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Foot and Ankle Clinics

journal
https://www.readbyqxmd.com/read/29362038/management-of-metatarsalgia-and-lesser-toe-deformities
#1
EDITORIAL
Todd A Irwin
No abstract text is available yet for this article.
March 2018: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/29362037/treatment-of-rigid-hammer-toe-deformity-permanent-versus-removable-implant-selection
#2
REVIEW
Jesse F Doty, Jason A Fogleman
Hammer-toe deformities that fail nonoperative treatment can be successfully addressed with proximal interphalangeal joint resection arthroplasty or fusion. The goal of surgery is to eliminate the deformity and rigidly fix the toe in a well-aligned position. Hammer-toe correction procedures can be performed with temporary Kirschner wire (K-wire) fixation for 3 to 6 weeks with high success rates. Pain relief with successful hammer-toe correction approaches 90%; patient satisfaction rates approximate 84%. Although complication rates are rare in most series, there remains a concern regarding exposed temporary K-wire fixation, which has led to the development of multiple permanent internal fixation options...
March 2018: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/29362036/conservative-management-of-metatarsalgia-and-lesser-toe-deformities
#3
REVIEW
Andrew E Federer, David M Tainter, Samuel B Adams, Karl M Schweitzer
There are several forefoot conditions that can result in metatarsal head pain. Various points of the gait cycle can predispose the metatarsal heads to pain based on intrinsic and extrinsic imbalances. Metatarsalgia can further be classified according to primary, secondary, or iatrogenic etiologies. Within these groups, conservative management is the first line of treatment and can often obviate surgical intervention. Depending on the cause of pain, proper shoewear, orthoses, and inserts coupled with targeted physical therapy can alleviate most symptoms of metatarsalgia and lesser toe deformities...
March 2018: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/29362035/treatment-of-flexible-lesser-toe-deformities
#4
REVIEW
Solenne Frey-Ollivier, Fernanda Catena, Marianne Hélix-Giordanino, Barbara Piclet-Legré
Lesser toe deformities are among the most common complaints presented to foot and ankle specialists. These deformities present in variable ways, which makes surgical decision making complex. For every type of deformity, there could be a combination of soft tissues and bony procedures, chosen according to the surgeon's preferences. This article first describes modern classification of lesser toe deformities, and then presents the different treatments and procedures available for those flexible deformities. In addition, this article proposes an algorithm based on clinical/radiological evaluation and step-by-step surgical decision making...
March 2018: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/29362034/gastrocnemius-recession-for-metatarsalgia
#5
REVIEW
Rose E Cortina, Brandon L Morris, Bryan G Vopat
Metatarsalgia is a common cause of plantar forefoot pain. Causes of metatarsalgia include foot anatomy, gait mechanics, and foot and ankle deformity. One specific cause, mechanical metatarsalgia, occurs because of gastrocnemius muscle contracture, which overloads the forefoot. Muscular imbalance of the gastrocnemius complex alters gait mechanics, which increases recruitment of the toe extensor musculature, thereby altering forefoot pressure. Patients with concomitant metatarsalgia and gastrocnemius contracture demonstrate ankle equinus and a positive Silfverskiold test...
March 2018: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/29362033/metatarsal-osteotomies-complications
#6
REVIEW
Veerabhadra Babu Reddy
Metatarsal osteotomies can be divided into proximal and distal. The proximal osteotomies, such as the oblique, segmental, set cut, and Barouk-Rippstein-Toullec (BRT) osteotomy, all provide the ability to significantly change the position of the metatarsal head without violating the joint. These osteotomies, however, have a high rate of nonunion when done without internal fixation and can lead to transfer metatarsalgia when done without regard to the parabola of metatarsal head position. Distal osteotomies such as the Weil and Helal offer superior healing but have an increased incidence of recurrent metatarsalgia, joint stiffness, and floating toe...
