Dysregulation of Wnt signaling in bone of type 2 diabetes mellitus and diabetic Charcot arthropathy.

Background: Type 2 diabetes mellitus (T2DM) patients show a markedly higher fracture risk and impaired fracture healing when compared to non-diabetic patients. However in contrast to type 1 diabetes mellitus, bone mineral density in T2DM is known to be normal or even regionally elevated, also known as diabetic bone disease. Charcot arthropathy is a severe and challenging complication leading to bone destruction and mutilating bone deformities.

[Management of midfoot instability in Charcot foot with the ring fixator : Use of a hybrid technique with internal and external stabilization].

Objective: Combination of external and internal fixation for improvement of stabilization in midfoot arthrodesis.

Indications: Charcot foot of the midfoot with/without (infection-free) ulceration.

Contraindications: Severe anesthesiological risks in multimorbid patients; untreated symptomatic peripheral arterial occlusive disease; severe soft tissue infection and defect with the necessity of amputation.

[Treatment of hindfoot instability in Charcot foot using a hybrid technique of internal and external fixation].

Objective: The main problem of patients with Charcot foot is their inability to off-load. Therefore the risk of internal fixation failure is increased, especially in hindfoot instability (Sanders type IV) with osteonecrosis of the talus. Combination of internal and additional external fixation guarantees the reconstruction and improves surgical outcome.

Reconstruction of focal cartilage defects in the talus with miniarthrotomy and collagen matrix.

Surgical Principal And Objective: Treatment of focal cartilage defects (traumatic or osteochondrosis dissecans) of the talus using a collagen matrix. The goal is to stabilize the superclot formed after microfracturing to accommodate cartilage repair. The procedure can be carried out via miniarthrotomy, without medial malleolus osteotomy.

[Lateral ligament injuries of the ankle joint].

Lateral ligament injuries are the most common sports injury and have a high incidence even in non-sportive activities. Although lateral ligament injuries are very common there is still a controversial debate on the best management. The diagnosis is based on clinical examination and X-ray images help to rule out fractures.

Effect of different orthotic concepts as first line treatment of plantar fasciitis.

Background: Evaluation of the effectiveness of three different types of prefabricated foot orthotics in the treatment of plantar fasciitis.

Methods: Prospective, randomized head-to-head trial in 30 adults (21 women, 9 men) with plantar fasciitis without any anatomic alterations. Three different prefabricated orthotics were tested (thin, non supportive orthotic (NO); soft supportive foam orthotic (FO); foam covered rigid self-supporting plastic orthotic (PO)).

[Technical aspects in the provision of orthopedic shoes for athletes].

From the technical point of view different groups must be distinguished in the provision of orthopedic shoes for athletes. The one group encompasses athletes who are provided with insoles in the hope of improved comfort or better performance. The other group includes athletes with diseases or injuries of the lower limbs for whom the provision of appropriate shoes and insoles makes it possible for them to participate again actively in their chosen sport.

[Problems in complex hindfoot corrections].

This article discusses the intraoperative and postoperative problems seen in the treatment of posterior tibial tendon dysfunction. Problems associated with tendon transposition procedures, osteotomy and arthrodesis are discussed. The preoperative, intraoperative and postoperative problems and complications and how to avoid or treat them will be addressed.

[Closed reposition of an acute midfoot luxation fracture in Charcot arthropathy with the ring fixator].

Diabetic neuropathic osteo-arthropathy (DNOAP; Charcot arthropathy) is a progressive disease characterized by joint luxation, fractures and excessive destruction of foot architecture. The operative therapy is indicated when conservative therapy fails, in progressive breakdown, in hindfoot Charcot and in spreading infections due to plantar ulcers. The complication rate of 10-20% in open surgery is high.

[Principles of treatment for deep infections of the diabetic foot].

Infections are the typical complications of ulcers related to the neuropathic diabetic foot. The loss of the foot or sepsis is the consequence due to the progression of an untreated infection. Therefore, prophylaxis of ulcer formation is the key to lower the rate of amputation.

Calcaneus replacement after total calcanectomy via vascularized pelvis bone.

Because of loss of function and chronic pain total calcanectomy is a serious impairment for the patient. There are few reports concerning replacement procedures using ribs [Brenner P, Zwipp H, Rammelt S. Vascularized double barrel ribs combined with free serratus anterior muscle transfer for homologous restoration of the hindfoot after calcanectomy.

[Management of acute wounds].

Uncomplicated wounds can be treated immediately in the general practitioner's office. Management by a specialist is necessary only in the case of wounds involving the eyes, nose or mouth, or in the presence of other unusual features.

[Diagnosis and treatment of paronychia].

Paronychia is a purulent infection of the lateral fingertip, and represents the most common infectious disease affecting the hand.The typical germ is Staphylococcus aureus, while a mixture of bacteria or pathogens of a different kind are usually seen in patients with immunodeficiency. Treatment ranges from bathing the finger in an antiseptic solution to lancing the abscess.

[Diagnosis and treatment of warts, corns, and clavi].

The term keratosis covers a variety of growths such as warts and pressure-induced callosities. Warts develop in the absence of pressure, and often clear up again after a certain period, usually without treatment. Clavi can develop as a result of wearing poorly fitting shoes, but also deformed toes or other anatomical deformities affecting the foot.

[Soft tissue infections treatable in the doctor's office].

A good number of infections requiring only minor surgery can be treated in the GP's office, simply and adequately. Of importance, however, is the physician's ability to recognize when a patient needs to be referred to a specialist. Provided the principles listed here are adhered to, treatment is usually successful.

[The case of a patient with multiple superinfected necrosis of both legs caused by vasculitis disease].

Vasculitis can lead to skin necrosis, which typically shows decayed recovery tendency and is able to lead to local as well as systemic inflammation. By repeated necrosectomy, vacuum therapy, split skin graft transplantation as well as simultaneous immunosuppression and systemic antibiotics, the cutaneous manifestations of vasculitis where cured.