Volume 18 - Issue 11 - November 2005
Continuing Education »
Calcaneal fractures continue to be one of the most complicated injuries of the lower extremity. Satisfactory outcomes are difficult to achieve and require extensive experience and understanding in treating the injury. Calcaneal fractures are much like pilon fractures of the distal tibia in that they are severe soft tissue injuries complicated by fracture of the heel bone. The importance of the soft tissue envelope cannot be overstated.
There continues to be a wide range of treatment strategies despite the significant ongoing research on this injury. Cast
Editor's Perspective »
There is no doubt that podiatrists see quite a bit of heel pain. Plantar fasciitis accounts for 11 to 15 percent of all foot symptoms in adults, according to an article published in the New England Journal of Medicine last year. As Stephen Barrett, DPM, points out in his cover story, “A Guide To Neurogenic Etiologies” (see page 36), projected estimates indicate that greater than two million patients per year are diagnosed with heel pain in the United States.
However, despite the prevalence of this condition, there are complex anatomical consid
Wound Care Q&A »
In a follow-up column to the previous discussion of lower extremity traumatic wounds (see “Essential Insights On Managing Traumatic Wounds,” page 32, September issue), the panelists discuss key principles in treating open fracture wounds in the forefoot and toes. They also share their thoughts on the use of plastic surgery techniques and advanced wound closure modalities. Without further delay, here is what the panelists had to say.
Q: How do you manage simple open fracture wounds in the forefoot/toes?
A: A. Douglas Spital
While heel pain is the most common condition podiatrists see in practice, heel pain can often be complex and occasionally difficult to treat.1 In recent years, we have seen the introduction of new treatments as logical conservative preludes to fasciotomy, including extracorporeal shockwave therapy, injection of the plantar fascia with autologous growth factors and coblation therapy.2
Clinicians are able to employ some of these modalities, such as autologous growth factors, due to a better understanding of the true histological and ph
Heel pain is the most common musculoskeletal complaint of patients presenting to the podiatric physician. While heel pain is estimated to comprise 10 percent of athletic injuries, the incidence of heel pain in the active and sedentary population appears to be significantly underreported in the medical literature. Most experienced practitioners report that heel pain complaints have risen to epidemic proportion over the past 20 years for reasons we still do not fully understand.
Certainly, changing demographics figures into the equation. The average patient
Given the common incidence of heel pain, patients may present to the office with symptoms that have been present anywhere between two or three weeks to perhaps two or three years. Often, these patients have already consulted with another clinician who had an incorrect approach to treatment. When the pain does not resolve, the patient may feel that he or she has to undergo an unnecessary surgical procedure.
This is unfortunate as the problem may be due to improper care. If the treating clinician does not implement the proper treatment plan, including foll
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