Volume 21 - Issue 8 - August 2008
Hallux rigidus of the first metatarsophalangeal joint (MPJ) is the most common form of osteoarthritis of the foot.1 Hallux rigidus is defined as a progressive arthritic process of the first MPJ that causes pain, stiffness and enlargement of the joint.1
There are numerous surgical procedures to help address the pain and stiffness of this joint. These procedures include cheilectomy, osteotomies, resection arthroplasty, interpositional arthroplasty, hemiarthroplasty, total joint arthroplasty and arthrodesis.
There are 15 million people in the United States with diabetes mellitus, half of whom are undiagnosed. Diabetic foot ulcers (DFUs) occur in 12 percent of these individuals, accounting for 60 percent of lower extremity amputations and costing more than $1 billion annually.1
Diabetic foot ulcers have various mechanisms including:
• microneurovascular dysfunction with loss of the nociceptive reflex and an exacerbated inflammatory response;
• vasomotor dysfunction with arteriovenous shunting;
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Given the significant dilemma of peripheral arterial disease and its strong association with diabetic complications in the lower extremity, this author reviews pertinent diagnostic keys and assesses the current research on treatment options.
The Charcot syndrome is a devastating condition that can affect the feet or ankles of those with diabetes and peripheral neuropathy. The reports on the incidence and prevalence of Charcot foot vary widely, and range between 0.1 to 29 percent among people with diabetes. These studies indicate a trend for a higher frequency in those with peripheral neuropathy and in specialty clinics.1 The specialty clinic providers may have a higher clinical suspicion and may accordingly arrive at a diagnosis more rapidly and definitively.
The risk of amput
While the majority of my podiatry practice occurs in my clinic between 8 a.m. and 5 p.m., there are activities I call extras. These are professional services that occur after hours, on weekends or sometimes in conflict with the office hours.
The past week was full of extras. My cell phone/pager started humming and playing a Bach fugue Tuesday morning. It was a nurse from the OB department announcing that a baby boy, born 30 minutes earlier, had bilateral club feet. I like to start care within the first hour so I grabbed some casting material and heade
I quickly scanned the article, “What You Should Know About Planal Dominance And Pronated Feet” (see page 52 in the June issue). I find it hard to believe there is no mention of forefoot supinatus as the key radiographic finding for the frontal plane component of flexible flatfoot. There is a mention of a positive Helbing’s sign. In my opinion, basing your treatment on the presence of a positive Helbing’s sign is irresponsible.
— Matthew DeMore III,
Chairman, Department of Surgery
Ohio College of Podiatric Medicine
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