Surgical Pearls

Stephen M. Schroeder, DPM, FACFAS
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The Achilles tendon is the largest and strongest tendon in the human body. Increased interest in physical fitness and athletic activity by young, middle-aged, and older patients has led to a higher incidence of rupture.1 Surgical correction is often the treatment of choice because it offers less immobilization time, early weightbearing, better rehab potential, lower risk for re-rupture and faster... Read More.
Noman A. Siddiqui, DPM, Corine L. Creech, DPM, and Bradley M. Lamm, DPM, FACFAS
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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... Read More.
John F. Grady, DPM, FASPS, FACFAOM, and Katy Trotter, DPM
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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... Read More.
Kyle S. Peterson, DPM, AACFAS, and Christopher F. Hyer, DPM, MS, FACFAS
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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,... Read More.
Nicholas J. Bevilacqua, DPM, FACFAS
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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... Read More.
Michelle Butterworth, DPM, FACFAS
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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.    In reality, the Evans calcaneal osteotomy provides multi-planal correction and foot and ankle... Read More.
Michael Tritto, DPM
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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... Read More.
Keith D. Cook, DPM, FACFAS, and Irene Labib, DPM, MS
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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... Read More.
Jason R. Miller, DPM, FACFAS, and Stanley Chen, DPM, AACFAS
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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... Read More.
By Bradly Bussewitz, DPM
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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... Read More.
Jodi Schoenhaus Gold, DPM, FACFAS
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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.    Patients typically present with pain and verbalize the discomfort they experience while walking barefoot or... Read More.
Lawrence Fallat, DPM, FACFAS, and Ruby Chahal, DPM
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Fifth metatarsal fractures are the most common of all metatarsal fractures.1 Avulsion fractures, Jones fractures and proximal diaphyseal fractures occur most frequently, but diaphyseal, neck and head fractures also occur.2 Clinicians can treat most of these fractures conservatively if the fractures are not significantly displaced.    The Jones fracture is well known for poor... Read More.