Surgical Pearls

By Jesse Burks, DPM
9,632 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
10,763 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
48,931 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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By Jesse B. Burks, DPM
20,404 reads | 0 comments | 05/03/2004

Isolated fusions of the rearfoot have long been a choice of many podiatric foot and ankle surgeons for conditions such as coalitions, arthrosis and symptomatic flatfoot deformities. Persuasive arguments can be made for fusion of the calcaneocuboid, subtalar or talonavicular joints, especially when it comes to deformities such as the symptomatic flatfoot. While each of these procedures provide certain benefits for surgeons, they can present their own unique intraoperative and postoperative challenges as well. With this in mind, I would like to share my thoughts as to why my talonavicular (TN)

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By Thomas Cusumano, DPM
60,125 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
27,766 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
19,622 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
21,805 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
5,659 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
19,050 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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