Surgical Pearls

Noman A. Siddiqui, DPM, Corine L. Creech, DPM, and Bradley M. Lamm, DPM, FACFAS
5,999 reads | 0 comments | 04/21/2014
Radiographic analysis for surgical intervention involving the foot and ankle has historically been recognized as a vital component of pre-operative planning.1 This is especially true when dealing with complex foot and ankle deformities.2 The advent of digital radiology has made the process of radiographic evaluation one of greater convenience and reproducibility.3 The creation of programs available for computers, smartphones and tablets has made it possible for busy surgeons to have these images at their fingertips. | Continue reading
John F. Grady, DPM, FASPS, FACFAOM, and Katy Trotter, DPM
14,515 reads | 0 comments | 02/24/2014
Although hallux valgus and hallux limitus comprise the majority of first ray pathology, sesamoid disorders are not uncommon and may even carry greater morbidity that demands attention. A generic diagnosis of sesamoiditis may encompass several etiologies including fracture, symptomatic nonunion, avascular necrosis, osteoarthritis, dislocation, infection and symptomatic bipartite sesamoids.1 | Continue reading
Kyle S. Peterson, DPM, AACFAS, and Christopher F. Hyer, DPM, MS, FACFAS
17,904 reads | 0 comments | 12/16/2013

Lesser metatarsophalangeal joint (MPJ) pathology is one of the most common conditions affecting the forefoot. Most commonly located at the second MPJ, progressive subluxation and dislocation of the phalangeal base on the metatarsal head primarily results from the disruption of the plantar plate, which often begins as predislocation syndrome.1 Painful dislocation of the toe in the dorsal plane, and less commonly in the medial or lateral planes, causes pain with ambulation and shoegear. Anatomic studies have demonstrated the importance of the plantar plate in stabilization of the MPJ in the sagittal plane.2,3

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Nicholas J. Bevilacqua, DPM, FACFAS
43,550 reads | 0 comments | 10/22/2013
Achilles tendon rupture occurs frequently and if it is neglected, there may be significant long-term disability. Early diagnosis of an acute rupture and prompt initiation of treatment will generally lead to optimal results. Acute Achilles tendon ruptures may be misdiagnosed up to 25 percent of the time.1 In other cases, patients may not seek immediate medical care if they are able to ambulate and the pain is tolerable. It may be weeks or months before the patient receives a referral or decides to pursue treatment. Ultimately, continued functional impairment and alterations in gait cause the patient to seek medical attention. | Continue reading
Michelle Butterworth, DPM, FACFAS
20,773 reads | 0 comments | 08/20/2013
The Evans calcaneal osteotomy, first described in 1975, is a lateral column lengthening procedure that preserves the calcaneocuboid joint.1 This laterally based opening wedge osteotomy is historically known to provide transverse plane correction for pes planovalgus deformities. | Continue reading
Michael Tritto, DPM
9,254 reads | 0 comments | 06/25/2013
The correction of a significantly subluxed or dislocated hammertoe in an elderly patient can be a challenge to any surgeon. Over the last 22 years, I have tried numerous ways to correct the problem, all with varying degrees of success. The use of the Weil osteotomy along with other procedures, including proximal interphalangeal joint fusion, flexor transfer and now plantar plate repair from a dorsal approach, has not given me consistent results with patients who are over 65 years of age. | Continue reading
Keith D. Cook, DPM, FACFAS, and Irene Labib, DPM, MS
34,070 reads | 0 comments | 04/19/2013
Both pediatric and adult-acquired flatfoot deformities, particularly posterior tibial tendon dysfunction (PTTD) stage II, remain difficult to treat and there is much controversy in regard to the optimal form of treatment. Patients usually present with increased pain and swelling along the medial aspect of the ankle or rearfoot. The foot generally maintains an abducted forefoot position and a decrease in the height of the medial longitudinal arch. Sometimes patients can perform a double heel raise but cannot perform a single heel raise. This signifies posterior tibial tendon pathology. | Continue reading
Jason R. Miller, DPM, FACFAS, and Stanley Chen, DPM, AACFAS
12,216 reads | 0 comments | 02/26/2013
Tendon and ligament pathologies are extremely common in the adult population. Eleven percent of runners experience Achilles tendinopathy with seven out of 100,000 people sustaining a rupture. There are 1 million ankle injuries per year, 85 percent of which are ankle sprains. The total cost of tendon and ligament treatment is approximately $30 billion per year in the United States alone.1 The medical community has actively sought the augmentation of these repairs and the response by orthobiologic companies has been great. | Continue reading
By Bradly Bussewitz, DPM
12,023 reads | 0 comments | 12/19/2012
The European approach to the bunion commonly involves the scarf bunionectomy, much more so than here in the United States. Of the many bunion approaches, why should we bother adding another to the list? Those who utilize the scarf approach understand the stability, power of correction and utilitarian nature of this bunionectomy choice. I use the scarf as one of my go-to procedures for correcting mild to severe hallux abducto valgus. | Continue reading
Jodi Schoenhaus Gold, DPM, FACFAS
17,193 reads | 0 comments | 10/26/2012
Fat pad augmentation or the use of grafting in the ball of the foot and the heel has gained popularity over the past decade. The goal is simply to add cushioning or padding to areas that demonstrate a loss or displacement of natural fat due to an increased peak pressure. | Continue reading