March 2018: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/29362032/treatment-of-metatarsalgia-with-proximal-osteotomies
#7
REVIEW
Emily C Vafek, Simon Lee
Metatarsalgia is among the most common sources of forefoot pain. Proximal metatarsal osteotomies are an important technique in the armamentarium of the surgeon treating metatarsalgia that has failed nonoperative management. Proximal osteotomies can provide powerful deformity correction with precise control to both shorten and elevate the metatarsal head. However, they can be technically challenging, difficult to attain satisfactory fixation, require increased postoperative immobilization, and can result in transfer lesions...
March 2018: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/29362031/treatment-of-metatarsalgia-with-distal-osteotomies
#8
REVIEW
David Redfern
Many different distal metatarsal osteotomies have been described in the surgical treatment of metatarsalgia. The surgeon should use such osteotomies judiciously, and indeed, in the author's experience, they are infrequently required and are certainly not a first port of call. In cases where nonoperative treatments have failed, a thorough understanding of the causes of metatarsalgia and a detailed clinical assessment of the patient are essential if good surgical outcomes are to be achieved. If using distal metatarsal osteotomies as part of the surgical plan, then the author favors extra-articular percutaneous osteotomies to minimize postoperative stiffness...
March 2018: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/29362030/treatment-of-freiberg-disease
#9
REVIEW
Jeffrey D Seybold, Jacob R Zide
Freiberg disease, or osteochondrosis of the lesser metatarsal head, usually involves the second metatarsal and presents during the second or third decades of life. Conservative measures to relieve pressure on the affected metatarsal head are the first-line treatments, with good success for Smillie stage I to III disease. Operative treatments are divided into joint-preserving and joint-reconstructing procedures. Although multiple case series describe success with numerous techniques, there are no established guidelines for treatment...
March 2018: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/29362029/managing-complications-of-lesser-toe-and-metatarsophalangeal-joint-surgery
#10
REVIEW
Phinit Phisitkul
The anatomy of the lesser toes is highly complicated and not yet well understood. The high propensity of the metatarsophalangeal joint to develop hyperextension deformity should be recognized. Surgeons should provide each patient with a realistic expectation for lesser toe reconstructive procedures. A successful surgical result requires a well-planned procedure, accurate execution using proper techniques, and meticulous postoperative care. When complications occur, surgeons should identify culprits so that proper treatment strategies can be successfully executed...
March 2018: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/29362028/lesser-metatarsophalangeal-joint-instability-advancements-in-plantar-plate-reconstruction
#11
REVIEW
Raymond Y Hsu, Alexej Barg, Florian Nickisch
The plantar plate and associated collateral ligaments are the main stabilizers of each of the lesser metatarsophalangeal joints. Although clinical examination and plain radiographs are usually sufficient to establish the diagnosis of a plantar plate tear, MRI or fluoroscopic arthrograms may help in specific cases. Recent results with a dorsal approach to plantar plate repair are promising with respect to pain relief and patient satisfaction.
March 2018: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/29362027/lesser-metatarsophalangeal-joint-instability-treatment-with-tendon-transfers
#12
REVIEW
Caio Nery, Daniel Baumfeld
Complex digital deformities and metatarsophalangeal joint instability encompass a wide range of pathology, and we must identify the different degrees of ligamentous disruption. It is important to address a combination of procedures to treat gross deformities of the lesser toes. Surgical treatment should be individualized and requires a sequential process for adequate reduction and deformity correction. There is no gold standard procedure for every deformity. Although residual stiffness can result from tendon transfer, overall patient satisfaction levels remain high when it is performed under the proper indications and concomitantly with other procedures to gain full correction of these challenging deformities...
March 2018: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/29362026/anatomy-and-physiology-of-the-lesser-metatarsophalangeal-joints
#13
REVIEW
Fred T Finney, Ezequiel Cata, James R Holmes, Paul G Talusan
Knowledge and command of anatomy is paramount to effectively treating disorders of the lesser metatarsophalangeal (MTP) joints. The osseous structures consist of the proximal phalanx of the toe and the metatarsal head. The soft tissues on the dorsum of the MTP joint include the joint capsule and the tendons of extensor digitorum longus and extensor digitorum brevis. The proper and accessory collateral ligaments form the medial and lateral walls and contribute to stability in the coronal and sagittal planes...
