Clinics in podiatric medicine and surgery最新文献

Medial malleolar osteotomy is a valuable but underutilized technique for correcting significant varus deformity in total ankle replacement (TAR). While soft tissue balancing is often sufficient, excessive varus may necessitate osseous correction to restore neutral alignment. This article reviews the etiology, indications, surgical techniques, and outcomes of medial malleolar osteotomy use in TAR, emphasizing a staged approach to optimize healing and implant stability. Proper deformity assessment and individualized patient treatment plans are essential to prevent early failure. Further research is needed to establish objective criteria for when medial malleolar osteotomy is preferable to soft tissue release alone.

Large and/or cystic osteochondral lesions of the medial talar dome, both primary and revision, often require a medial malleolar osteotomy to perform complete resection of the diseased cartilage, subchondral bone, and cancellous bone substrate. Oblique and biplanar chevron medial malleolar osteotomies for access to the medial talar dome are the focus of this article. The authors present an in-depth description of the surgical technique for both types of osteotomies of the medial malleolus, as well as a review of how to prevent and address the most common complications encountered.

Pes cavus can be a painful and debilitating condition that is often recalcitrant to conservative treatment. Oftentimes surgical reconstruction is necessary for the patient to obtain a pain-free plantigrade foot. An intimate knowledge of pes cavus foot architecture is necessary to select appropriate surgical treatment of the symptomatic patient. Midfoot osteotomies such as the Cole osteotomy can be a powerful procedure to reduce deformities where the apex is located in the midfoot. Midfoot osteotomies are almost never performed in isolation. Midfoot osteotomies including the Cole osteotomy are an attribute in any foot and ankle surgeon's armamentarium.

Supramalleolar osteotomies of the distal tibial metaphysis or distal tibial metaphyseal-diaphyseal junction are indicated when angular, rotational, and/or translational malalignment of the ankle joint are present. Varus and valgus deformities of the ankle that can be readily corrected through opening wedge osteotomies of the distal tibia are the focus of this article. The authors present an in-depth description of the surgical technique for opening wedge osteotomy of the distal tibia, as well as a review of how to prevent and address the most common complications encountered.

One of the most important fundamental cornerstones in treating diabetic foot ulcers involves offloading plantar pressure. Many dressings and devices have been developed with variable success rates secondary to design and patient adherence and tolerance of the designs. The current gold standard involves use of total contact casting or an irremovable cast walker. Following successful healing of a diabetic foot ulcer, devices such as custom orthotics and shoes are essential to reduce plantar pressures implicated in these wounds' recurrence.

This article explores limb salvage in diabetic patients, emphasizing the orthoplastic approach to managing complex lower extremity wounds. It delves into various reconstructive flaps tailored to specific wound locations, providing essential background, surgical techniques, and expert tips. By integrating orthopedic and plastic surgery principles, the article offers strategies to optimize flap viability, achieve successful functional outcomes, and ensure effective and sustainable limb preservation.

Diabetic foot complications remain a significant global health challenge, contributing to morbidity and disability. This article chronicles the transformative collaboration between the Beth Israel Deaconess Medical Center (BIDMC) and Vietnamese institutions over 25 years, focusing on training, capacity-building, and the establishment of diabetic foot care centers. Key milestones include advancements in surgical techniques, reduced amputation rates, and the creation of regional diabetic foot care hubs. Challenges encountered and future plans for expanding these efforts are also discussed, highlighting the global implications of these partnerships.

The multidisciplinary team approach to diabetic foot care has evolved over the past century. This article traces the development of collaborative care models from their origins to their global implementation. Key figures pioneered innovations in surgical techniques and team-based approaches that dramatically reduced amputation rates. The integration of podiatrists within these teams has proven particularly impactful. Contemporary multidisciplinary teams focus on 4 areas: glycemic control, wound management (including surgical reconstruction), vascular intervention, and infection control. This comprehensive team approach has demonstrated the capacity to reduce major amputations by up to 94%.

Empiric antimicrobial therapy for diabetic foot infections must be selected with attention to wound severity and patient-specific factors including comorbidities, antibiotic allergies, prior cultures, risk factors for antibiotic-resistant organisms and the local antibiogram. Subsequent therapy can be tailored in spectrum by culture results and its duration informed by surgical approach and pathologic data. After initial clinical improvement, most patients can be transitioned to oral step-down therapy. The duration of treatment for soft tissue infection (STI) is based on the severity of STI and when osteomyelitis is present, whether surgical resection of the involved bone has been performed.