Surgical Pearls
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.
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.
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.
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.
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.
The interdigital neuroma is a common source of forefoot pain that podiatric foot and ankle surgeons see in their practices every day. The characteristic symptoms have been well known since Morton first described them in 1876.1 Even though Morton believed the problem was located at the fourth metatarsophalangeal articulation, his name has been associated with the pathology for over a century.... Read More.
Subtalar joint arthrodesis and subtalar joint arthroereisis are widely used surgical procedures for eliminating motion or limiting excessive pronation at the subtalar joint.1-3
Although the indications for either procedure may be vastly different, the successful outcome of both relies on proper positioning of the subtalar joint. A poorly positioned fusion or arthroereisis may... Read More.
Hallux limitus is generally responsive to conservative care consisting of anything from changing foot gear, changing activity and exercises to orthoses, injections, anti-inflammatory medication and physical therapy.1 When these things fail, surgery is necessary.
It has long been believed that arthrodesis is the optimum procedure of choice to resolve any painful arthritic... Read More.
Ankle fractures are seemingly uncomplicated injuries. However, in the elderly and people with diabetes, this seemingly straightforward injury can have catastrophic outcomes.
Systemic illnesses such as diabetes with end-organ damage clearly affect the overall outcome of ankle fractures and complications may occur due to a failure to recognize the unique treatments necessary for... Read More.
There has been a variety of research looking at treatments for acute Achilles tendon ruptures including non-operative repair with different rehabilitation protocols, extensile open repairs, percutaneous repairs, percutaneous repair with ultrasound guidance, percutaneous repair with endoscopic guidance and mini-open repairs.1-3 Some physicians advocate for surgical repair whereas others insist... Read More.
Imagine that you were running late on your way to the hospital to attend to an urgent patient. You have a choice of two routes. One route is longer because it uses two streets, each with a traffic light, and no place to make a U-turn and change direction if the traffic is heavy. The shorter route is a straight shot but has no traffic lights with options for U-turns if necessary.
... Read More.
Arthrodesis of the first metatarsophalangeal joint (MPJ) was first advocated in 1894 by Clutton for severe, painful hallux valgus.1 McKeever refined the technique in 1952 using intramedullary screw fixation, which is currently the gold standard for treatment of advanced arthritis and/or significant deformities of the hallux.2 Common indications for arthrodesis include stage 3 hallux rigidus (... Read More.
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