Clinics in podiatric medicine and surgery最新文献

Avascular necrosis (AVN) of the talus results from disrupted blood flow, causing bone death, collapse, and joint degeneration. Its vascular structure makes it prone to ischemia, with causes including trauma, corticosteroids, and metabolic disorders. Charcot neuroarthropathy shares pathologic similarities with AVN. A study of 135 Charcot reconstructions found talar AVN in 14%, linked to talonavicular dislocation, renal disease, and high body mass index. Starling resistor modeling explains microcirculatory failure. Management ranges from immobilization to surgical options like arthrodesis and distraction osteogenesis. Early diagnosis and tailored treatment are critical for stabilizing joints and preserving limb function.

Rearfoot and ankle deformities can be caused both secondary to distal foot deformities as well as suprastructural deformities. Suprastructural deformities include deformity at the tibia, knee, femur, or hip and can significantly alter weight-bearing mechanical forces at the level of the rearfoot and ankle. The mechanical axis of the limb is a useful radiographic measurement not only to diagnose suprastructural deformity but also to appropriately align the limb relative to the weight-bearing forces. Appropriate alignment can prevent reoperation, adjacent joint deformity or pain, and total ankle implant failure.

Charcot Neuroarthropathy (CN) is a chronic condition characterized by rapid destruction of the foot's bone structure and joints, primarily due to loss of sensory feedback. It commonly occurs in patients with diabetes and peripheral neuropathy but can also arise from various other conditions. The treatment aims to prevent amputation by creating a stable, plantigrade foot through surgical reconstruction. While traditional techniques have faced high failure rates due to inadequate fixation and joint instability, emerging methods focus on comprehensive deformity management and long-term stability. Preoperative evaluations are crucial for optimizing patient outcomes and ensuring proper postoperative support.

Tendon and ligament tears are common and disabling musculoskeletal injuries. Chronic injury tends to occur in 15% to 48% of cases leading to surgical management after failed conservative care. Once soft tissues integrity is disrupted, the body begins to form scar tissue, which is inferior to a healthy tissue and demonstrates a lack of tensile strength and a stiffening that diminishes the range of motion. The main goal of surgical repair of tendons and ligaments is to restore anatomic structure and function. We follow 2 patients with complex soft tissue injuries treated with direct repair using structural collagen grafts.

Acute ankle sprains are the most common lower limb injury seen in sports and recreational activities. They typically occur in younger population groups with an estimated 2 million acute ankle sprains being diagnosed each year. Inversion ankle sprains can lead to chronic instability, which often necessitates surgical intervention. The standard operative treatment of lateral ankle stabilization has been the Brostrom-Gould procedure, which has produced good results. This article details the surgical technique, advantages, and outcomes of an arthroscopic approach to surgical management of lateral ankle instability.

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.