Arthroscopy of the ankle and subtalar joint.

Arthroscopy has become a useful diagnostic and therapeutic tool in foot and ankle surgery. There are a reasonable number of indications for its use in the ankle and a limited number for the subtalar joint. Procedures previously performed as open surgeries typically necessitate a lengthy recovery and were met with higher complication rates. Many of these procedures can now be performed through small incisions with the assistance of arthroscopy. This article reviews the pathologies amenable to arthroscopy as well as describes the indicated procedures and technical aspects of each.

Arthroscopic stabilization of the ankle.

Arthroscopic lateral ankle stabilization is a method for repair of the anterior talofibular ligament which involves decreased morbidity and minimal soft tissue disruption while restoring function and stability to the joint. This technique utilizes soft tissue anchoring systems that reinforce or repair the anterior talofibular ligament. Several techniques are described for the various types of ligamentous injuries. These methods are compared and contrasted with standard open reconstructive and reparative techniques. Advantages of the newer anchoring systems are discussed.

Peripheral skeletal tuberculosis of the foot. Etiologic review and case study.

Mycobacterium tuberculosis is a disease that is being reported much more frequently in the literature, primarily because of the rapid increase in severely immunocompromised patients, but also because of the development of multiple drug-resistant tuberculosis strains. Extrapulmonary M. tuberculosis is also reportedly on the rise, and may manifest itself at a number of sites in the body, including the peripheral skeleton. It is important to recognize peripheral tuberculosis osteomyelitis early because early treatment can effectively eliminate long-term morbidity. The authors present a review of the diagnosis and treatment of extrapulmonary M. tuberculosis, with special emphasis on peripheral skeletal tuberculous osteomyelitis. A case study involving peripheral skeletal tuberculous osteomyelitis in the foot is presented.

Arthroscopic lateral ankle stabilization.

The indications for arthroscopic stabilization include those patients with isolated ruptures or strains of the ATF. The procedure is particularly convenient for patients with ankle joint pathology that is already most commonly treated arthroscopically, such as chronic instability, in which inflamed synovium or meniscoid bodies are to be excised. Although significant stability can be gained with this technique, injuries that result in damage to the calcaneofibular ligament may require additional open surgery, since this ligament cannot be visualized arthroscopically. However, the anchoring techniques described in this article can still be used when performing open surgery.

A new radiographic classification for hallux limitus.

A new classification system for hallux limitus that is based on objective radiographic changes around the first metatarsophalangeal joint is introduced. The new system is demonstrated in a 3-year, 110-patient retrospective study. From the information gathered, a surgical algorithm has been developed. Statistical analysis demonstrates an 87% satisfaction rate with the recommended surgical algorithm.

Rigid internal fixation of the Austin/Chevron osteotomy with Herbert screw fixation: a retrospective study.

One of the adaptations of the Herbert bone screw (Zimmer Corp., Warsaw, Indiana) in podiatric surgery has been in the fixation of the Austin type osteotomy of the first metatarsal, to obtain rigid internal fixation. Technical difficulties in performing the procedure and complications have resulted in the development of several modifications of the original technique to better facilitate application of the Herbert screw. A brief review of the literature including history of distal metaphyseal osteotomies, and the uses of the Herbert screw is included. The purpose of this manuscript is to present utilization of the Herbert bone screw and modified jig in a modified Austin osteotomy, and to produce rigid internal fixation without the disadvantages of other internal fixation techniques.

Modifications of the Regnauld osteochondral autogenous graft for correction of hallux limitus/valgus: a 2-year review.

This study compares modifications of Regnauld's enclavement procedure, the in situ "hat-shaped" and in situ "inverted" osteochondral graft. A 2-year retrospective analysis consisted of patients' satisfaction, activity level, first metatarsophalangeal joint range of motion, and radiographic evaluations. The result of this study demonstrates that both the "hat" and "inverted" type grafts are highly successful and satisfactory procedures. However, the "inverted" technique is found to provide faster healing rates and a broader range of motion of the first metatarsophalangeal joint; it is more stable and technically easier to perform. Therefore, the "inverted" graft provides more consistent and predictable results for the treatment of hallux rigidus and hallux valgus.

