January 2007 (Volume 2, No.1)

1.  Haglund’s Correction with Removal Retrocalcaneal Spur and Transverse Achilles Tenoplasty: 2 Case Reports Al Kline, DPM [HTML] [PDF]

Abstract: Two case presentations are described using a transverse incision technique for Achilles tendon repair. This approach differs from the vertical incisional approach of tendon repair that is most often described in the literature. These two cases represent the most severe type of retrocalcaneal exostosis. The transverse incisional approach allows adequate exposure and removal of bone. Both cases utilize soft tissue anchor sutures to plicate the tendon directly to raw bone with secure and strong fixation of the tendon attachment. An in-depth discussion is outlined discussing the anatomy of the posterior calcaneus and the Achilles tendon attachment into the posterior calcaneal tubercle. The vertical and transverse tenoplasty are compared and discussed. A literary review of Achilles attachment supporting this technique is introduced. Mid-line, vertical incisions continue to have their place in tendon pathology that may require removal of mid-tendon pathology. However, in the absence of such pathology, this technique is an alternative to mid-line transection of the tendon.

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2.  Subungual Verruca or Benign Squamous Papilloma under the Toenail: A Case Report Al Kline, DPM

Abstract: Benign squamous verrucae is from HPV or human papillomavirus origin. It is commonly called verrucae vulgaris or common wart. Although not as common as plantar warts, a case is presented describing subungual squamous papilloma. Differential diagnosis and treatment is discussed.

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3.  Streptococcal Group-B Osteomyelitis of the Foot: A Case Presentation Al Kline, DPM [HTML] [PDF]

Abstract: Osteomyelitis is a challenging condition to treat in the foot. Although staphylococcal osteomyelitis has been more commonly reported, there appears to be an increasing emergence of streptococcal infections reported in the literature. Streptococcal infections can be much more virulent in their presentation and more difficult to treat. A case is presented describing streptococcal infection of bone in the fifth metatarsal head. A panel discussion includes current concepts on metatarsal resection and the appropriate time to close a surgical wound in the presence of osteomyelitis. Conclusions derived from this case study would support leaving a surgical wound open in the presence of osteomyelitis, especially in the presence of streptococcal organisms.

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4.  Talar Osteochondral Defect Grafting with NEXA Orthopedics OsteoCure™ Bone Graft Mark A. Hardy, DPM,FACFAS , Jonathan Sharpe, DPM

Abstract: Osteochondritis dessicans of the ankle is a condition often encountered by the foot and ankle physician. Many treatments have been described in the literature including cast immobilization, arthroscopic debridement, open debridement, and autogenous grafting. The NEXA OsteoCure™ bone graft plug allows for immediate lesion excision while avoiding the morbidity associated with obtaining an autograft. The authors provide a brief review of talar dome lesions including staging and classification and their experience and technique involved for utilizing NEXA Orthopedics OsteoCure™ bone graft plugs.

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5.  Aneurysmal Bone Cyst of the Middle Cuneiform: A case report Al Kline, DPM

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.

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