Volume 19 - Issue 6 - May 2006

Surgical Pearls »

Plantar Calcaneal Spurs: Is Surgery Necessary?

By Don Green, DPM and Peter S. Kim, DPM | 98676 reads | 0 comments

The etiology of heel pain is quite varied. First described by Wood in 1812, the most common cause is thought to be plantar fasciitis. This is typically marked by focal tenderness to any component of the aponeurosis but most frequently at the proximal medial insertion of the plantar aponeurosis.1
Many symptomatic patients with plantar fasciitis demonstrate plantar heel spurs (traction enthesopathies) of the os calcis. One may best appreciate this shelf of exostosis on the lateral and lateral oblique views of standard radiographic studies.2 On rare occasions, fracture of



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Assessing The Pros And Cons Of Subtalar Implants

By Donald Green, DPM, Mitzi Williams, DPM, and Chul Kim, PMS IV | 61225 reads | 1 comments

“Collapsing” pes planovalgus or flexible flatfoot is a complex pedal pathological condition with numerous components. In its most significant form, the condition can lead to significant disabling and an inability to ambulate efficiently. Arthroereisis is a relatively modern surgical technique one may employ for pes planovalgus correction.
Arthroereisis is defined as the limitation of exogenous joint motion without complete arthrodesis. This procedure, which involves placing a motion blocking implant within the sinus tarsi, has been designed to restrict excessive subtalar joint (STJ) pron



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Plantar Fasciitis: How To Maximize Outcomes With Conservative Therapy

By Brian Fullem, DPM | 37936 reads | 0 comments

Plantar fasciitis is often inaccurately referred to as “heel spur syndrome.” Clinicians should no longer use this terminology. Most of the time, the presence or absence of a plantar calcaneal spur has no effect on symptoms or treatment. The term fasciitis may also be a misnomer. Lemont studied the pathology of 50 patients who underwent fascial release surgery.1 The findings did not show any evidence of inflammatory cells within the fascia. The common finding was degeneration of the tissue. The inflammation appears to be in the underlying intrinsic musculature so perhaps the corr



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Secrets To Managing Complications Of First MPJ Fusion

By William Fishco, DPM | 62898 reads | 1 comments

Arthrodesis of the great toe joint has been described for the repair of just about every problem affecting the great toe joint, including hallux valgus, hallux varus, hallux limitus/rigidus, osteoarthritis, rheumatoid arthritis and salvage of failed surgeries of the first ray.
Many foot surgeons view the great toe joint fusion as a salvage procedure and will not consider it for primary repair of hallux valgus or hallux rigidus. One of the reasons for doing any type of fusion surgery is to stabilize an unstable or hypermobile joint.

With that said, the great toe joint fusion can be benefi



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A Closer Look At The Percutaneous Calcaneal Displacement Osteotomy

By Lawrence DiDomenico, DPM | 22600 reads | 0 comments

Podiatric surgeons commonly perform an extraarticular calcaneal osteotomy on hindfoot deformities of the foot and ankle.1 One would typically perform this powerful osteotomy in conjunction with other procedures. Complications with the percutaneous calcaneal displacement osteotomy are rare.2-4
This is in contrast to the customary lateral approach of a calcaneal osteotomy as the surgeon may see complications that include wound dehiscence, sural nerve damage, sural neuritis, delayed union, non-union, infection and invasion of the medial neurovascular structures.2-6



Continuing Education »

Soft Tissue Masses: When To Treat, When To Refer

By Bradley W. Bakotic, DPM, DO | 18724 reads | 0 comments

The recognition and characterization of soft tissue tumors is central to the practice of podiatric medicine. In many instances, clinicians of the lower extremity serve as the frontline physicians when it comes to the identification of such tumors. Given the inverse relationship between the amount of time prior to diagnosis and patient survival rates, the role of podiatrists may be of paramount importance.
Depending upon one’s depth of experience and comfort level, some clinicians might limit their role to clinical recognition and ordering preliminary imaging studies. Others may go a step



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