Foot & ankle surgery (New York, N.Y.)最新文献

Turf toe is often described as an athletic injury commonly affecting football players on artificial turf. However, any trauma resulting in hyperextension of the first metatarsophalangeal joint (MTP) can disrupt the plantar capsular structures. Left untreated these injuries can result in prolonged pain and dysfunction of the foot. There is a paucity of literature discussing the surgical treatment of grade III turf toe injuries in the professional athletic population and at the community level. This case presents the diagnosis, surgical technique, and rehabilitation of a patient with a grade III turf toe injury after a traumatic hyperextension injury. This report illustrates the novel two incision technique with suture button fixation for a grade III turf toe injury.

Case

A 26-year-old elite male swimmer presented with chronic, isolated, hallux metatarsophalangeal joint varus instability status post previous lateral collateral ligament repair. We report a novel surgical technique for revision first metatarsophalangeal joint (MTP-1) lateral collateral ligament reconstruction using soft tissue imbrication and augmentation with a degradable polycaprolactone-based polyurethane urea (PUUR) matrix. There is paucity in the literature describing the surgical management of revision lateral collateral ligament injury in these cases.

Conclusion

Our reconstruction technique using degradable PUUR matrix restores natural soft tissue elasticity, provides a scaffolding for neocollagenesis, is bioinert, and delivers a low-profile reconstruction allowing the patient to return to high level competition with excellent patient outcomes at one year follow up.

Introduction

Retronychia is a unique type of nail ingrowth that has been described by De Berker and Renall in 1999. We present a case that was diagnosed and treated involving a multidisciplinary team consisting of dermatologist, radiologist, and a general surgeon. Furthermore, recurrence of such condition was prevented by patient education and empowerment.

Case presentation

This is a young female who presented with two months history of right great toe pain and discharge. Antibiotic alone was prescribed but did not show improvement. She previously underwent left side nail avulsion for a similar complaint. In examination, she had tender hallux valgus of the right big toe, associated with turbid discharge from the nail bed. We confirmed the diagnosis of retronychia using ultrasound and treated the condition with nail avulsion. However, she had signs of recurrence during follow up, and we advised her to raise the distal end of the nail manually using a local anesthetic which was successful.

Discussion

This unique condition needs timely diagnosis to choose the proper treatment. Treatment depends on the stage, and starts with topical steroids and eventually might end with nail avulsion. Recurrence is uncommon, unlike our case. We hypothesized that early lifting of the distal end of the nail can prevent full recurrence. This maneuver proved to be effective in our case and there was no recurrence.

Conclusion

Retronychia is a new term that shares treatment with other nail disorders. Patient education and empowerment is crucial in the treatment. Further studies in that matter are needed.

Introduction

A large proportion of patients with chronic lateral ankle instability suffer from recurrent ankle sprains and develop concurrent peroneal tendon pathology. This is associated with significant pain, post-traumatic ankle osteoarthritis and severe impairments in quality of life. Currently, evidence-based treatment guidelines for peroneal pathology are lacking despite a high failure rate with nonoperative management of tears or ruptures. This case report details the first cited peroneal L-lengthening tenodesis and modified Brostrom-Gould to date.

Case presentation

A 56-year-old male presented with chronic pain, disability and instability following a forced ankle plantarflexion-inversion injury. The patient was diagnosed with a complete rupture of the peroneus brevis tendon at the level of the retro-malleolar groove with 5 cm retraction, marked peroneal tenosynovitis and tendinopathy, and chronic lateral ankle ligament deficiency. Surgical management was successful, involving an L-lengthening peroneal tendon repair and tenodesis, with a concurrent modified Brostrom-Gould procedure. Following 12 months follow-up after” surgical management, the patient returned to activities of normal living and sports with significant improvements in pain levels and reported quality of life.

Conclusions

A high index of suspicion is necessary for peroneal tendon injury following inversion ankle trauma, especially in the presence of chronic ankle instability. The reported surgical technique may be considered as a feasible option for patients with chronic ankle instability and concurrent peroneal tendon rupture. Further research is warranted to establish evidence-based guidelines to facilitate clinical decision-making.

There has been increasing interest and studies reporting the clinical and radiologic outcomes of minimally invasive bunion surgeries (MIS). These studies address how to perform these surgeries, however there are no clear standards or guidance to help surgeons improve and optimize their operating room setup for minimally invasive bunion surgeries unlike other orthopedic procedures.

Improving and optimizing operating room setup for MIS bunion surgeries is important to improve surgeon's convenience, patient safety and outcomes and hopefully shorten the learning curve for MIS bunion surgeries.

The aim of this paper is to share our experience with what we believe is an improved operating room setup for MIS bunion and forefoot surgeries. This setup might help new MIS surgeons improve their outcomes, decrease the complication rates and shorten the learning curve.

According to the orthopedic principle based on the three-point force system, this study aimed to reveal the orthopedic effect and patterns of the orthopedic based on this system in 3 patients with strephenopodia through the weight-bearing stance phase experiment and numerical simulation analysis of ankle-foot orthoses (AFOs). After the correction with AFOs, Under the pressure tolerance of human skin, different three correction forces were applied to the medial heel, above the medial ankle, below the lateral ankle and the first metatarsal bone,the weight-bearing region of the affected foot gradually shifted to the normal region of the first metatarsal bone, the fifth metatarsal bone, and the heel. The weight-bearing capacity of the affected foot increased by 11.4 %. After the three-point force was adjusted for the AFO, the distribution of the plantar weight-bearing region became more uniform, and the supporting force of the affected foot increased signifcantly, the weight-bearing capacity of the affected foot increased to 15.19 %, which approached the theoretical value. When the three-point force of was over-adjusted to exceed the pain threshold, the weight-bearing capacity of the affected foot decreased by 2.79 % compared with the theoretical value. It was confirmed that the foot varus angle was attenuated significantly 8 weeks after the orthopedic with three-point force system. Further, the strephenopodia with 10° was corrected with the finite element method based on the three-point force principle, and orthopedic angle and the plantar weight-bearing region before and after the correction were also obtained. The visualization of orthopedic effects and the orthotic principle is clear contributes to clinicians provide important scientific reference for the formulation of scientific and accurate orthopedic regimens.

Chronic ankle instability is a pathology arising from one of the most common orthopedic injuries, lateral ankle sprains. The gold standard surgical procedure for lateral ankle instability is repair of the anterior talofibular and calcaneofibular ligaments with imbrication of the inferior extensor retinaculum. The senior author's indications for a modified Brostrom versus a modified Chrisman-Snook have evolved over the past decade. Indications for a modified Chrisman-Snook include: revision reconstruction, generalized laxity, collagen vascular disease, BMI greater than 35, and significant hindfoot varus or midfoot cavus. The primary aim of this report is to provide a narrative review of the Chrisman-Snook procedure and overview of our modified technique.