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Clinics in Podiatric Medicine and Surgery

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https://www.readbyqxmd.com/read/28576199/foot-and-ankle-arthrodesis
#1
EDITORIAL
John J Stapleton
No abstract text is available yet for this article.
July 2017: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/28576198/current-orthobiologics-for-elective-arthrodesis-and-nonunions-of-the-foot-and-ankle
#2
REVIEW
George F Wallace
A fusion rate of 100% would be ideal. Despite adhering to sound surgical principles, complete compliance, and no adverse comorbidities, that 100% fusion rate goal is elusive. Orthobiologics are a special class of materials developed to enhance the fusion rates in foot and ankle arthrodesis sites. Whether orthobiologics are used for the first fusion or reserved for a nonunion is debatable, especially when considering cost.
July 2017: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/28576197/soft-tissue-coverage-after-revisional-foot-and-ankle-surgery
#3
REVIEW
Geoffrey G Hallock
Unlike the traumatic "mangled" foot and ankle in which amputation could be an acceptable if not preferred option, revisional foot and ankle surgery starts with a viable foot that is then injured by the surgeon hopefully to benefit the patient. Any untoward sequela, such as inadequate wound healing, instead always requires consideration of limb salvage. Unfortunately, this may not be so simple. A proactive approach to solve this problem in a timely fashion is important. The goal must always be to get a healed wound so the final result improves the ability for independent ambulation by the patient...
July 2017: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/28576196/management-of-osteomyelitis-and-bone-loss-in-the-diabetic-charcot-foot-and-ankle
#4
REVIEW
Daniel J Short, Thomas Zgonis
Bone loss and destruction due to diabetic Charcot neuroarthropathy (CN) and osteomyelitis of the foot and ankle is a challenging clinical condition when lower extremity preservation is considered. Resection and excision of osteomyelitis and associated nonviable soft tissue can lead into large osseous and soft tissue defects that will most likely need the utilization of bone grafting and subsequent arthrodesis for stability and anatomic alignment. In the diabetic population with peripheral neuropathy, osseous instability can lead to subsequent lower extremity deformity, ulceration, infection and/or amputation...
July 2017: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/28576195/tibiotalocalcaneal-arthrodesis-for-foot-and-ankle-deformities
#5
REVIEW
Patrick R Burns, Augusta Dunse
Tibiotalocalcaneal arthrodesis is a safe and viable option to treat patients with arthridities affecting ankle and subtalar joints, neuromuscular disorders, avascular necrosis of the talus, failed ankle arthrodesis, instability, and Charcot neuroarthropathy. Choice of incision and fixation is based on deformity, pathology, prior surgery and hardware, and surgeon comfort and preference. Intramedullary nails offer high primary stability, reduce sustained soft tissue damage, and may allow for earlier return to activities than traditional plate or screw constructs...
July 2017: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/28576194/operative-fixation-options-for-elective-and-diabetic-ankle-arthrodesis
#6
REVIEW
Crystal L Ramanujam, John J Stapleton, Thomas Zgonis
Ankle arthrodesis remains one of the most definitive treatment options for end-stage arthritis, paralysis, posttraumatic and postinfectious conditions, failed total ankle arthroplasty, and severe deformities. The general aims of ankle arthrodesis are to decrease pain and instability, correct the accompanying deformity, and create a stable plantigrade foot. Several surgical approaches have been reported for ankle arthrodesis with internal fixation options. External fixation has also evolved for ankle arthrodesis in certain clinical scenarios...
July 2017: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/28576193/hindfoot-arthrodesis-for-the-elective-and-posttraumatic-foot-deformity
#7
REVIEW
John J Stapleton, Thomas Zgonis
Triple (talonavicular, subtalar, and calcaneocuboid) joint arthrodesis and most recently double (talonavicular and subtalar) joint arthrodesis have been well proposed in the literature for surgical repair of the elective, posttraumatic, and/or neuropathic hindfoot deformities. The articulation of the hindfoot with the ankle and midfoot is multiaxial, and arthrodesis of these joints can significantly alter the lower extremity biomechanical manifestations by providing anatomic correction and alignment. This article reviews the indications and preoperative planning for some of the most common procedures to address the hindfoot deformity...
