Volume 2, No. 12
Anniversary Issue-Selected Articles from PIJ, now The Foot & Ankle Journal
A Simple Classification System for the Treatment of Ingrown Toenails Al Kline, DPM
Jones Fracture: A case report with Special Emphasis on Fixation PlacementAl Kline, DPM [HTML]
Abstract: The Jones fracture describes a fracture to the base of the fifth metatarsal. It was named after Sir Robert Jones, who in 1902, sustained this fracture while dancing around a maypole at a garden dance. The injury is caused by stress plantarflexion and inversion. While there are a number of techniques used to fix the fracture, a case report is highlighted that presents an open reduction and internal fixation using a Synthese 3.0 cannulated screw. This report highlights the ideal placement for the screw in a Type 3 (Stewart Classification) fracture. Special emphasis is placed on screw head placement along the inferior depression of the metatarsal tuberosity. In an earlier article, we discussed the anatomy of the fifth metatarsal. The anatomical outline of the fifth metatarsal will be repeated in this article.
Cuboid Decompression for Treatment of Plantar Ulcers in Charcot Arthropathy: A Modified Incisional ApproachAl Kline, DPM [HTML]
Abstract: A modified approach to resolving plantar cuboid ulcers as a complication of Charcot Arthropathy is discussed. Historically, two basic approaches to addressing plantar cuboid ulcerations involves 1) an elipse with skin flap to promote primary closure and 2) an incision along the lateral border of the foot away from the ulcer. We discuss a modified technique to a plantar approach incision that creates a closure flap without the need for aggressive undermining of tissue. This modified technique has several advantages: 1) a hand and glove type fit of the tissue and skin edges, 2) a small length incision and 3) undermining of tissue flaps is usually not necessary. A case presentation is described.
Aneurysmal Bone Cyst of the Middle Cuneiform: A case report Al Kline, DPM [HTML] [PDF]
Abstract: The incidence of Aneurysmal bone cysts (ABC’s) is rare. About 1% of all primary bone tumors constitute these lesions. They are most common in the upper extremity and rarely are reported in the foot. A case is presented reporting ABC of the middle cuneiform. To date, this appears to be the only documented case of ABC to the middle cuneiform. Surgical presentation and treatment using AlloMatrix ® bone putty as a moldable composite for an small, uncontained defect is described. Tuberculosis of the Foot: A case report J. Terrence Jose Jerome, MBBS, DNB (Ortho), MNAMS (Ortho), Mathew Varghese, M.S., Balu Sankaran, FRCS,FAMS [HTML] [PDF]
Abstract: A case report discusses the presentation, diagnosis and treatment of a 22 year old male who presents with extra-pulmonary tuberculosis of the foot. Extra-pulmonary tuberculosis is extremely rare and accounts for less than 10% of osteoarticular tuberculosis. Radiographic and MRI correlations are introduced.
Delayed Primary Closure of Diabetic Foot Wounds using the DermaClose™ RC Tissue Expander David L. Nielson, DPM, Stephanie C. Wu, DPM, MSc, David G. Armstrong, DPM, PhD [HTML] [PDF]
Abstract: Closure of large wounds has been a challenge in podiatric surgery, especially after large defects created by ulcer debridement, metatarsal resection and amputation. The DermaClose™ RC tissue expander allows for closure of large defects without the need for traditional complex skin closure, tissue grafting or creation of skin and tissue flaps. Skin anchors made of surgical steel clips are used with a tension controller to allow for gentle skin stretching on the subcutaneous planes of the wound or defect. It also has special application in the closure of chronic wounds. Two case reports are presented to describe this technique.Synovial Sarcoma of the Foot: A case report John Salamone, DPM, Martha A. Anderson, DPM [HTML] [PDF]
Abstract: Synovial sarcoma is a rare soft tissue neoplasm commonly found in the lower extremity. It is included in the differential diagnosis of all soft tissue masses of the foot and ankle. It has a particular predilection for the lower extremity. Early diagnosis and staging with definitive treatment provides the highest probability in preventing metastasis and local recurrence. A case of synovial sarcoma masquerading as sesamoiditis is presented. Clinical, MRI and histopathologic findings are presented. Haxthausen’s Disease or Keratoderma Climactericum: A case report
Al Kline, DPM [HTML] [PDF]
