Volume 20 - Issue 11 - November 2007
Diabetes Watch »
While various researchers have implicated the equinus deformity as a major deforming force in a host of foot and ankle pathologies, the exact definition of equinus remains unclear.1-4 However, Root states that “the minimal range of ankle joint dorsiflexion that is necessary for normal locomotion is 10 degrees.”5 Subsequent studies report that the ankle joint range of motion for asymptomatic patients ranges from 0 to 13.1 degrees with the knee extended and from 5 to 22.3 degrees with the knee flexed.6-9
The implication from these studies and
Wound Care Q&A »
Important questions arise when traumatic wounds occur in the lower extremity. Accordingly, our expert panelists address key considerations in the initial evaluation and when one should consider an amputation. They also explore the use of soft tissue coverage, skin substitutes and topical dressings with traumatic wounds.
Q: What protocol/triage steps do you utilize in the initial evaluation of a traumatic wound?
A: For a patient with extreme pain and a traumatic wound that requires immediate surgical debridement, Molly Judge, DPM, says pain management and a
Surgical Pearls »
The fully keratinized, thick multilayered structure of the nail plate presents a formidable barrier to nail bed access. This limits the options for treatment of nail diseases such as onychomycosis and subungual hematoma from nail trauma. Until recently, clinicians considered nail removal as an option for formal repair of the nail bed for subungual hematomas involving large regions of the nail bed.1
Penetration enhancing formulations have aided the delivery of molecules to the nail bed through the impermeable nail plate.2 Researchers have used a carbon diox
Treatment Dilemmas »
In the United States, at least 10 percent of the population experiences heel pain secondary to plantar fasciitis. Reportedly, 600,000 outpatient visits to medical professionals a year are due to plantar fasciitis.1 According to a 2003 study, plantar fasciitis frequently occurs in people who are on their feet most of the day, those who are obese and those who have limited ankle dorsiflexion.2
However, it is important to recognize that all heel pain symptoms do not stem from plantar fasciitis. There are many different etiologies for heel pain and making the
Cryosurgery is an effective pain relief modality that uses freezing temperatures for ablation of the nerves that provide sensation to the heel. While this treatment is relatively new for foot pain, physicians have utilized cryosurgery for pain relief for decades. This modality has proven to be a viable treatment and is an excellent choice for appropriate patients prior to considering more invasive procedures.
Heel pain has become an epidemic in our society. Diabetes, arthritis, weight gain, injuries, previous heel surgery and other medical conditions are known contributing factors.
As with any peripheral nerve surgery, tarsal tunnel surgery is demanding and can sometimes be excessively difficult. Additionally, one may not have a full appreciation of the outcome until some point in the postoperative period — if at all — when the nerve has had adequate time for recovery and/or regeneration.
Sadly, there are many misnomers in podiatric medicine and surgery. For example, the nomenclature of “tarsal tunnel syndrome” implies that the site of chronic nerve entrapment is at the level of the tarsal tunnel,