Surgical Treatment of Diabetic Foot and Ankle Osteomyelitis.

A review of the literature regarding the evaluation and management of osteomyelitis and discussion on clinical, radiographic, laboratory, and pathologic findings with both acute and chronic cases is presented. Cases illustrate the complexities that can typically present at an academic setting, which often require a stepwise approach and interdisciplinary collaboration. Surgical pearls and ancillary treatment of osteomyelitis highlight the technical challenges and surgeons' preferences.

External fixation techniques for plastic and reconstructive surgery of the diabetic foot.

Wound healing in high-risk patients with diabetes is often lengthy and fraught with complications. Techniques in plastic and reconstructive surgery of the diabetic foot continue to develop as a result of advances in external fixation. This article highlights the surgical aspect of the diabetic foot with an emphasis on the indications, advantages, technical pearls, and complications with use of external fixation as an adjunct to plastic and reconstructive surgery of the diabetic foot.

Recurrent acute compartment syndrome of the foot following a calcaneal fracture repair.

Acute compartment syndrome is a known possible complication of calcaneal fractures and few case reports have documented a recurrent event after initial surgical fasciotomies. This article describes a rare case demonstrating a recurrence of acute compartment syndrome within days of initial fasciotomies and surgical repair of a comminuted calcaneal fracture.

Trimethoprim-sulfamethoxazole-induced Stevens-Johnson syndrome: a case report.

Stevens-Johnson syndrome and toxic epidermal necrolysis are rare; however, when they occur, they usually present with severe reactions in response to medications and other stimuli. These reactions are characterized by mucocutaneous lesions, which ultimately lead to epidermal death and sloughing. We present a unique case report of Stevens-Johnson syndrome and associated toxic epidermal necrolysis in a 61-year-old man after treatment for a peripherally inserted central catheter infection with trimethoprim-sulfamethoxazole.

Synovial sarcoma of the foot: a case report.

We report a case of a 40-year-old woman with synovial sarcoma who presented with neural symptoms in the medial aspect of the right foot and ankle. The radiographic appearance of the foot and ankle was unremarkable, but magnetic resonance imaging showed a relatively well-defined enhancing lesion in the plantar soft tissues extending from the master knot of Henry to the posterior tibialis tendon. After orthopedic oncologic evaluation and workup, the patient was ultimately treated with a transtibial amputation, and no evidence of recurrence or metastatic disease was seen at 6-month follow-up.

Bone growth stimulation for foot and ankle nonunions.

During the last few decades, electrical current stimulation has gone from an investigational modality to an accepted method of treatment to assist with bone healing. This article provides an overview of electrical bone stimulation for nonunions in the foot and ankle.

Plantar foot donor site as a harvest of a split-thickness skin graft.

The authors present a minimally invasive procedure for harvesting a split thickness skin graft (STSG) from the plantar surface of the foot. This is another option to consider for soft tissue reconstruction of diabetic foot wounds to help restore form and function and to prevent amputation. The authors do not recommend this technique for all soft tissue wounds of the toes and plantar aspect of the foot but believe it is a viable option for selected small diabetic foot wounds that may benefit from a STSG.

Complications and revisional hallux valgus surgery.

Complications with hallux valgus surgery can manifest in a variety of ways, but ultimately preventing them depends on the surgeon's expertise in patient and procedural selection, ability to perform the surgery selected, and knowledge in dealing with postoperative care and complications if present. In this article, the authors discuss common diagnostic and treatment dilemmas when dealing with recurrent hallux valgus, hallux varus, malunion, and avascular necrosis following bunion surgery.

A case report of a simultaneous local osteochondral autografting and ankle arthrodiastasis for the treatment of a talar dome defect.

Talar osteochondral defects (OCDs) are a challenge for treating physicians because they frequently are missed or diagnosed incorrectly, often resulting in severe degenerative arthritis of the ankle joint. Surgical intervention becomes a viable option in the presence of larger OCDs associated with loose bodies or osteochondral lesions that have failed conservative treatment. The successful use of autologous osteochondral autograft in the knee has promoted the applicability in the ankle.

Combined medial displacement calcaneal osteotomy, subtalar joint arthrodesis, and ankle arthrodiastasis for end-stage posterior tibial tendon dysfunction.

Combining an ankle arthrodiastasis with a medial displacement calcaneal osteotomy and a subtalar joint arthrodesis offers surgeons a joint-sparing procedure for young and active patients who have end-stage posterior tibial tendon dysfunction and ankle joint involvement. An isolated subtalar joint arthrodesis or triple arthrodesis combined with an ankle arthrodiastasis is an option that can be used in certain case scenarios. Delaying the need for a joint destructive procedure through an ankle arthrodiastasis, however, may have a great impact in the near future, as advancements are underway to improve the use of ankle endoprosthesis.

A case report of a double advancement flap closure combined with an Ilizarov technique for the chronic plantar forefoot ulceration.

Soft tissue closure of defects on the plantar surface of the foot continues to be a challenge for the reconstructive surgeon secondarily to the limited number of surgical options and often difficulty of replacing durable and similar soft tissue coverage. Primary closure and skin grafting may not be suitable for the weight-bearing surfaces of the plantar forefoot area, and closure may then be obtained by other means of plastic surgery techniques.

Revisional Charcot foot and ankle surgery.

Charcot neuroarthropathy is often a devastating diabetic foot complication that poses a great risk for limb loss and can have a significant impact on a patient's quality of life in the presence of multiple existing comorbidities. It is a progressive and debilitating condition characterized by joint dislocation, pathologic fracture(s), and extensive destruction of the foot or ankle architecture secondary to dense peripheral neuropathy. This pathologic process can be idiopathic, secondary to acute trauma or previous surgery, or attributable to repetitive "microinjury.

Surgical treatment of calcaneal fracture malunions and posttraumatic deformities.

The surgical management of calcaneal fractures presents with several obstacles to the treating physician. Many experienced surgeons acknowledge a steep and significant learning curve in the operative management of calcaneal fractures. Nonoperative management of displaced intra-articular calcaneal fractures may result in malunion, thereby affecting the function of the ankle and subtalar joint.

Complications encountered with circular ring fixation in persons with diabetes mellitus.

Background: The purpose of this study was to identify and report the complications associated with the use of circular ring fixation in diabetic patients, and to compare the frequency of complications in patients without diabetes. We hypothesized that complications with circular ring fixation occurred more frequently in patients with diabetes than patients without diabetes.

Materials And Methods: Institutional Review Board approval was obtained and patient charts were retrospectively reviewed from June 2004 and February 2007.

Epidemiology of the Charcot foot.

The Charcot foot (osteoarthropathy) is a significant lower extremity complication of diabetes mellitus that can result in significant deformity, ulceration, and subsequent limb loss. A result of even unrecognized trauma to an insensitive foot, continued weight bearing on the injured foot promotes the evolution of the disorder that is often diagnosed only after significant deformity has occurred. Although this entity is considered a rare complication of the diabetic population, it has profound implications for those persons affected.