Surgical Pearls

By Luke D. Cicchinelli, DPM, FACFAS
20,318 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
11,622 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
42,792 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
22,688 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
25,060 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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One should then evaluate the entire construction and use one suction tube to complete the seal among the three wounds.
By Luis Leal, DPM
20,351 reads | 0 comments | 09/03/2007

Vacuum Assisted Closure (VAC) is one of our greatest tools in managing large as well as deep wounds. It crosses multiple surgical disciplines and is applicable to virtually all anatomical sites. This technology has revolutionized limb salvage surgery and has prevented untold numbers of amputations. There is an exciting growth curve with the use of this technology. Surgeons can modify the technology to aid in the closure of a multitude of wound scenarios.

In the course of utilizing VAC therapy (KCI), one must be cognizant of adjacent tissue and protect it from the deleterious effects of negat

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By Gordon Zernich, CP, Tomas Dowell, CPO/LPO, Gary M. Rothenberg, DPM, FACFAS, and Michael M. Cohen, DPM, FACFAS
42,947 reads | 0 comments | 07/03/2007
By Devon Glazer, DPM
7,057 reads | 0 comments | 05/03/2007
By Anthony Weinert, DPM, Ali Elkhalil, DPM, and Ahmad Farah, DPM
9,541 reads | 0 comments | 03/03/2007

      Practitioners have described various osteotomies for the proximal hallux. However, the Akin closing wedge osteotomy is currently the most common procedure. Podiatric surgeons commonly employ the transverse plane closing wedge osteotomy for the correction of hallux abductus interphalangous deformity. One may also use this as an additional procedure for the correction of hallux abductovalgus deformity.       Akin noted that one should perform the closing base wedge osteotomy at the proximal one-third of the proximal hallux and orient it in the transverse p

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By Kerry Zang, DPM
19,176 reads | 0 comments | 01/03/2007

      One of the most common conditions that the foot and ankle surgeon will encounter is the hammertoe deformity. Surgeons have used multiple procedures for more than 60 years to deal with this condition. These have included amputation of the digit, arthrodesis of the interphalangeal joints, soft tissue releases, arthroplasty (removal of bone, partial or complete), tendon transfers, implants and/or a combination of the above. The most popular procedure during this time has been the arthroplasty with resection of the head of the proximal phalanx.       However,

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