Surgical Pearls

By Kerry Zang, DPM, Shahram Askari, DPM, A’Nedra Fuller, DPM, and Chris Seuferling, DPM
50,894 reads | 2 comments | 03/03/2006

Addressing the biomechanics of the first metatarsophalangeal joint (MPJ) as well as the first ray are the keys to any surgical correction of first metatarsal pathology. According to Rootian theory, the principal etiologies of hallux limitus are as follows.1 • A long first metatarsal or when the position of the first metatarsal head is relative to the second. When the first metatarsal is long, there will be jamming of the metatarsophalangeal joint during the initiation of the propulsive phase of gait. This causes a reduction in the range of dorsiflexion of the hallux and in

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By John A. DeBello, DPM, Kordai I. DeCoteau, DPM, and Eric Beatty, DPM
27,835 reads | 0 comments | 01/03/2006

   Hammertoes may have an etiology that is either congenital or acquired. Pain and cosmetic appearance are the leading factors for patients wanting surgical intervention for hammertoe deformities. While there are a variety of approaches for hammertoe correction, we have found success with a novel approach that emphasizes the use of medial and lateral incisions.    Typically, surgeons use dorsal linear, dorsal longitudinal semi-elliptical, dorsal transverse semi-elliptical, plantar longitudinal and medial/lateral incisions in hammertoe surgery.1 Howe

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By John Mozena, DPM, PC, and Tyler Marshall, DPM
18,806 reads | 0 comments | 11/03/2005

   One of the most documented postoperative complications of distal metatarsal osteotomies is adhesive capsulodesis that limits dorsiflexion of the first metatarsophalangeal joint (MPJ). When faced with such a post-op complication, one may be able to use a proven cartilage preservation procedure that maintains, if not improves, the first MPJ range of motion.    Austin and Leventon first described the Austin bunionectomy in 1962 and the original procedure has undergone many modifications over the years.1 Each modification has different indications and

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By Peter M. Wilusz, DPM, and Guy R. Pupp, DPM
22,548 reads | 0 comments | 09/03/2005

   Multiple etiologies exist for painful conditions that involve the first metatarsophalangeal joint (MPJ). Hallux abducto valgus and hallux limitus are the most common pathologies of the first MPJ podiatrists see in most foot and ankle clinics. Other causes may include rheumatoid arthritis, trauma, connective tissue disorders, infection, iatrogenic and metabolic disorders. Historically, treatment has been geared to realigning structural abnormalities of bone as they affect the joint.1    Unfortunately, very little literature discusses specific treat

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By Erwin Juda, DPM, R.Ph.
15,798 reads | 0 comments | 07/03/2005

   Pain management in the elderly remains one of the most challenging issues for the podiatric surgeon. As life expectancy continues to advance, more geriatric patients will undergo surgery. While these patients may undergo these procedures to help facilitate independence and a better quality of life, one must carefully weigh the risks and benefits of surgical intervention in this patient population.    Regardless of the success of the given surgical procedure, one may still encounter significant tissue damage and the subsequent release of pain and inflammator

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By Graham A. Hamilton, DPM
38,678 reads | 0 comments | 05/03/2005

   A challenging problem for any podiatric surgeon is surgically managing cases in which a silicone elastomer implant in the first metatarsophalangeal joint (MPJ) has failed. When patients initially present with this problem, they will complain of pain, deformity or both at either the first or lesser metatarsophalangeal joints.    The cause of the pain or deformity can be multifactorial. The possible causes may include: chronic synovitis and swelling around the implant; chronic skin fistulas; implant breakage or fragmentation; severe periarticular bony subside

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By Richard O. Lundeen, DPM
17,365 reads | 0 comments | 03/03/2005

   Back when I left the didactic world of podiatry school and entered my residency, I was ready for a transition that would blend the books with practice. Of course, the first two surgeries I performed did not fit the mold. The first one was a cartilage articulation preservation procedure (CAPP) and the other was a Keller procedure.    The CAPP procedure was familiar to me only in books and the Keller seemed “outdated.” To my surprise, both surgeries turned out well and gave me an appreciation that diverse types of procedures can have a good outcome when t

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By Jesse Burks, DPM
9,472 reads | 0 comments | 11/03/2004

   Severe, acute or repetitive chronic inversion ankle sprains can often result in lateral instability of the lateral ankle complex. Although one can treat the vast majority of these conditions conservatively, a significant and unresponsive case may require surgical intervention. Over the course of the past two decades, improved soft tissue anchors and arthroscopic procedures have reduced the necessity of traditional open procedures.    However, these procedures can still play a vital role in the surgical management of this condition. Naturally, there are numer

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By Michael Baker, DPM, CWS
10,641 reads | 0 comments | 09/03/2004

As foot and ankle surgeons, we are constantly reminded that we are the ultimate champions of diabetic foot care. However, another emerging problem is chronic venous insufficiency (CVI) ulcerations. While it does not have nearly the potential impact of limb loss one may see with complications from the diabetic foot, there is an increasing incidence of CVI with the continued aging of the population. According to current estimates, CVI affects between 0.1 and 0.3 percent of the total population in the United States. The healthcare industry spends $400 million annually on treating CVI. Unlike th

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By Lynnelle R. Gabriel, DPM
47,760 reads | 0 comments | 07/03/2004

Treating a Morton’s neuroma can be a delicate operation. There is currently much discussion and controversy over whether to remove an intermetatarsal neuroma or leave the nerve intact and release the deep transverse intermetatarsal ligament via a minimally invasive nerve decompression (MIND). There have not been enough studies to sway the majority of surgeons to leave the intermetatarsal neuroma and only release the ligament. Although I believe this is truly an entrapment of the nerve, I have found removing the neuroma has been quite successful. The clinical signs and symptoms of a neurom

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