Foot injuries and arthroscopy in sport.

Arthroscopy of the foot and ankle is a valuable tool for treating athletic foot injuries. The ability to evaluate and treat injuries without an extensive open approach is very important when dealing with the athletic population, allowing a much quicker rehabilitation and return to sport. The diagnostic and therapeutic indications for foot and ankle arthroscopy have increased significantly over recent years. Techniques and instrumentation have become more advanced and more readily available to the orthopaedist. This article defines the conditions in which arthroscopy is appropriate and presents current techniques for treatment.

Arthroscopy of the foot and ankle.

Arthroscopic surgery of the foot and ankle represents a relatively new and exciting addition to the armamentarium of the orthopedic surgeon. Direct visualization of all intraarticular structures without extensive surgical approach, arthrotomy, or malleolar osteotomy is now possible. Laxity or incompetency of ligamentous structures can be demonstrated by intraoperative stress testing maneuvers.

Management of acquired adult dropfoot.

Dropfoot is a catchall term for ankle equinus, equinovarus, and equinovalgus. The deformity can be flexible or rigid and may be associated with other pathology. In the adult, dropfoot may be congenital or acquired. Acquired dropfoot results from weakness of the ankle dorsiflexors, overpull of the plantarflexors, contracture of the soft tissues, bony deformity, or any combination of these factors. Appropriate treatment includes observation, orthotic devices, bracing, tendon transfers, arthrodesis, and neurolysis. The purpose of this paper is to review the pathophysiology and treatment of acquired dropfoot.

Peri-operative jejunostomy-tube feeding in reconstructive spinal surgery.

Eight malnourished children with neuromuscular spinal deformity were treated with jejunostomy tubes for supplemental feeding to attain appropriate weight before reconstructive surgery. All patients had significant gastro-esophageal reflux and had failed to gain weight during an eight-month oral supplementation program. There were no complications associated with the placement or use of the jejunostomy feeding tubes and all patients gained weight in a safe and predictable fashion, had successful spinal fusion and have maintained satisfactory weight at follow-up. Jejunostomy feeding is a safe and effective method of correcting malnutrition in patients with spinal deformity which precludes gastrostomy and Nissen fundoplication.

Histologic evidence of retinacular nerve injury associated with patellofemoral malalignment.

Patellofemoral malalignment is frequently accompanied by pain that may respond to conservative treatment or lateral retinacular release. Frequently, there is little or no evidence of chondromalacia patellae in these patients. This study presents consistent evidence of nerve damage (demyelination and fibrosis) in the lateral retinaculum of patients with intractable patellofemoral pain requiring lateral retinacular release or realignment of the patellofemoral joint. The changes observed in the retinacular nerves resemble the histopathologic picture of Morton's interdigital neuroma. It is likely that the lateral retinaculum itself is painful in many patients with patellofemoral malalignment.