March 2018: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/29078833/all-those-worms
#14
EDITORIAL
Selene G Parekh
No abstract text is available yet for this article.
December 2017: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/29078832/chronic-rupture-of-the-peroneal-tendons
#15
REVIEW
Kamran S Hamid, Annunziato Amendola
Chronic rupture of the peroneal tendons can be a functionally limiting condition with a multitude of causes. Conservative and operative interventions are heterogenous and tailored to the functional demands of the patient. Surgical plans are based on muscle viability, patient preference, and surgeon expertise. Clinical outcomes evidence remains limited in this domain, and further well-designed studies are warranted to guide treatment.
December 2017: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/29078831/acute-peroneal-injury
#16
REVIEW
James W Brodsky, Jacob R Zide, Justin M Kane
A high clinical suspicion and greater understanding of the anatomy and pathophysiology of lateral ankle injuries have enabled early diagnosis and treatment-improving outcomes of acute peroneal tendon tears. Multiple conditions can be the cause of lateral ankle pain attributed to the peroneal tendons: tenosynovitis, tendinosis, subluxation and dislocation, stenosing tenosynovitis, abnormality related to the os peroneum, as well as tears of the peroneal tendons. It is imperative for the clinician to maintain a high suspicion for peroneal tendon abnormality when evaluating patients with lateral ankle pain...
December 2017: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/29078830/treatment-of-acute-and-chronic-tibialis-anterior-tendon-rupture-and-tendinopathy
#17
REVIEW
Elizabeth Harkin, Michael Pinzur, Adam Schiff
Tibialis anterior (TA) tendon rupture is a rare injury that has been described and studied in orthopedic literature through case reports and low-volume case studies. This article reviews the current literature on TA tendinosis and acute and chronic ruptures. It discusses the patient presentation, physical examination, nonoperative management, surgical treatment options, and outcomes.
December 2017: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/29078829/what-do-you-do-with-the-achilles-if-you-have-no-fancy-toys
#18
REVIEW
Rajiv Shah, Sampat Dumbre Patil
Surgical management of Achilles disorders warrants excision of the degenerated tendon and removal of impinging bone. Resulting defects can be bridged by various methods. Although FHL is the most commonly used tendon for transfer, large defects in cases of chronic Achilles ruptures may be bridged by use of a distant donor tendon. Bony anchorage of a lengthened or transferred tendon into the calcaneus can be done with suture anchors or with interference screws. In developing countries, such implants may not be available or affordable, necessitating the adoption of innovative ways to anchor tendons into the calcaneus...
December 2017: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/29078828/using-arthroscopic-techniques-for-achilles-pathology
#19
REVIEW
Rebecca Cerrato, Paul Switaj
Endoscopically assisted procedures have been established to provide the surgeon with minimally invasive techniques to address common Achilles conditions. Modifications to some of these techniques as well as improvements in instrumentation have allowed these procedures to provide similar clinical results to the traditional open surgeries while reducing wound complications and accelerating patient's recoveries. The available literature on these techniques reports consistently good outcomes with few complications, making them appealing for surgeons to adopt...
December 2017: Foot and Ankle Clinics
https://www.readbyqxmd.com/read/29078827/insertional-tendinopathy-of-the-achilles-debridement-primary-repair-and-when-to-augment
#20
REVIEW
Rachel J Shakked, Steven M Raikin
Insertional Achilles tendinopathy is a degenerative enthesopathy associated with pain and dysfunction. Nonsurgical management is first attempted for a period of 3 to 6 months and may consist of physical therapy with eccentric training and other modalities. Surgical treatment can be successful with a variety of approaches. A thorough debridement through a midline tendon-splitting approach is associated with high satisfaction rates. Flexor hallucis longus transfer to augment the repair is considered in older, heavier patients or if more than 50% of the tendon was debrided...
December 2017: Foot and Ankle Clinics
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