Oblique metaphyseal osteotomy for the correction of Tailor's bunions: a 3-year review.

This study presents a 3-year review of patients undergoing a fifth metaphyseal osteotomy for the treatment of Tailor's bunions. Postoperative analysis consisted of patient's subjective appraisal, activity level, physical examination, and radiographic studies. The fifth metaphyseal osteotomy, in this study, reduced lateral deviation and fourth-fifth intermetatarsal angles to less than or equal to normal values, while decreasing intermetatarsal head distance and returning the fifth metatarsophalangeal joint to congruency. Patient satisfaction was high while providing a low incidence of transfer lesions. This manuscript demonstrates the fifth metaphyseal osteotomy to be a viable treatment for Tailor's bunions.

An unusual intermetatarsal coalition.

Synostoses commonly occur in the midfoot and rearfoot. However, metatarsal synostosis is a less common phenomenon. Several etiologies have been described. The authors present a case of a fourth-fifth intermetatarsal bar, which does not fit into one of the established categories, along with the surgical technique used in its correction.

Alternative autogenous bone graft donor sites in brachymetatarsia reconstruction: a review of the literature with clinical presentations.

The authors present a literature review on the surgical treatment of brachymetatarsia. They discuss the identification of donor sites for autogenous bone graft harvesting from the foot. Three case reports of brachymetatarsia, one of iatrogenic, and two of congenital origin are presented.

Pseudogout of the ankle: a case study and arthroscopic-assisted treatment.

Chondrocalcinosis, also known as pseudogout, a calcium pyrophosphate dihydrate crystal deposition disease, has been reported in many joints of the human body. A review of the literature reveals few reported cases of pseudogout of the ankle and various uncertainties of the etiology of pseudogout. The authors offer a review of the disease and a case presentation with the use of arthroscopy to assist in the diagnosis and treatment of pseudogout of the ankle.

Aneurysmal bone cyst of the cuboid.

Aneurysmal bone cysts are a rare entity encountered in podiatric medicine. The frequency of aneurysmal bone cysts distal to the ankle joint is low. The authors present a literature review of the etiologies and possible treatments of an aneurysmal bone cyst. An unusual case of an aneurysmal bone cyst in the cuboid is also presented. Only one other documented case of an aneurysmal bone cyst in the cuboid has been reported since 1967.

Preliminary report: modifications of the Regnauld osteochondral autogenous graft.

The enclavement procedure was originally described by Bernard Regnauld in 1968. The basal portion of the proximal phalanx of the hallux is used as an osteochondral autogenous graft in the treatment of hallux limitus, hallux rigidus, and hallux valgus. This paper presents a review of Regnauld's techniques, emphasizing an in situ modification of the inverted graft that allows for greater technical ease, increased stability, and improved graft viability, with more rapid incorporation.

Tendon and ligament prostheses.

The topic of artificial tendons and ligaments for the foot and ankle has been investigated. Close attention has been given to three implants, the Silastic-rod implant, the carbon-fiber implant, and Marlex mesh. A brief historical background was given to the development of the lateral ankle reconstructive procedures and to the development of the individual artificial prostheses. The biologic reactions produced by the implants have been presented. Carbon-fiber implants and Marlex mesh induce a fibrous growth that produces a neotendon or neoligament, depending on their use. Silastic-rod implantation establishes a hollow tube with qualities very similar to the normal tendon sheath. Carbon fiber and Marlex mesh are directly implanted and used as a temporary tendon or ligament. During this time, they act as a scaffold on which the new tendon or ligament is formed. Silastic-rod implants are incorporated into a two-stage tendon-graft procedure. The Silastic rod is used during stage one to develop a new tendon sheath. Placement of an autologous tendon within the newly formed sheath occurs in stage two. Details of the actual procedure have been presented. Any tendon used in the transfer should be of similar strength with similar expansive qualities. These implants have many potential uses in podiatry. They are particularly useful in trauma cases and patients that present with ankle instability. Research pertaining to the development of an ideal suture and anastomosis technique is still needed.