Abstract: A case report is presented describing Haxthausen’s Disease or Keratoderma Climactericum. This condition is characterized by hyperkeratosis of both the palms and soles in post-menopausal women. The exact etiology of the disease is unknown, but it only occurs in women with hormonal imbalances as a result of menopause or after hysterectomy and often associated with uncontrolled hypertension. The dermatitis begins as simple keratoses that progresses and coalesces to form diffuse palmar and plantar keratoses with fissures.Stingray Envenomation of the Foot: A case report Al Kline, DPM [HTML] [PDF]
Abstract: Stingrays are docile marine animals that only strike their victim when provoked or startled. Lower extremity and foot envenomation is common when fishing in shallow waters off the beach. The stingray tail has a sharp, serrated barb along the proximal third of the tail that is usually hidden and encased in an integumentary sheath and can deliver painful enzymes causing tissue necrosis. Immediate treatment including rapid cleansing and heat submersion of the foot is recommended after injury. If treatment is delayed, infection from marine bacteria often requires hospitalization including intravenous antibiotics and surgical treatment. Open Extrusion of the Talus: A case report Mark A. Hardy, DPM, FACFAS, Stella Chiunda, DPM [HTML] [PDF]
Abstract: Open talar extrusion is an uncommon injury that the foot and ankle surgeon may encounter. Possible sequelae of this injury include arthrosis, osteomyelitis and avascular necrosis (AVN). The authors present a case involving an open lateral talar extrusion, with further discussion including mechanism of injury, anatomical considerations, incidence of AVN and perioperative concerns. Chondroblastic Osteosarcoma of the Lower Tibia: A case report J. Terrence Jose Jerome, MBBS, DNB (Ortho), MNAMS (Ortho), Mathew Varghese, M.S., Balu Sankaran, FRCS,FAMS [HTML] [PDF]
Abstract: Osteosarcoma is the third most common cancer in adolescence, occurring less frequently than only lymphomas and brain tumors. It is thought to arise from a primitive mesenchymal bone-forming cell and is characterized by production of osteoid. The most common form of treatment is removal of the lesion. Limb-sparing procedures can often be used to preserve function. Chemotherapy is also required to treat micrometastatic disease, which is present, but not detectable in most patients at diagnosis. We present a chondroblastic osteosarcoma of the lower tibia in a 13 year old boy. Diagnosis was confirmed by MRI and histopathology. Neo-adjuvant chemotherapy, en bloc resection of the tumor with ankle arthrodesis, fibular grafting and post-operative chemotherapy was performed. The patient made a full clinical and symptomatic recovery after 2 years of follow-up.
Aberrant Tendo-Achilles Tendon in Club Foot: A case report J. Terrence Jose Jerome, MBBS, DNB (Ortho), MNAMS (Ortho), Mathew Varghese, M.S., Balu Sankaran, FRCS,FAMS , Rajendra Kumar Gupta (Ortho), Simon Thomas MBBS,DNB (Ortho), MNAMS (Ortho), Amit Mittal (Ortho) [HTML] [PDF]
Abstract: A case report discusses the presentation and treatment of a baby boy with club foot deformity. The baby was initially treated by Ponseti’s method of weekly POP casting. The club foot did not reduce after 6 weeks of serial casting. The boy then underwent percutaneous Achilles tendon lengthening and placed in a Steinbek Splint. After 12 weeks, the equinus persisted and we decided to perform an open Achilles lengthening. An aberrant tendoachilles tendon was discovered during open tenotomy and this was released. Once the aberrant tendon was released, the club foot reduced and at 9 months, the baby could walk with good heel strike and the foot was supple with no residual deformity.
Gaenslen’s Heel Incision for Calcaneal Osteomyelitis: A case report J. Terrence Jose Jerome, MBBS, DNB (Ortho), MNAMS (Ortho), Mathew Varghese, M.S., Balu Sankaran, FRCS,FAMS , Simon Thomas MBBS,DNB (Ortho), MNAMS (Ortho) [HTML] [PDF]
Abstract: Patients who have a recurrent ulcer of the heel often have a below-the-knee amputation because durable soft tissue coverage cannot be obtained over the calcaneus. Often, even if the ulcer heals satisfactorily or the area appears to be revascularized as a result of a peripheral vascular procedure, the resulting surface is not durable and the ulcer recurs. We report a 40 year old lady who had a chronic osteomyelitis right calcaneum with a large non-healing ulcer and discharging sinus, treated by split heel incision of Gaenslen.
no comments yet
