Podiatry Today Current Issue

Can A Diabetic Foot Surgery Classification System Help Predict Complications?

admin — Wed, 03 Sep 2008 17:01:42 -0400

Various classification systems categorize diabetic wounds and infections. One system, devised in 2003, categorizes different levels of non-vascular diabetic foot surgery. How effective is such a system? A recent study, the first to evaluate the system’s effectiveness, suggests including various risk factors in the system may better predict surgical complications. The study, presented as an abstract at the American College of Foot and Ankle Surgeons Annual Scientific Meeting, evaluates the classification system’s four categories: elective, prophylactic, curative and emergency surgery. Res

Key Considerations For Utilizing Silver Dressings

admin — Wed, 03 Sep 2008 17:01:42 -0400

Given the increasing prevalence of antimicrobial resistance, there is a growing interest in emerging wound care products that contain silver. Topical silver has a broad range of antimicrobial activity and has been used extensively to help treat high-risk burn patients. Research has confirmed that silver is effective against gram negative and positive bacteria, methicillin resistant Staph aureus (MRSA), yeast, filamentous fungi and viruses (including varicella zoster and herpes simplex types I and II).^1-4 Interestingly, the use of silver for medicinal purposes has been docume

Plantar Calcaneal Spurs: Is Surgery Necessary?

admin — Wed, 03 Sep 2008 17:01:42 -0400

The etiology of heel pain is quite varied. First described by Wood in 1812, the most common cause is thought to be plantar fasciitis. This is typically marked by focal tenderness to any component of the aponeurosis but most frequently at the proximal medial insertion of the plantar aponeurosis.¹ Many symptomatic patients with plantar fasciitis demonstrate plantar heel spurs (traction enthesopathies) of the os calcis. One may best appreciate this shelf of exostosis on the lateral and lateral oblique views of standard radiographic studies.² On rare occasions, fracture of

Assessing The Pros And Cons Of Subtalar Implants

admin — Wed, 03 Sep 2008 17:01:42 -0400

“Collapsing” pes planovalgus or flexible flatfoot is a complex pedal pathological condition with numerous components. In its most significant form, the condition can lead to significant disabling and an inability to ambulate efficiently. Arthroereisis is a relatively modern surgical technique one may employ for pes planovalgus correction. Arthroereisis is defined as the limitation of exogenous joint motion without complete arthrodesis. This procedure, which involves placing a motion blocking implant within the sinus tarsi, has been designed to restrict excessive subtalar joint (STJ) pron

Plantar Fasciitis: How To Maximize Outcomes With Conservative Therapy

admin — Wed, 03 Sep 2008 17:01:42 -0400

Plantar fasciitis is often inaccurately referred to as “heel spur syndrome.” Clinicians should no longer use this terminology. Most of the time, the presence or absence of a plantar calcaneal spur has no effect on symptoms or treatment. The term fasciitis may also be a misnomer. Lemont studied the pathology of 50 patients who underwent fascial release surgery.¹ The findings did not show any evidence of inflammatory cells within the fascia. The common finding was degeneration of the tissue. The inflammation appears to be in the underlying intrinsic musculature so perhaps the corr

Secrets To Managing Complications Of First MPJ Fusion

admin — Wed, 03 Sep 2008 17:01:42 -0400

Arthrodesis of the great toe joint has been described for the repair of just about every problem affecting the great toe joint, including hallux valgus, hallux varus, hallux limitus/rigidus, osteoarthritis, rheumatoid arthritis and salvage of failed surgeries of the first ray. Many foot surgeons view the great toe joint fusion as a salvage procedure and will not consider it for primary repair of hallux valgus or hallux rigidus. One of the reasons for doing any type of fusion surgery is to stabilize an unstable or hypermobile joint. With that said, the great toe joint fusion can be benefi

A Closer Look At The Percutaneous Calcaneal Displacement Osteotomy

admin — Wed, 03 Sep 2008 17:01:42 -0400

Podiatric surgeons commonly perform an extraarticular calcaneal osteotomy on hindfoot deformities of the foot and ankle.¹ One would typically perform this powerful osteotomy in conjunction with other procedures. Complications with the percutaneous calcaneal displacement osteotomy are rare.^2-4 This is in contrast to the customary lateral approach of a calcaneal osteotomy as the surgeon may see complications that include wound dehiscence, sural nerve damage, sural neuritis, delayed union, non-union, infection and invasion of the medial neurovascular structures.^{2-6read more}

Soft Tissue Masses: When To Treat, When To Refer

admin — Wed, 03 Sep 2008 17:01:42 -0400

The recognition and characterization of soft tissue tumors is central to the practice of podiatric medicine. In many instances, clinicians of the lower extremity serve as the frontline physicians when it comes to the identification of such tumors. Given the inverse relationship between the amount of time prior to diagnosis and patient survival rates, the role of podiatrists may be of paramount importance. Depending upon one’s depth of experience and comfort level, some clinicians might limit their role to clinical recognition and ordering preliminary imaging studies. Others may go a step

Why The Lapidus Procedure Is Ideal For Bunions

admin — Wed, 03 Sep 2008 17:01:42 -0400

With over 50 different surgical procedures in the literature relating to bunion surgery, there is a great deal of debate as to the best surgical procedure. Some consider a minimum incision technique to be ideal while others believe an open and more extensive correction is the best. For years, I have pondered the best surgical procedure for hallux valgus correction and have tried many of the procedures. I have come to some conclusions that have dramatically changed my practice and resulted in far better outcomes related to hallux valgus correction. First and foremost, I have to state that th

Is Microdebridement A Viable Option For Treating Tendinosis?

admin — Wed, 03 Sep 2008 17:01:42 -0400

Many people suffer from tendinosis or similar tendon aliments that involve tissue scarring. In seeking relief for their pain and discomfort, patients may try a variety of conservative modalities ranging from bracing to injections. If conservative methods fail, there is another option before one considers the possibility of an invasive surgical procedure. The Topaz Microdebrider (Arthrocare) enables clinicians to perform microdebridement of soft tissue, such as tendons, in the foot and ankle. Essentially, the device uses radiofrequency energy to cause microscopic “trauma” to the scar tissu