Podiatry Today

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Managing the Diabetic Foot: A Clinical and Economic View Complimentary Archived Webcast
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Understanding Collagen Dressings and their Benefit in Wound Care

Complimentary Archived Webcast
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To Radiograph Or Not To Radiograph A Bunion Deformity: What The Intraoperative Findings Reveal

Molly Judge DPM FACFAS's picture
Blog By: Molly Judge DPM FACFAS

Figure 1. This case appeared as a “jumbo IM bunion” clinically and seemed rather bland radiographically. Figure 2. Here one can see a large intra-capsular mass mimicking an enlarged medial eminence. Figure 3. This photo reveals evidence that one can lift and reflect the capsule from around this unusual soft tissue mass. Figure 4. With close inspection, this photo reveals a giant, well organized tophaceous deposit. Figure 5. Here it is easy to appreciate that the joint has been completely eroded and is shut down. There is a hardened chalk white margin to the joint that represents the acidic destruction of concentrated uric acid crystal deposition. Figure 6. This simply illustrates the chalky in-growth of uric acid deposition interspersed over a completely degenerative changes in the first metatarsal head. Figures 7. Here is a medial view of the end result after excision of the mass, an aggressive debridement of the joint and sodium bicarbonate lavage. Figure 8. This is a frontal view following excision of the mass. The author performed a modified cheilectomy and the patient began range of motion exercises within the first week of surgery.
Figure 1. This case appeared as a “jumbo IM bunion” clinically and seemed rather bland radiographically.
Figure 2. Here one can see a large intra-capsular mass mimicking an enlarged medial eminence.
Figure 3. This photo reveals evidence that one can lift and reflect the capsule from around this unusual soft tissue mass.
Figure 4. With close inspection, this photo reveals a giant, well organized tophaceous deposit.
Figure 5. Here it is easy to appreciate that the joint has been completely eroded and is shut down. There is a hardened chalk white margin to the joint that represents the acidic destruction of concentrated uric acid crystal deposition.
Figure 6. This simply illustrates the chalky in-growth of uric acid deposition interspersed over a completely degenerative changes in the first metatarsal head.
Figures 7. Here is a medial view of the end result after excision of the mass, an aggressive debridement of the joint and sodium bicarbonate lavage.
Figure 8. This is a frontal view following excision of the mass. The author performed a modified cheilectomy and the patient began range of motion exercises within the first week of surgery.

In the discussion of whether or not you really need to use X-rays in bunion surgery, there seem to be more posted comments in my camp (see see http://www.podiatrytoday.com/blogged/emphasizing-the-importance-of-radio... and http://www.podiatrytoday.com/blogged/can-you-select-a-bunion-procedure-b...). I have always considered the radiographic evaluation an important component of both the preparation for and execution of bunion surgery.


Emphasizing The Importance Of Radiographs In Choosing A Bunion Procedure

Molly Judge DPM FACFAS's picture
Blog By: Molly Judge DPM FACFAS

I have enclosed the radiographs (see above) that are associated with the case I presented in last month’s blog (http://www.podiatrytoday.com/blogged/can-you-select-a-bunion-procedure-b...). How does this change your procedure selection and are there any further tests you would order?


Can You Select A Bunion Procedure Based Solely On Clinical Evaluation?

Molly Judge DPM FACFAS's picture
Blog By: Molly Judge DPM FACFAS

Dorsal ViewFrontal PlaneMedial View
Dorsal View
Frontal Plane
Medial View

I was talking with some colleagues of mine recently and we were reviewing bunion surgery, the most common of the elective procedures that we perform. During this conversation, one more experienced colleague said he really does not even need X-rays as he can tell from the clinical evaluation what procedure is going to work out best for the patient. At this point in his career, he feels that getting X-rays is now simply an issue of medicolegal documentation rather than a tool for measuring angles and procedure selection. Most of the others at the table seemed to agree with his philosophy.


Failure To Biopsy: When Alleged ‘Wound Care Specialists’ Fall Short Of The Standard Of Care

Molly Judge DPM FACFAS's picture
Blog By: Molly Judge DPM FACFAS

I do not know about you but I continue to find myself wondering who are these so-called wound care specialists who undertake management of wounds but are nowhere to be found when bad wounds take a turn for the worse.


Keys To Identifying Patients At Risk For Charcot Foot

Molly Judge DPM FACFAS's picture
Blog By: Molly Judge DPM FACFAS

It is well known that patients who present with the acute or chronic Charcot joint require a tremendous amount of time, energy and effort in both patient education and proactive management in an attempt to reduce the risk of limb loss.


Enduring The Endless Paperwork Shuffle: Why Tort Reform Is Essential

Molly Judge DPM FACFAS's picture
Blog By: Molly Judge DPM FACFAS

Have you gone to a hospital for a case using local anesthesia lately? It has truly become bizarre. When I began private practice in 1997, you could walk into the hospital, fill out little more than a consent form and you could be in and out as fast as you would at any outpatient surgery center.


Why We Need To Take A Closer Look At The Roles Of ‘Wound Care Specialists’

Molly Judge DPM FACFAS's picture
Blog By: Molly Judge DPM FACFAS

Currently, there are a number of people on the health care team touting themselves as wound care specialists. For those of you who may not know, the term “wound care specialist” does not imply a physician, a physician’s assistant or even a member of the nursing staff for that matter. Scores of people who might otherwise be considered “volunteer staff” or “nursing assistants” are now being sent for an abbreviated course in wound care products and, after taking this course, are subsequently referred to as “wound care specialists.”


Vessel Loops: A Simple Alternative For Wound Closure

Molly Judge DPM FACFAS's picture
Blog By: Molly Judge DPM FACFAS

Among the many tips, quips and pearls that we have learned over the years, some techniques will stand the test of time better than others. Indeed, some techniques are more a matter of fad than function and will soon fall by the wayside. Valuable techniques, those that become a part of every day practice, serve patients very well and become a part of the standard of care.








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