Fracture-dislocation of the first metatarsophalangeal joint: open reduction through a medial incisional approach.

A case of traumatic fracture-dislocation of the first metatarsophalangeal joint is reported. This type of injury is extremely rare. The injury was associated with complete disruption of the following anatomic structures: conjoined tendon of abductor hallucis and medial head of flexor hallucis brevis, plantar plate, and the intersesamoid ligament. Additionally, there was a transverse fracture of the tibial sesamoid. Excision of the fractured tibial sesamoid trapped within the joint and primary repair was achieved through a medial incisional approach. A complete description of the repair and rationale for the surgical procedure is discussed.

Arthrodesis of the interphalangeal joint of the hallux: a simple and effective technique.

The authors present a simple and effective technique to achieve arthrodesis of the hallucal interphalangeal joint. Stabilization is achieved by external fixation with crossing Kirschner wires joined together to create a single functional unit, a technique that avoids common problems often associated with Kirschner-wire fixation. The authors propose that this simple technique be considered for patients in whom it has been determined that screw fixation should not be used to obtain fusion of the interphalangeal joint.

The effect of hallux abducto valgus surgery on the sesamoid apparatus position.

A new parameter, the tibial sesamoid-second metatarsal distance, was established to determine whether the sesamoids move in relation to the foot in hallux abducto valgus surgery. The reliability of the tibial sesamoid-second metatarsal distance was assessed and shown to be excellent. Seventy-five feet underwent surgical correction of hallux abducto valgus. Four radiographic parameters--the intermetatarsal angle, the hallux abductus angle, the tibial sesamoid position, and the tibial sesamoid-second metatarsal distance--were measured before and after surgery. The hallux abductus angle, intermetatarsal angle, and tibial sesamoid position were all significantly reduced following surgery. The tibial sesamoid-second metatarsal distance was not affected by hallux abducto valgus correction. Thus the correction in sesamoid position gained with hallux abducto valgus correction is a direct result of lateral translocation of the metatarsal head, with no contribution from change in position of the sesamoid apparatus relative to the foot.

Aneurysmal bone cyst of the fibula.

Aneurysmal bone cysts are benign, expansile lesions that are not at all uncommon in the lower extremity. These lesions are difficult to recognize clinically. This paper is a thorough review of the current literature regarding aneurysmal bone cysts. After this review, one should be able to diagnose and appropriately treat aneurysmal bone cysts. Also provided is a case report with classic histologic, clinical, and radiographic findings that was treated by en bloc resection.

Podiatry Institute ankle fusion technique.

The authors review the ankle and pantalar fusion literature. The authors performed a retrospective review on 42 ankle and pantalar fusions, emphasizing the role of internal fixation. The Podiatry Institute technique for internal fixation of ankle fusions is described and experience with the technique is reviewed. Complications included delayed union and nonunion at the fusion site or the repaired fibular osteotomy site and tibial fractures at screw stress riser sites. Modifications to reduce these complications are discussed. Experience with internal fixation in ankle and pantalar fusions, both in this study and in current literature, has been positive.

Iatrogenic deformities of the first ray.

Surgical correction of a hallux valgus deformity is common among podiatric and orthopedic surgeons. Complications following hallux valgus surgery are not uncommon. Although many of these complications can be avoided by a comprehensive understanding of the pathomechanics of a hallux valgus deformity and continual honing o surgical skills, some are inevitable. This article provides a comprehensive overview and insight into the diagnosis and treatment of the more common complications encountered with hallux valgus surgery.

Hallux interphalangeal joint sesamoidectomy.

Painful lesions on the plantar aspect of the interphalangeal joint of the great toe respond well to surgical excision of the accessory bone found lying superior to or within the flexor hallucis longus tendon. Several incisional approaches are available, each with potential advantages and disadvantages. Failure to consider each incisional approach and address concomitant deformities may result in a less than desirable postoperative result.

Chondroblastoma of the talus.

Chondroblastomas are rare cartilaginous tumors that are found in the foot or ankle. They are usually located in portions of the humerus, tibia, or femur, and comprise approximately 1 to 3% of all osseous tumors. This is a unique case report of a chondroblastoma involving the talus of a young individual.

An unusual case of diabetic cellulitis due to Pasturella multocida.

Pasturella multocida is a well known potential cause of infection following bites or scratches by animals. The organism causes the usual clinical manifestations of a rapidly developing cellulitis at the site of injury. The resultant infection is dangerous and can progress on to a deep infection, osteomyelitis, and septicemia. In compromised patients, the source and etiology of the infection may be obscure making definitive diagnosis difficult. This paper reviews a very unusual case of a foot infection in a diabetic patient that was due to a domestic pet licking an excoriation on the foot.

