Surgical Pearls

Adam R. Johnson, DPM
22,530 reads | 0 comments | 04/23/2009
   While total joint replacement has been successful in the shoulder, the hip and the knee, we have not seen similar success with total ankle replacement in the past.    Initial reports on total ankle replacements were promising in 1979.1 However, long-term follow-up studies painted a different picture as many failures and poor survivorship of the implants led many authors to abandon the procedure in favor of arthrodesis as it had more predictable results and fewer complications.2-4    Yet there has been a recent resurg | Continue reading
Gary Peter Jolly, DPM, FACFAS
24,113 reads | 0 comments | 02/26/2009
   Compression neuropathies of the posterior tibial nerve and its branches are a fairly common group of disorders, which are often misdiagnosed.1,2 In order to diagnose lesions of these nerves accurately, one must maintain a fairly high index of suspicion of their presentation. Relying on abnormal findings via electromyography and nerve conduction velocity testing is risky because the incidence of false negatives is quite high.2,3    In contrast, pressure specific sensory testing may produce false positive results. Although the classical | Continue reading
By Sean Grambart, DPM
15,807 reads | 0 comments | 12/30/2008
   Joint sparing procedures include total ankle arthroplasty, distraction arthrodiastasis and allograft total ankle replacement. However, the gold standard is still ankle arthrodesis.    Traditional exposure for ankle arthrodesis has been through the open transfibular approach. This approach usually involves a fibular takedown osteotomy but researchers have described a medial malleolar approach.1 Unfortunately, this technique has the disadvantages of a larger skin incision that can lead to wound dehiscence and increased risk of postoperative infecti | Continue reading
Jerome Slavitt, DPM
23,981 reads | 0 comments | 10/29/2008
   While warts are among the most common pathological problems that podiatrists treat, they are also among the most frustrating conditions. While there are multiple forms of therapy available, the success rate is not what we would like to see. In my clinical experience, I have found that these modalities only have an average cure rate of 75 percent.    There is no individual approach that can be construed as the single most effective form of wart therapy. It is also a good idea to inform the patient about the possibility of recurrence both during and after th | Continue reading
Using a blunt needle, the surgeon may place the calcium phosphate bone cement directly into the surgical void as shown above. In this procedure, surgeons are utilizing OsteoVation calcium phosphate bone cement with a total non-constrained great joint impl
Kerry Zang, DPM
22,908 reads | 0 comments | 09/03/2008


Over the years, hallux valgus repair has evolved from simple bunionectomies to complex and multiple osteotomies. The keys to a successful outcome are the realignment of the structural abnormalities and a stable postoperative environment.The former is important for proper function and the latter facilitates the healing process.
With this in mind, let us take a closer look at the potential benefits of utilizing calcium phosphate bone cement (OsteoVation™, OsteoMed Corp.) for filling voids in metatarsal osteotomy-type bunionectomies to achieve a favorable surgica | Continue reading

By Luke D. Cicchinelli, DPM, FACFAS
19,473 reads | 1 comments | 09/03/2008
Learning and performing effective surgery is akin to studying and speaking a foreign language. Not every one does so with the same fluency. The patient often does not speak a single word. Anatomy is the vocabulary, surgical procedure selection is the syntax and some aspects like verb conjugation and internal fixation sequences simply have to be committed to memory. | Continue reading
Benjamin Sefcik, DPM, and Peter M. Wilusz, DPM
10,802 reads | 0 comments | 05/03/2008


We are an aging population. One can ascertain that with aging comes an increased incidence of comorbid conditions. With the vast majority of podiatric surgical cases being elective, documentation supporting the vascular system prior to surgery will protect the surgeon from postoperative complications associated with circulatory issues, or may help surgeons recognize an asymptomatic issue for appropriate intervention prior to surgery. Recognition of asymptomatic circulatory issues is of particular importance in the younger diabetic population prior to surgery.
Systemic atheroscle

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This MRI is of a 48-year-old patient who presented complaining of numbness in the ball of his right foot. He said he had more pain with rest than with activity.
Dina Stock, DPM, Cory Baxter, DPM, James Sferra, MD, Christopher Herbert, DPM, and Elizabeth Baracz, BS
38,452 reads | 0 comments | 03/03/2008


Tarsal tunnel syndrome is an entrapment of the posterior tibial nerve or its branches within the tarsal tunnel.1 This syndrome is most frequently unilateral as opposed to carpal tunnel syndrome in the upper extremity, which is typically bilateral.2 Keck and Lam first described the term “tarsal tunnel syndrome” in 1962.3,4
Malaisé first described the clinical signs and symptoms of tarsal tunnel syndrome in 1918. Some of the symptoms include numbness or tingling in the soles of the feet and toes or a burning pain in the ankles.

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By Graham A. Hamilton, DPM
20,776 reads | 0 comments | 01/03/2008

     Nonunion is a well-documented potential complication of the Lapidus arthrodesis. It reportedly occurs anywhere from 3.3 percent to 12 percent of the time, and is a very challenging problem to fix.1-7      Granted, a strict definition of nonunion and timeline for classifying a nonunion varies from one surgeon to another. However, for the purpose of this discussion, nonunion has both clinical and radiographic definitions. Nonunions involve the failure of bone healing at the fusion site after six months, broken hardware or both. A clinical nonunio

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The PathFormer cable is connected to a pair of monitoring electrodes on the patient’s skin. The operator presses and holds down the actuating button until the cutter automatically pulls away from the nail after creating a microconduit.
By Andreas Boker, MD; Clinical Editor: Jesse Burks, DPM
24,000 reads | 0 comments | 11/03/2007

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

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