Forefoot adductus correction in clubfoot deformity with cuboid-cuneiform osteotomy: a retrospective analysis.

Background: Forefoot adduction is the most common residual deformity in the treatment of pediatric clubfoot. Little documentation exists regarding its late occurrence and early detection. A retrospective analysis was conducted to determine the effect of primary posterior medial release for idiopathic clubfoot that had failed to improve with conservative treatment or had presented after a treatment delay and a subsequent forefoot adduction correction with a cuboid-cuneiform osteotomy.

Talar neck osteotomy for flatfoot reconstruction: a 27-year follow-up study.

The talar neck osteotomy is done at the junction of the head and neck of the talus, frequently in conjunction with desmoplasty and posterior tibial tendon advancement. This is done effectively to correct severe deformities involving the talus. The correction produces a structural realignment of the talar head.

Retrospective evaluation of postoperative intralesional steroid injections on wound healing.

Steroids have been implicated as an etiology in delayed wound healing. Although there is much documentation in the literature that steroids delay wound healing, most studies are in vitro or use high systemic doses. No studies have used a one-time, postoperative, intralesional steroid injection and evaluated wound healing.

Clawfoot deformity: an analysis of the causes and surgical treatment using a modification of the Jones suspension procedure.

The authors present a modification of the Jones Suspension procedure for clawfoot deformity. The specific mechanisms of this deformity are analyzed. The procedure is a split transfer of the extension level with an aggressive clawfoot release and fixation.

Computer-generated orthoses. A review.

It is obvious with the various casting techniques used in the study that the ease with which individuals adjust to the fashionette orthotic makes it a desirable device. It is tolerated well with higher-heeled shoes and shoes that are used more for fashion purposes. Future studies need to assess the degree of control compared with the type of deformity and the type of symptoms the patient has.

Calcaneal "L" osteotomy: a retrospective study.

In this retrospective study of 36 patients and 58 feet, the "L" shaped osteotomy of the calcaneus body was investigated. The procedure, designed to add intrinsic stability to the shape of the osteotomy, was performed to correct triplane deformities of the heel in a variety of pathologic foot types. A retrospective analysis of clinical and radiographic data suggests that this procedure is a valuable alternative for surgical treatment of deformities of the calcaneus.

Continuous passive motion following partial ankle joint arthroplasty.

Retrospective preliminary report of 19 cases undergoing partial ankle joint arthroplasties with open surgical procedures were rehabilitated with continuous passive motion (CPM). Preoperative and post-operative ankle range of motion and subjective findings (pain, physical signs, activity, quality of motion) were evaluated. Results indicated significant increases to ankle joint range of motion with the use of continuous passive motion, decreased pain, increased activity, decreased edema, and improved quality of motion in the majority of patients undergoing ankle joint arthroplasty with continuous passive motion.

Tarsal tunnel syndrome. Comprehensive review of 87 cases.

The results of the study indicate that tarsal tunnel syndrome is a pathologic condition in which there are multiple etiologies, which in some cases are poorly defined. In order to arrive at a definitive diagnosis, all available tests, including pathology reports, are important. Where proper diagnosis is made and followed with appropriate adjunctive care, the probability of recurrence will be minimized.

The tendo Achillis as it relates to rearfoot position. A new classification for evaluation of calcaneal stance position.

In summary, it has been demonstrated by the statistical analysis of 48 subjects (96 feet) that as the foot moves from the neutral to the resting calcaneal stance position, the tendo Achillis alignment is displaced lateral to the center of gravity. Class I heels demonstrated a direct correlation with tendo Achillis deviation suggesting that their subtalar joint motion is in the transverse plane. Class II and III heels did not directly correlate with Achilles deviation, suggesting probable frontal plane variability.

Use of the subcutaneous tissue expander for delayed primary closure of flaps.

Two cases of deforming, painful scars on the dorsum of the foot are presented. Simple excision and primary closure of these wounds was not possible. Subcutaneous tissue expanders were implanted proximal to the scar and inflated gradually.

