy.

A retrospective comparison of endoscopic plantar fasciotomy to open plantar fasciotomy with heel spur resection for chronic plantar fasciitis/heel spur syndrome.

The authors review the etiologies and treatments of plantar fasciitis or heel spur syndrome. They offer results of a retrospective study. Comparison of the return to work time after surgery for this condition, examinations of the effects of patient age at the time of surgery, gender, duration of pain prior to surgery, and type of surgical procedure, either endoscopic plantar fasciotomy or open plantar fasciotomy with heel spur resection, is provided.