July 2017: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/28576192/subtalar-joint-arthrodesis-for-elective-and-posttraumatic-foot-and-ankle-deformities
#8
REVIEW
Lawrence A DiDomenico, Danielle N Butto
Subtalar joint arthrodesis is a procedure used in posttraumatic arthritis, osteoarthritis, tarsal coalition management, posterior tibial tendon dysfunction, and inflammatory arthropathies, and can be used in deformity correction. The goals of the procedure are to eliminate pain, improve function, restore stability, and realign the hind foot. The procedure has high patient satisfaction with low complications while preserving motion in adjacent tarsal joints. Joint preparation is important and time should be spent preparing the joint for successful arthrodesis and the fixation construct needs to be done well and effectively to provide a solid Arbeitsgemeinschaft für Osteosynthesefragen (AO) construct for good results...
July 2017: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/28576191/tarsometatarsal-arthrodesis-for-lisfranc-injuries
#9
REVIEW
Nicholas J Bevilacqua
This article discusses tarsometatarsal arthrodesis for Lisfranc injuries. Although open reduction and internal fixation has traditionally been the treatment of choice for most Lisfranc fracture-dislocations, there is a trend toward primary fusion, especially for purely ligamentous injuries. Consideration should be made for primary fusion in select fracture-dislocation cases. Primary fusion offers a single-stage alternative with potentially more stable, predictable results overtime.
July 2017: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/28576190/first-metatarsal-phalangeal-joint-arthrodesis-primary-revision-and-salvage-of-complications
#10
REVIEW
Thomas S Roukis
Arthrodesis of the first metatarsal-phalangeal joint has been proposed for treatment of severe hallux valgus, end-stage hallux rigidus, rheumatoid arthritis, and revision of failed surgery due to the perceived safety and efficacy. This article discusses the principles of first metatarsal-phalangeal joint arthrodesis in primary and revision situations, joint preparation, configurations of osteosynthesis, and common complications, including salvage of nonunion and revision of malunion with realignment osteotomy...
July 2017: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/28576189/digital-arthrodesis-of-the-lesser-toes
#11
REVIEW
James P Sullivan, Catherine L Churchill
Foot and ankle surgeons frequently treat digital deformities of the lesser toes surgically. Arthrodesis of the proximal interphalangeal joint is the workhorse procedure for correction of hammer toe contractures. Fusion of the interphalangeal joint can be fixated with a variety of methods, including K-wire fixation, intramedullary implants, absorbable pins, and screws. Each method of fixation has advantages and disadvantages, such as variations in complication rates, cost, and fusion rates. Further research is necessary to determine the best method of fixation for digital interphalangeal joint fusion...
July 2017: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/28257681/the-essential-achilles
#12
EDITORIAL
Paul Dayton
No abstract text is available yet for this article.
April 2017: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/28257680/surgical-correction-of-the-achilles-tendon-for-diabetic-foot-ulcerations-and-charcot-neuroarthropathy
#13
REVIEW
Crystal L Ramanujam, Thomas Zgonis
Achilles tendon pathologic conditions are implicated in contributing to the development of many diabetic foot complications including diabetic foot ulceration and Charcot neuroarthropathy. Surgical correction of the diabetic equinus deformity has been studied as an isolated or adjunctive treatment when dealing with difficult-to-close diabetic foot ulcerations or when surgically addressing the diabetic Charcot neuroarthropathy foot or ankle. This article reviews the most common indications, complications, and surgical procedures for equinus correction by either a tendo-Achilles lengthening or gastrocnemius recession for the management of diabetic foot conditions...
April 2017: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/28257679/repair-of-neglected-achilles-rupture
#14
REVIEW
Bradly W Bussewitz
Acute Achilles tendon ruptures is routinely missed or undertreated, leading to functional deficits. The neglected Achilles ruptures often requires surgical repair to regain functional improvement. The tendon retraction and resultant necessary debridement of the rupture site leads to difficulty completing end-to-end repair. Advanced techniques, including fascial advancements, tendon transfers, and use of allografts, allow the treating surgeon many viable repair options for the neglected Achilles presentation...
