Surgical Pearls

By Thomas Cusumano, DPM
54,147 reads | 0 comments | 03/03/2004

Hallux limitus/rigidus is defined as a degenerative arthrosis of the first metatarsophalangeal joint (MTPJ) which is characterized by a decrease in the MTPJ range of motion and an eventual lack of motion.1 Treatment for this condition is a frequently discussed topic at podiatric conferences. When it comes to the stages of osteoarthritis in the MTPJ, one may consider performing joint preservation or joint destructive procedures. Joint preservation procedures include cheilectomy procedures, soft tissue correction and distal/proximal osteotomies as indicated for osseous correction. Wi

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By Jesse B. Burks, DPM
26,729 reads | 0 comments | 11/03/2003

Surgery in general seems to gravitate toward smaller and less invasive procedures. Obviously, the less tissue disruption that occurs during surgery, the less risk one has of postoperative complications such as scarring, infections, delayed healing, etc. Although this may not be true with every surgical advance, arthroscopy has revolutionized the treatment of joint disorders and allowed many of these common complications to be almost entirely eliminated. Increasing indications for this technique include the treatment of subtalar, calcaneal cuboid and first metatarsal disorders. However, for t

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By Stephen L. Barrett, DPM
19,210 reads | 0 comments | 09/03/2003

Keck first described tarsal tunnel syndrome in the literature back in 1962 and it remains a controversial topic today.1 While tarsal tunnel syndrome is a prevalent and common condition, lower extremity peripheral nerve entrapments and other nerve pathology can be clinically difficult to appreciate and understand. Needless to say, making a decision to proceed with surgical intervention for this condition can also be difficult. Experienced practitioners with a high degree of neurological understanding and appreciation for peripheral nerve pathology are more likely to focus on these p

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By J. Michael Miller, DPM
19,698 reads | 0 comments | 07/03/2003

Minimizing postoperative discomfort for patients is a common goal of all surgeons. Techniques for achieving this goal seem to vary significantly among surgical specialties. Unfortunately, patients often have preconceived expectations that they will experience considerable discomfort after foot surgery. This is usually based on their experience with other surgical procedures or from discussions with other people in their community who have expressed their “experience” with foot surgery. This fear of significant postoperative discomfort occasionally will preclude some patients from undergo

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By Harold Schoenhaus, DPM, Jodi Schoenhaus, DPM, and Dawn Pfeiffer, DPM
5,589 reads | 0 comments | 05/03/2003

One of the most commonly performed procedures in the foot is an implant arthroplasty of the first metatarsophalangeal (MPJ) joint. However, we have occasionally noted a hollow medullary canal after resecting the base of the proximal phalanx. This can cause problems with incorporation of the implant. Yet there is an intraoperative option one can use to address this problem. Adequate bone stock of the proximal phalanx is crucial for proper seating of the hemi-implant. In some cases, we have found the cancellous bone to be cystic with liquefied fat. However, there has been no evidence of cortica

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By Gerald W. Paul, DPM
18,564 reads | 0 comments | 01/03/2003

The advantages of lesser proximal interphalangeal joint arthrodesis in hammertoe surgery are numerous and well known. Arthrodesis is indicated in patients who have compromised intrinsic muscle function and are lacking both digital and metatarsophalangeal joint stability. Indeed, digital arthrodesis has always been an excellent procedure to consider if you fear reoccurrence of the hammertoe deformity due to biomechanical factors. Through the years, surgeons have employed several methods and devices to facilitate fusion across the lesser proximal interphalangeal joints (PIPJ) for stable hammer

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By Jason S. Harrod, DPM
8,403 reads | 0 comments | 11/03/2002
There are many methods you can use to prepare the first metatarsophalangeal joint (MPJ) for arthrodesis. One of those techniques involves using a cup and cone reamer system. Using this system can be helpful, especially when there has been some trauma to the joint surface, when you’re dealing with an extremely arthritic joint with hypertrophy or when the patient has a square metatarsal head. These conditions could potentially prohibit an exact coaptation of the opposing bones. However, the cup and cone reamer system (Howmedica) is designed to take advantage of the convexity of the first met | Continue reading
By Jesse B. Burks, DPM, MS
13,615 reads | 0 comments | 09/03/2002
Numerous conditions can result in the need for arthrodesis of the ankle joint. In particular, neuropathic osteoarthropathy, post-polio syndrome, neuromuscular disease and severe degeneration secondary to trauma can all make it especially difficult for podiatric surgeons to achieve a successful fusion.1-4 Although implant arthroplasty is gaining acceptance and distraction arthroplasty may postpone the joint destructive procedure, arthrodesis remains a viable and effective treatment for patients with gross deformity of the ankle. While all patients will require modifications in surg | Continue reading
By Thomas Cusumano, DPM
57,672 reads | 0 comments | 07/26/2002
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 metatarsal. Keep in mind that these lesions can lead to stress fractures and compensation-induced pains in the lower extremity and back. | Continue reading
By Richard Braver, DPM
78,506 reads | 2 comments | 05/03/2002
When patients experience intense pain, a burning sensation, tightness and/or numbness in the lower extremities during exercise activity, and the pain usually resolves quickly once the patients stop the activity, you may be looking at exertional compartment syndrome (ECS). ECS is certainly one of the more confounding conditions as differentiating between the various leg pains can be difficult. Parasthesia to the anterior leg, ankle or between the first and second metatarsal is indicative of anterior leg compartment involvement. In addition, weakness of ankle dorsiflexion or a drop foot also in | Continue reading