Cefadroxil in skin and skin-structure foot infections: a retrospective review.

The efficacy and safety of cefadroxil in eradicating localized skin and skin-structure infections of the foot were investigated in a retrospective chart review of 222 consecutive patients from two private practices seen over a 10-year period. Of the 189 patients for whom follow-up data were available, 187 (99%) received cefadroxil 500 mg twice daily, and 2 patients (1%) received 250 mg twice daily. The duration of therapy was 2 weeks or less in 87% of patients, with a median duration of therapy of 11.4 days (range, 5 to 35 days). Of the 189 clinically evaluable patients, 179 (95%) achieved a favorable clinical response to treatment; of the 57 patients with microbiologic cultures, 54 (95%) experienced a satisfactory bacteriologic response to therapy; no adverse events related to cefadroxil therapy were identified during the review. The overall results from this retrospective study suggest that cefadroxil is an effective agent with a favorable safety profile for the treatment of skin and skin-structure infections of the foot.

Arthrodesis of the first metatarsophalangeal joint. Current recommendations.

Fusion of the first metatarsophalangeal joint is a time-honored, effective procedure for multiple conditions. Numerous fixation techniques have been described over the years. The authors provide an extensive overview of specific fixation techniques used throughout the past 6 years. Emphasis is placed on the potential advantages and disadvantages of the individual fixation techniques.

Residual calcaneovalgus deformity: review of the literature and case study.

The treatment of pediatric deformities is relatively common in the typical foot and ankle practice. Talipes calcaneovalgus deformity represents one of the more prevalent deformities. This postural deformity, which is present at birth, is characterized by marked dorsiflexion and valgus position of the foot in relation to the leg. It is essential that an accurate diagnosis is established early and conservative treatment instituted. In most cases, the deformity is highly responsive to conservative therapy consisting of manipulation and casting. Deformity not identified at birth or soon thereafter, or residual deformity treated later in life, presents a greater challenge to the physician. This paper is intended to provide an overview of the deformity of calcaneovalgus including a discussion of etiology, incidence, clinical and radiographic manifestations, differential diagnosis, and recommended treatment. The authors present an unusual case of residual talipes calcaneovalgus left untreated since birth and the approach to management.

The split peroneus longus lateral ankle stabilization procedure.

The authors present an interesting approach to lateral ankle stabilization using the peroneus longus tendon. The more commonly utilized procedures for instability of the ankle complex, rationale for use of the peroneus longus tendon, and the details of the split peroneus longus lateral ankle stabilization procedure are presented. When evaluating patients with lateral ankle joint instability, the subtalar joint (STJ) complex needs to be assessed. In addition, the role of STJ instability and its relationship to lateral ankle joint instability are discussed.

Soft tissue anchor systems.

The concept of soft tissue attachment and reattachment has been addressed over the years through a variety of surgical techniques. This includes tendons and ligaments that have been detached both surgically and traumatically from their osseous origins or insertions. This study is designed to provide the reader with a comprehensive overview of current commercially available devices. Detailed descriptions of the various devices are provided along with a discussion of the advantages and disadvantages of each. Their application and use in reconstructive foot and ankle surgery are also discussed.

Benign rheumatoid nodule versus subcutaneous granuloma annulare: a diagnostic dilemma--are they the same entity?

The authors differentiate benign rheumatoid nodules from similar subcutaneous lesions based on location and pathologic characteristics. Although many of these lesions spontaneously resolve, recurrence rates may be high. Various therapeutic modalities are therefore suggested. An illustrative case study is presented.

Recurrent plantar fibromatosis.

Plantar fibromas are a disease entity that are encountered by all foot surgeons. When a tentative diagnosis is made, aggressive surgical resection of the mass and the plantar fascia is necessary to prevent recurrence. Presented in this paper is a review of the literature and clinical illustrations of recurrent plantar fibromatosis with long-term follow-up.

Surgical management of metatarsus adductus deformity.

This article is intended to provide the podiatric physician with a comprehensive overview of the surgical management of metatarsus adductus deformity. Both soft tissue and osseous procedures are reviewed including a practical discussion of the preferred incisional approaches, surgical techniques, and postoperative care. Current indication and concepts for each procedure are discussed. A comprehensive history and physical exam, with emphasis on the clinical evaluation and radiographic findings, are critical aspects in the management of the patient with metatarsus adductus. Selection of procedures will be based upon this information as well as chronological age and osseous maturity. When significant deformities in the rearfoot complex are present (that is, pes valgo planus, equinus), consideration should be given to surgical correction simultaneously with correction of the forefoot deformity or at a later stage.