Surgical Pearls

Nga T. Ho, DPM, Branden R. Rhodes, DPM, and Stephen Kominsky, DPM, FACFAS
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The original Akin osteotomy for the correction of hallux abducto valgus (HAV) included resection of the medial prominence of the first metatarsal head in combination with a medial based wedge osteotomy of the proximal phalanx of the hallux.1 Subsequently, there have been several modifications to the original procedure in order to address factors such as location, rotation, shortening,... Read More.
Michael E. Graham, DPM, FACFAS
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Subtalar arthroereisis has a long evolutionary history since its first conception in the 1940s. Since then, researchers have created and abandoned many different methods, materials and devices. The promise of the next great device to stabilize the subtalar joint complex without osteotomy or arthrodesis usually diminished with long-term usage.    The need to stabilize the talus on... Read More.
Kenneth Seiter, DPM
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   Surgical revision of a failed silicone prosthesis in the first metatarsophalangeal joint (MPJ) is a difficult dilemma that many foot and ankle surgeons increasingly encounter. While advocates of silicone and similar implants have alluded to their preliminary benefits, there is a scarcity of literature on how to salvage these failures, especially when they occur in younger,... Read More.
Lawrence Fallat, DPM, FACFAS
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   There are numerous surgical procedures designed to correct the variations of bunion deformities. Often, the final step of the operation is to correct the valgus and abduction component of the great toe. This has been the subject of a popular and technically simple procedure that was introduced approximately 85 years ago.    In 1925, Akin proposed a hallux valgus... Read More.
Michael S. Downey, DPM, FACFAS­­
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   The management of posterior heel pain can be a perplexing diagnostic and therapeutic problem. The differential diagnosis is extensive and even the skilled clinician can experience difficulty establishing an accurate diagnosis. Of the challenging conditions affecting the back of the heel, the retrocalcaneal exostosis may be the most onerous to treat.    Unlike... Read More.
Graham A. Hamilton, DPM, and Travis L. Sautter, DPM
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   Arthroscopy is an expedient tool in the management of intra-articular fractures of the ankle and post-fracture articular defects. It provides the surgeon the ability to anatomically reduce a fracture under direct visualization with minimal intervention. It also enables the surgeon to address any articular injury primarily.    The AO philosophy has remained... Read More.
Jodi Schoenhaus, DPM, and Jason Gold, DPM
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   Entrapment neuropathy of the tarsal tunnel and its terminal branches is a painful condition, which can be challenging to diagnose given the possibility of concurrent conditions with overlapping symptoms. Heel spur syndrome/plantar fasciitis and entrapment neuropathy often present at the same time. However, it is important to differentiate clearly between the two pathologies as... Read More.
Adam R. Johnson, DPM
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   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... Read More.
Gary Peter Jolly, DPM, FACFAS
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   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... Read More.
By Sean Grambart, DPM
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   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... Read More.
Jerome Slavitt, DPM
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   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... Read More.
By Thomas Cusumano, DPM
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Metatarsalgia may develop from osseous, neurological, vascular or dermal etiologies. The causes are numerous and commonly involve a cavus foot structure, a long second metatarsal, short first metatarsal, hypermobile first ray, iatrogenic pain from forefoot surgery or manifest from a rheumatology-induced systemic disease. When symptoms persist, you may see callus lesions develop under the affected... Read More.