Clinics in podiatric medicine and surgery最新文献

Since 1911, the Lapidus procedure for bunionectomy has evolved from a severity-based indication to an anatomic based system. It addresses the hallux valgus deformity at the anatomic center of rotational and angulation and frontal, transverse, and sagittal plane deformities. It has been shown to be predicable in outcomes and has a low recurrence rate versus other bunion procedures.

Subtle Lisfranc injuries are commonly overlooked, and the severity of the injury is often underestimated. Lisfranc injuries can cause severe pain and debilitation if missed and not treated. Patients with midfoot pain following even a minor trauma should be evaluated for a Lisfranc injury with bilateral weightbearing radiographs when they are able to tolerate. There should be a low threshold for open reduction with internal fixation in the active, healthy patient population. Surgical technique is described. Primary fusion may be considered in more severe cases as well as those where the diagnosis is delayed.

This study outlines what the current literature proposes for different treatments for the challenging problem of talar shoulder lesions and the published outcomes. A case study is presented for a technique utilizing an en-bloc partial talar shoulder allograft insertion with bioabsorable screw fixation.

Total ankle arthroplasty (TAA) has become a recognized solution for patients suffering from end-stage ankle arthritis. Despite advancements in implant design and surgical techniques over the past decade, the long-term survivorship of these implants remains ill-defined. A notable deficiency exists in published data regarding failure rates and the underlying causes of implant failures. As indications for TAA expand-with more complex deformities, the incidence of revision surgeries is expected to rise. Accordingly, surgeons need to be familiar with the principles of total joint revision to successfully modify these failures to avoid amputation or conversion to fusion.

Septic ankle arthritis is a serious, limb threatening condition that requires a prompt and comprehensive treatment approach. Treatment of a septic ankle and/or hindfoot infection can be a challenging endeavor, often complicated by concomitant deformity and patient comorbidities that prolong healing time. Eradication of the infection and stabilization of the limb are fundamental concepts when performing septic fusion, often requiring staged procedures with various fixation methods. There is a paucity of literature outlining the approach to septic fusion of the ankle/hindfoot. Herein, we review current methods of septic ankle fusion while featuring an algorithmic approach for management of this challenging pathology.

Non-insertional Achilles tendinopathy is a common condition among aging athletes participating in high-impact activities. The authors have summarized the typical presentation and objectives in surgical management and have provided a proposed surgical treatment algorithm for the successful management of non-insertional Achilles tendinopathy.

Forefoot nonunions present significant challenges in clinical practice due to their complex etiology and the essential role of the forefoot in weight-bearing and ambulation. Risk factors such as poor vascular supply, diabetes, smoking, poor nutritional status, non-compliance, and infection exacerbate the condition. Diagnosis primarily relies on clinical evaluation and imaging modalities. The effective management of forefoot nonunions requires a multifaceted approach that integrates accurate diagnosis, appropriate conservative or surgical treatment, and thorough postoperative care and long-term follow- up. Understanding the underlying causes and appropriately managing patient comorbidities can significantly enhance treatment outcomes and patients' quality of life.

Minimally invasive surgery has a high learning curve and multiple instructional courses and trainings should be completed by the surgeon prior to patient application. Modified Lapidus also is still a valid procedure selection in patients that may have concomitant medial column pain and/or dysfunction. Procedure selection is not "one-size fits all".