Volume injection adhesiotomy.

The authors present a modified method for treating painful cicatrix nerve entrapments. A series of three high-volume injections of local anesthetic, steroid, and hyaluronidase are used to perform percutaneous adhesiotomies and extraneural fibrosis decompression. If special attention is given to the tissue plane level in performing the sequential injections, circumferential neural trunk decompression or cicatrix adhesiotomy can be obtained.

Peroneal tendon balance procedure.

The authors introduce the peroneal tendon balance procedure and discuss normal and hypermobile function of the first ray. The procedure is based on the theory that the peroneus longus tendon is a primary retrograde stabilizer of the proximal portion of the first ray. The theory emphasizes that abnormal pronation results in a positional weakness of the peroneus longus tendon, which induces first ray hypermobility.

Spontaneous rupture of the peroneus longus tendon with fracture of the os peroneum.

Injuries of the peroneus longus and os peroneum are rarely reported. Two cases are presented, each occurring with an inversion stress and resultant audible snap. One patient sustained a complete spontaneous disruption of the peroneus longus with fracture of the os peroneum.

Talar neck osteotomy for the treatment of severe structural flatfoot deformities.

A new surgical procedure for the treatment of severe structural flatfoot with forefoot varus is presented. The talar osteotomy for flatfoot deformity and the pathology in the talus with medial column forefoot varus is described. The flatfoot considerations, adjunctive deformities, and the surgical reduction are presented.

Complications of adjacent grafting.

Complications of adjacent tissue transfers tend to be lessened due to similarity in structure and function of adjacent skin. When complications are encountered, prompt and effective treatment is of tantamount importance.

Free split-thickness skin grafts. A comparative study of various donor sites into recipient sites on the foot and ankle.

Presented is a retrospective study in plastic surgery comparing various donor sites for split-thickness grafting in the lower extremity. Split-thickness donor grafts obtained from the buttocks, thigh, leg, and medial arch of the foot were transferred to various sites on the foot and ankle. Results indicate that medial arch donor sites provide a more functional graft and a cosmetic result which is generally more acceptable to the patient.

Split-thickness skin grafts from the junctional skin of the arch.

This article presents a technique for obtaining a split-thickness graft from the junctional skin of the arch. This anatomic area is easily accessed and readily utilized as a split-thickness skin donor site. Junctional skin is similar in durability to plantar skin and responds well to weight-bearing and ambulation stress.

Lines of minimal movement.

The lines of maximal tension are parallel to the skin creases, or lines of cleavage, as described by Langer. This study verifies that incisions in the foot produce the least amount of scarring when made parallel to the lines of minimal movement. Incisions made perpendicular to these cleavage lines produce maximal scarring, and oblique incisions produce an intermediate amount of scarring.

Grappling suture fixation technique.

Presented is an alternative surgical anchoring technique which alleviates the need for button, bolster, and osseous fixation devices. This method can be applied to the fixation of tendon and ligamentous structures in the foot and ankle. The available fixation tension is increased, while the potential for complications from hardware is eliminated.

Peroneus tertius reconstruction for flexible clawtoes associated with cavus deformity: a preliminary report.

Numerous procedures and techniques are used to correct clawtoe deformity. This paper reports on a new method of correcting clawtoe deformity surgically. Treatment of this condition is not new, and a survey of the literature is offered initially.

An evaluation for compensated anterior cavus.

Anterior cavus is a multiplane structural deformity that can originate from different areas within the foot. Differentiation of these areas is a necessary examination in order to determine the effect of proper treatment. A depressed fourth and fifth ray or lateral column is a major deformity in anterior cavus.

An examination procedure for cavo-adducto-varus.

This examination is used in cava-adducto-varus feet to determine the primary areas producing the secondary forefoot pathology. Table I is a compilation of the data and shows by means of an asterisk those pathologies possible with an additional primary deformity. The fold face test parts, when indicated in the exact order, are diagnostic.