Reinventing The Delivery Of Quality Care

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Dr. Armstrong says the Sheffield Ring Fixator is “much more flexible” than the standard Ilizarov set and is easier to adjust postoperatively. As with all external fixation devices, he notes there is a learning curve to using the modality.
“MIIG is an excellent alternative approach to implant seating in light of poor proximal phalangeal support,” notes Harold Schoenhaus, DPM.
Here is a view of the Isoguard instrument in the third interspace during a nerve decompression procedure.
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Author(s): 
By Jeff Hall, Editor-in-Chief

There are some consistent themes that have emerged from this year’s roundup of leading innovations in podiatry. “Minimally invasive” seems to be the phrasing of choice as the technology seems to be more and more focused on reducing patient pain and downtime via more targeted surgical solutions. In addition to products geared toward common podiatric ailments such as flatfoot, plantar fasciitis and Achilles tendonitis, there are other modalities in the mix that may not be on the cusp of mainstream acceptance, but show intriguing promise for the future.
Without further delay, here is what the experts had to say …
1. Minimally Invasive Injectable Graft (Wright Medical). As Harold Schoenhaus, DPM, and colleagues wrote earlier this year (see page 22, May 2003 issue), Minimally Invasive Injectable Graft (MIIG) offers “surgical grade calcium sulfate that has been formulated to replace defects in metaphyseal bone and provide temporary structure for hardware fixation in fractures.”
Steven Boc, DPM, Chairman of the Department of Foot and Ankle Surgery and Director of Residency Training at St. Agnes Medical Center in Philadelphia, praises the osteoconductive biomaterial of the MIIG. In his experience, Dr. Boc has found that the MIIG provides a stable, osteoconductive scaffold that hardens within three minutes. He says the MIIG is an “excellent way to fill large osseous defects secondary to limb deformity as well as those formed from bone tumors.”

Dr. Boc recalls one particular case of a patient who came into the office with a 2 cm tibial metaphyseal defect from a previous arthrodesis failure. He says they removed the failed bone block, put in MIIG and achieved arthrodesis and stability for the patient within four weeks.
Dr. Schoenhaus, the Chief of Foot and Ankle Surgery at the Graduate Hospital in Philadelphia, has used the MIIG as an intraoperative option for patients who undergo implant arthroplasty of the first metatarsophalangeal (MPJ) joint, but lack the adequate bone stock to keep the implant in place.
As he and his colleagues noted in the article, they found that patients who underwent the procedure with MIIG had “adequate dorsiflexory motion of the great toe and (were) able to stand on their toes.” They also noted that post-op radiographs three months out revealed that there was no “bulldozing or loss of stability of the implant” and the implant position had remained unchanged.
“MIIG is an excellent alternative approach to implant seating in light of poor proximal phalangeal support,” wrote Dr. Schoenhaus, a Fellow of the American College of Foot And Ankle Surgeons.

Exploring Minimally Invasive Treatment Options
2. Isoguard System (Koby Surgical). This five-component system offers podiatrists minimally invasive surgical approaches to performing Morton’s neuroma decompressions and plantar fasciotomies.
When it comes to the intermetatarsal nerve decompression, the Isoguard system is indicated when the patient has failed conservative treatment for chronic neuroma pain or when the surgeon opts to decompress the nerve as opposed to excising it.

Bruce Werber, DPM, concurs, noting that he reserves the small incision procedure for patients who have relatively new neuromas of less than a year in duration and have failed sclerosing alcohol injections and orthotic control.
While Dr. Werber cautions that he has only performed eight procedures with this device to date and that eight months out is a better barometer to judge the effectiveness of the procedure for Morton’s neuroma, he says the preliminary results have been “very encouraging” so far.
Dr. Werber, the President of the American College of Foot and Ankle Surgeons, reports no recurrences and that all of the patients have done well postoperatively with minimal inconvenience to their lives. He notes that those who had sedentary jobs went back to work the next day. He says one nurse took some time off but was back at work in two weeks and was “extremely happy” with the results.

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