Surgical Pearls

By Dave Nielson, DPM, FAPWCA and Guy Pupp, DPM, FACFAS
14,497 reads | 0 comments | 11/03/2006

     While the concept of infections has been studied for many years, our current understanding of infections is based upon studies and observations of planktonic bacteria. This is free floating bacteria that cause diseases such as pneumonia, sepsis, urinary tract infections, gas gangrene and many other examples. These types of infections often respond well to antibiotics and resolve without recurrence.      However, there are several infections that occur out of the typical sequence of planktonic bacterial infections. These infections occur postoperatively aft

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By Richard O. Lundeen, DPM
15,320 reads | 0 comments | 09/03/2006

   Foot and ankle surgeons have no shortage of choices when it comes to selecting instruments for surgical procedures. Our surgical team has found success in using the Koby line of instruments (OsteoMed) for the treatment of various conditions.    For the last four years, surgeons have found success using Koby instruments for three procedures commonly performed in the foot and ankle. Koby instruments are designed to perform the partial plantar fasciotomy for heel spur syndrome, intermetatarsal ligament decompression of neuroma and release of the gastrocnemius

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By Daniel K. Lee, DPM, and Gregory E. Tilley, DPM
20,371 reads | 0 comments | 07/03/2006

   There have been many surgical treatment modalities described in the podiatric and orthopedic literature for the correction of hallux limitus.1-5 Since the Regnauld procedure was introduced in 1968, surgeons have used it in the treatment of a pathologically long proximal phalanx and hallux limitus.6 However, since its development, this procedure has been characterized as a technically challenging procedure for the treatment of hallux limitus with or without moderate degenerative arthritis.7-10    In 1995, Kissel, et. al., and

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By Don Green, DPM and Peter S. Kim, DPM
171,689 reads | 0 comments | 05/03/2006

The etiology of heel pain is quite varied. First described by Wood in 1812, the most common cause is thought to be plantar fasciitis. This is typically marked by focal tenderness to any component of the aponeurosis but most frequently at the proximal medial insertion of the plantar aponeurosis.1 Many symptomatic patients with plantar fasciitis demonstrate plantar heel spurs (traction enthesopathies) of the os calcis. One may best appreciate this shelf of exostosis on the lateral and lateral oblique views of standard radiographic studies.2 On rare occasions, fracture of

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By Kerry Zang, DPM, Shahram Askari, DPM, A’Nedra Fuller, DPM, and Chris Seuferling, DPM
52,345 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
29,918 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
19,572 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
23,693 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.
16,427 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
41,175 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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