Editor’s note: Peripheral nerve decompression for patients with diabetes and lower extremity neuropathy continues to be a hotly debated topic in podiatric medicine and other specialties. The driving force of evidence based medicine has looked critically upon this procedure while many respected surgeons in a variety of fields have found great clinical successes. Dr. Mowen reviews many of the debate topics and presents some helpful information and opinion in this column.
— Dr. Steinberg

It has long been recognized that patients with diabetes experience a higher rate of carpal tunn

Nonunions can be difficult to address with any patient. Accordingly, the surgeon may benefit from any additional modalities that can prevent a recurrent nonunion after a revision. When evaluating a nonunion for surgical revision, one should critically evaluate the primary fixation. If a fixation technique has failed with the use of screws and both sides of the failed fusion have been penetrated, bone pegs can be a consideration for a secondary form of fixation.
The revised fusion will need primary fixation. My personal choice is to place the new fixation in a different manner than the one th

Balance is defined as “the act of maintaining an upright posture in standing or locomotion.” Until recently, human balance was not a function normally evaluated or treated by podiatric physicians. Yet it is now understood that many of the pathologies we treat are accompanied by significant balance disorders. If you have not noticed this already, try asking your next patient presenting with posterior tibial tendon dysfunction to do a modified Romberg test, namely standing on one foot with the eyes closed and his or her arms crossed over the chest.

Perform a similar test of any patient w

In the United States, venous stasis ulcers have been estimated to cause the loss of 2 million working days and reportedly incur treatment costs of approximately $3 billion per year.1 The likelihood of developing venous stasis ulcerations increases with age. It is well known that patients with a history of venous insufficiency are more likely to develop venous ulcerations. Paraplegic patients are also more likely to develop venous ulcerations due to the fact that the calf muscle is immobile.
Lower extremity venous ulcers have a variety of etiologies. However, chronic venous insuffic

There has been a great deal of debate over the years about the potential cause of foot pain being associated with tightness and decreased dorsiflexion motion at the ankle due to an equinus deformity. To define equinus, we look at the horse (equine) and find that the legs are in a plantar position with what is essentially toe walking. As the term equnius has subsequently been adapted to medical pathology, it suggests the lack of dorsiflexion at the ankle due to tightness of the Achilles or gastrocnemius complex.
The main issue with such a problem has been the lack of clinical research suggest