Clinics in podiatric medicine and surgery最新文献

Modified Lapidus arthrodesis (MLA) has become a common procedure to address hallux valgus deformity, being performed with increasing frequency. Advantages and benefits of MLA include multiplanar correction and addressing the deformity at its apex. Recent technological advances, which have been designed to produce consistent and predictable results, have further increased the popularity of MLA. As such, we are likely to encounter a greater number of complications, such as nonunion and malunion. Bone loss and sagittal plane malalignment are often encountered and can present technical challenges. This article reviews workup, surgical considerations, and technical approach to dealing with these complications.

Arthritis of the first metatarsophalangeal joint is a commonly treated pathologic condition. Traditionally, when nonoperative care fails, arthrodesis has been the gold standard for operative care. Although this procedure has demonstrated good outcomes and high patient satisfaction, there remains a subset of patients who prefer to avoid arthrodesis. The aim of this article is to analyze the role of allogeneic cartilage replacement in comparison with arthrodesis for the treatment of hallux rigidus.

The peroneus brevis muscle flap is a versatile reconstructive option for lower extremity wounds and defects. Preoperative considerations, including patient comorbidities and wound characteristics, can be used to guide flap design as well as the use of combination therapy to optimize outcomes. Meticulous surgical technique is essential for flap success. The robust vascular supply of the peroneus brevis muscle flap offers reliable coverage and improvement in local tissue perfusion to promote healing. Its reliable anatomy and minimal donor site morbidity make it a valuable tool for lower extremity reconstruction and limb salvage.

This article reviews the principles of limb deformity correction, focusing on foot and ankle. The historical content of deformity correction is discussed and highlights Dr Dror Paley's work of the Center of Rotation Angulation and osteotomy principles for surgical planning. This article emphasizes the importance of comprehensive clinical and radiographic evaluations, establishing normal angular relationships, and ensuring accurate and successful surgical outcomes. The article emphasizes the pronounced influence that the Western Pennsylvania Foot and Ankle Residency Program had on the development of the field foot and ankle deformity correction and how these principles have made profound change in our profession.

Ankle arthrodesis has proven to be a time-tested procedure for not only degenerative joint disease but a variety of indications. With the addition of updated techniques and improved fixation, results have become even more reproducible. There has been a recent shift away from ankle arthrodesis to total ankle arthroplasty. However, data shows that while there has been a significant increase in usage of total ankle replacements, the utilization of ankle arthrodesis remains unchanged. This article incorporates the various indications, approaches, and fixation methods that make the ankle arthrodesis procedure so successful.

Total ankle replacements have made profound progress with respect to kinematics, biomedical technology, engineering, and surgical technique since its inception nearly 50 y ago. Though it may never completely usurp tibiotalar arthrodesis as the gold standard for end stage arthritis, ankle arthroplasties continue to evolve in their capacity to offer a legitimate alternative with quality patient outcomes. Given the multitude of anatomic and biomechanical challenges intrinsic to the ankle joint, patient-specific surgical planning, advanced imaging, and equipment are invaluable in yielding successful implantation and long-term retention.

Opioid pain medication has long been the standard for control of postoperative pain following foot and ankle surgery. However, the ongoing opioid crisis has necessitated the development of alternative forms of postoperative pain control. Multimodal analgesia utilizes combination therapy in order to achieve a synergistic effect to manage pain. In this article, we highlight various therapeutic options available to use in a multimodal pain regimen and highlight the available research supporting their use in foot and ankle surgery. Lastly, we discuss the multimodal pain regimen that has been adopted and utilized throughout our institution over the past several years.

Calcific insertional Achilles tendinopathy (CIAT) is a common musculoskeletal issue that results in not only daily pain and discomfort but also functional deficits affecting patients' quality of life. After failure of conservative management, CIAT often transitions to surgical problem requiring not only repair of the tendon but also a posterior debridement of excess enthesophytes, thickened Achilles tendon, and prominent calcaneal bone. In this article, the author describes a single case study of surgical management of CIAT with flexor hallucis longus transfer and augmentation of the Achilles tendon utilizing Tapestry Biointegrative implant to aid in collagen restoration, tendon health, and recovery.

Achilles tendon ruptures can be classified as acute and chronic varying on the timing of diagnosis and/or presentation to the clinic. Acute ruptures can be treated with either conservative or surgical treatment options. Furthermore, surgical treatment of acute ruptures can be divided into open, percutaneous, or minimally invasive. Chronic ruptures of the Achilles are diagnosed greater than 4 to 6 weeks from injury. Chronic ruptures are best treated with augmentation of the repair, with either a gastrocnemius advancement or turndown, or a tendon transfer.

Stage 1 Progressive Collapsing Foot Deformity (PCFD) presents as a reducible deformity characterized by peritalar subluxation as a result of soft tissue insufficiency leading to clinical and radiographic hindfoot, and ankle deformity. More recently, due to improved understanding and surgical technique, medial soft tissue reconstruction of the tibiospring ligament offers robust correction of the pathologic anatomy in Stage 1 PCFD and can serve as an alternative to indirect, non-anatomic, lateral calcaneal osteotomies.