Use of the ROC anchor in foot and ankle surgery. A retrospective study.

A retrospective study was conducted on the use of the ROC (Radial Osteo Compression) soft-tissue anchor in foot and ankle surgery. This article describes how the anchor is deployed, problematic aspects of using the anchor, and complications and success rates associated with the anchor in ankle stabilizations, posterior tibial tendon reconstruction, peroneus brevis tendon reconstruction after fracture of the base of the fifth metatarsal, and detachment and reattachment of the Achilles tendon. The ROC anchor consists of the anchor with nonabsorbable suture attached to the shaft, the deployment handle, and drill bits. The anchor and shaft are snapped into the deployment handle and inserted into the drill hole. Compression of the trigger deploys the anchor into the hole. The ROC anchor was found to be reliable, useful, and relatively easy to deploy, with outcomes similar to those of other soft-tissue anchors.

An update on repair of Achilles tendon rupture. Acute and delayed.

Current surgical treatments for Achilles tendon rupture are thoroughly discussed. New repair techniques, such as the use of soft-tissue anchors, are reviewed, as is the use of synthetic mesh to augment the surgical repair. A classification system devised by the author is presented to make it easier to select the appropriate surgical procedure or combination of procedures in delayed rupture repair. Postoperative physical therapy is paramount in the return to preinjury level of activity for these patients.

Retrospective study of the use of a plantar transverse incision versus a dorsal incision for excision of neuroma.

The authors present a retrospective study comparing the results and complications of dorsal incision versus plantar transverse incision for excision of neuroma. The authors found several advantages using the plantar transverse incision. These included improved exposure and access to the neuroma, and no incidence of amputation neuromas postoperatively.

Diagnosis and treatment of Achilles tendon rupture.

Achilles tendon ruptures are challenging injuries. The author's intraoperative classification and concomitant reconstructive procedures serve as guidelines for surgeons. The goals of surgical repair are outlined.

Current concepts in the diagnosis and treatment of ankle sprains.

Simple ankle sprains are common injuries. Failure to evaluate, diagnose, and adequately treat severe ankle sprains results in continued pain, instability, and decreased function. This article reviews the examination, stabilization procedures, physical therapy techniques, and complications of these injuries.

Transchondral fractures of the talar dome.

The authors thoroughly review transchondral fractures of the talar dome. The causes, presentation, diagnosis, and treatments are discussed in detail. In addition, a study of 85 patients with chronic ankle pain is presented.

A severe acute Achilles rupture and repair.

An unusual type IV rupture is described, whereby the Achilles tendon was ruptured in two places. This required several innovative techniques to repair this injury, which are described herein. The patient recovered uneventfully and returned to his exercise activities in 3 months.

Plantar incisional approaches. Current perspectives.

Plantar incisions on the feet have been a controversial subject for many years because of the potential untoward effects of scarring. The author presents a variety of techniques and the rationale for the use of plantar foot incisions, along with discussion on the prevention of complications.

Long-term retrospective analysis of the treatment of sinus tarsi syndrome.

The author presents a 15-year follow-up on conservative and surgical treatment of chronic sinus tarsi syndrome. Most of the patients eventually required surgical intervention after conservative treatment failed to alleviate their symptoms. Surgical correction proved to be effective in relieving sinus tarsi pain long-term.

Critical analysis of tendo Achillis repair using Achilles tendon rupture classification system and repair.

The author presents a long-term follow-up on Achilles tendon rupture and repair. The study includes comparison of Achilles tendon rupture and repair performed by the author and other surgeons. There was an alarmingly high incidence of complications with the Achilles repair and partial ruptures not reported in the literature. Discussion regarding ways to reduce complications using the author's classification system, and repair, was effective based on this study.

Chronic ankle instability and pain: a case report of a teenager with open epiphysis.

The author discusses the treatment of chronic ankle instability in a young child of 14 years of age. A procedure is described that avoids drilling of the fibula and disruption of the epiphyseal plate. An autogenous graft procedure is described.

Retrospective analysis of calcaneal spur removal and complete fascial release for the treatment of chronic heel pain.

Doctors Gormley and Kuwada investigate the pathology of chronic heel pain secondary to soft tissue and osseous inflammatory conditions. Pertinent literature review regarding success following fascial release as well as bone spur removal is provided. Ninety-four patients are reported having sustained spur removal with fascia resection according to the authors' technique. They report a 95% success rate postoperatively.

Long-term evaluation of partial and total surgical and phenol matrixectomies.

Surgical matrixectomies and phenol alcohol matrixectomies have been effective in eliminating certain nail conditions. The complication rate is at an acceptable level; however, there is a need for comparison to other techniques, such as negative galvanism, trephine, osteotripsy, and laser ablation. Of the 353 patients in this study, two were known diabetics who were seen preoperatively by a vascular surgeon for vascular studies and by their internist. Both consultants agreed that the patients would heal. Both patients healed without complications. The author described the use of a modified Frost partial matrixectomy and modified Fowler total matrixectomy in this review. The phenol alcohol technique had a total complication rate of 9.6%, as did the partial matrixectomy. The total matrixectomy had an overall complication rate of 10.9%.

Classification of tendo Achillis rupture with consideration of surgical repair techniques.

The author presents a classification system for complete tendo Achillis rupture. The system is based upon experience following 28 repairs and 102 lengthenings and gastrocnemius recessions. Specific surgical procedures based on this system are reviewed.

Five year retrospective analysis of the autogenous tendon graft procedure for primary ankle repair and ankle stabilization.

A 5-year review regarding the autogenous tendon graft procedure using the peroneal tendons to repair acute ruptures of the anterior talofibular and calcaneofibular ligaments, and to correct chronic, unstable ankles is presented. The autogenous tendon graft has been used to limit excessive subtalar inversion in feet with mild-to-moderate calcaneal varus causing an unstable foot and ankle. This is achieved by placing the tendon graft perpendicular or distal to the vertical axis of the lateral malleolus at the calcaneofibular ligament site.

Complications following traumatic incidents with STA-peg procedures.

The authors describe use of a Silastic plug to limit subtalar joint motion in symptomatic pediatric flatfeet. Three patients sustained postoperative injury resulting in pedal complications. Successful resolution of these cases is discussed.

A retrospective analysis of modification of the flexor tendon transfer for correction of hammer toe.

A modified flexor tendon transfer for flexible and semiflexible toes has been described in this retrospective analysis. The study revealed three laterally deviated and one slightly dorsiflexed digit postoperatively. However, there were no recurrences of lesions or digital contractures. Varying degrees of joint stiffness was prevalent in each of the patients. The procedure was initially developed for contracted toes associated with pronated and rectus foot types. The author has found the procedure effective in cavus foot structures when other procedures failed to reduce the hammer toe deformities. The patient population studied found this procedure to be very gratifying.

Contact dermatitis. A review.

Contact dermatitis of the lower extremity is reviewed in regard to symptoms, clinical manifestations, etiologic agents, and treatment. Examples of some of the clinical manifestations are presented pictorially.

Ankle stabilization and primary repair with a peroneus brevis tendon graft.

Nineteen of the author's 20 patients recovered fully from a ruptured anterior talofibular ligament when it was repaired or replaced by a tendon graft from one-half of the peroneus brevis tendon. The patients wore a below-the-knee weight-bearing cast for 3 to 4 weeks after the surgery and none of the patients had residual instability.