Surgical Pearls

By Gerald W. Paul, DPM
19,271 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
8,854 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
14,397 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
58,692 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
84,784 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
By Richard Braver, DPM
27,219 reads | 0 comments | 03/03/2002

Distal posterior heel pain is a deformity we see quite often. It masquerades as chronic Achilles tendinitis, when in fact a calcaneal step (aka retrocalcaneal exostoses) is present at the Achilles insertion. You must also clinically differentiate it from adjacent problems, such as Haglund’s deformity, retrocalcaneal bursitis and intra-Achilles tendon tear. Often, these problems may be concurrent, however, you must treat the calcaneal exostoses for complete cessation of pain. Keep in mind that retrocalcaneal exostoses are most symptomatic in active individuals over 30. On inspection, you w

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By Richard T. Braver, DPM
298,624 reads | 1 comments | 01/03/2002
In my experience, the Modified Kidner procedure is one of the most reliable operations for reducing arch pain associated with an accessory navicular bone (a.k.a. os tibial externum). You can also use this procedure to treat a prominence at the inner aspect of the arch, which has been caused by an enlarged navicular bone. The most common patients to visit our office with these problems are between the ages of 8 and 15 and are involved in activities like ice skating, ballet and soccer. What precipitates the pain? It will usually be caused by rubbing of the skate or other footwear against the p | Continue reading