April 2017: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/28257678/acute-achilles-rupture-percutaneous-repair-approach-materials-techniques
#15
REVIEW
Jason George DeVries, Brandon M Scharer, Benjamin J Summerhays
Closed traumatic Achilles tendon rupture is a common injury, especially in the aging athlete. Traditionally open repair has been recognized to offer a lower rerupture rate compared with nonoperative methods but with a higher complication rate. Percutaneous repair has been described to offer the benefits of open repair while avoiding the complications. The sural nerve is potentially susceptible to injury, and specialized instrumentation has been developed to avoid this event. This article discusses several techniques of minimally invasive Achilles tendon repair...
April 2017: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/28257677/acute-rupture-open-repair-techniques
#16
REVIEW
Robert D Santrock, Andrew J Friedmann, Andrew E Hanselman
Achilles tendon injuries can be serious injuries requiring either operative or nonoperative management. For appropriate surgical candidates, operative intervention may provide lower rerupture rates and adequate end-to-end tendon healing. Our preference is an open Achilles tendon repair, specifically a limited open technique using the PARS device (Arthrex, Naples, FL). Postoperatively, we use functional rehabilitation and early range of motion. Although the current literature remains controversial regarding operative versus nonoperative management, the authors have obtained satisfactory results in appropriately chosen surgical candidates...
April 2017: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/28257676/acute-achilles-tendon-rupture-clinical-evaluation-conservative-management-and-early-active-rehabilitation
#17
REVIEW
Merrell Kauwe
The Achilles tendon (AT) is the strongest, largest, and most commonly ruptured tendon in the human body. Physical examination provides high sensitivity and specificity. Imaging studies are not recommended unless there are equivocal findings in the physical examination. Recent studies have shown that the risk of re-rupture is negated with implementation of functional rehabilitation protocols. Heterogeneity in study design makes conclusions on the specifics of functional rehabilitation protocols difficult; however, it is clear that early weight bearing and early controlled mobilization lead to better patient outcome and satisfaction in both surgically and conservatively treated populations...
April 2017: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/28257675/equinus-and-lengthening-techniques
#18
REVIEW
Patrick A DeHeer
Equinus is linked to most lower extremity biomechanically related disorders. Defining equinus as ankle joint dorsiflexion less than 5° of dorsiflexion with the knee extended is the basis for evaluation and management of the deformity. Consistent evaluation methodology using a goniometer with the subtalar joint in neutral position and midtarsal joint supinated while dorsiflexing the ankle with knee extended provides a consistent clinical examination. For equinus deformity with an associated disorder, comprehensive treatment mandates treatment of the equinus deformity...
April 2017: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/28257674/insertional-achilles-tendinopathy
#19
REVIEW
Gage M Caudell
Posterior heel pain is a common condition of the foot and ankle and is seen in a variety of foot types. Nonoperative treatment methods consisting of shoes inserts, heel lifts, stretching, physical therapy, nonsteroidal antiinflammatory drugs, eccentric strength training, and other modalities have been shown to have mixed results. When indicated, surgical repair can produce good long-term results. Complications, although uncommon, most commonly result from wound healing complications.
April 2017: Clinics in Podiatric Medicine and Surgery
https://www.readbyqxmd.com/read/28257673/midsubstance-tendinopathy-surgical-management
#20
REVIEW
William T DeCarbo, Mark J Bullock
Noninsertional Achilles tendinopathy often responds to nonoperative treatment. When nonoperative treatment fails, the clinician must distinguish between paratendinopathy and noninsertional tendinopathy. In paratendinopathy, myofibroblasts synthesize collagen, causing adhesions, and the paratenon may be released or excised. If a core area of tendinopathy is identified on MRI, the area is excised longitudinally and repaired with a side-to-side suture. If greater than 50% of the tendon diameter is excised, the authors recommend a short flexor hallucis longus tendon transfer with an interference screw...
April 2017: Clinics in Podiatric Medicine and Surgery
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