Charcot's arthropathy in a patient with HIV-associated neuropathy.

Charcot's arthropathy is a destructive arthritis that can occur in patients with peripheral neuropathies of various etiologies. This report describes a rare case of Charcot's arthropathy attributable to the distal sensory polyneuropathy associated with HIV infection. As treatments for HIV/AIDS advance and life expectancy increases, cases of end-organ sequelae, such as Charcot foot, may become more common.

Imaging of the Charcot foot.

Charcot foot is a serious problem that causes considerable morbidity and may lead to limb loss. Arriving at a definitive diagnosis can be challenging. Given the progressive, destructive nature of Charcot's arthropathy, this delay can result advancing deformity, ulceration, infection, and place the limb at risk for amputation.

A technique to protect external fixation devices.

The indications for external fixation in foot and ankle surgery are expanding and now include the use on patients with significant comorbidities. Protecting the contralateral limb from inadvertant injury is important especially in patients with diabetes where the contralateral limb is already "at risk". The authors describe a simple and inexpensive technique to protect the external fixator and the contralateral limb from potential injury.

Restoration and preservation of first metatarsal length using the distraction scarf osteotomy.

The authors reviewed the records of 8 patients who underwent a distraction scarf osteotomy of the first metatarsal, and report the radiographic outcomes achieved with this procedure. The osteotomy was used to reestablish or maintain the length of the first metatarsal, without the use of a structural bone graft. The osteotomy was used as part of a revisional procedure for a failed bunionectomy in 4 patients.

Peritonsillar abscess.

Peritonsillar abscess remains the most common deep infection of the head and neck. The condition occurs primarily in young adults, most often during November to December and April to May, coinciding with the highest incidence of streptococcal pharyngitis and exudative tonsillitis. A peritonsillar abscess is a polymicrobial infection, but Group A streptococcus is the predominate organism.

The use of marrow-derived stem cells to accelerate healing in chronic wounds.

Adult bone marrow-derived stem cells may aid the healing of chronic lower extremity wounds by transplanting a population of progenitor cells locally into the wound. We present results from three cases in which bone marrow aspirate containing marrow-derived cells was applied/injected locally into complex lower extremity chronic wounds of differing aetiologies. Our case series suggest that bone marrow aspirate, applied topically and injected into the wound periphery, may be a useful and potentially safe adjunct to wound simplification and ultimate closure.

The narrowed forefoot at 1 year: an advanced approach for wound closure after central ray amputations.

Central ray resections often result in a biomechanically unsound forefoot often accompanied by a cleft wound that is difficult to heal. Narrowing the forefoot enables the surgeon to close the plantar defect primarily, foregoing prolonged wound care and lowering the risk for postoperative complications. The authors present a technique of narrowing the forefoot using a small light-weight external fixation device that allows for immediate wound closure without adjacent metatarsal osteotomies.

Surgical management of Charcot midfoot deformities.

Diagnosing Charcot neuroarthropathy requires a heightened index of suspicion. Early recognition and intervention can limit deformity. Aggressive conservative management should be initiated early in the treatment plan to minimize the devastating effects often seen with this condition.

The diagnosis of Charcot foot.

Charcot foot is a rapidly progressive disease process occurring in those with peripheral neuropathy. The disease is frequently misdiagnosed resulting in a delay of appropriate treatment, worsening the outcome. We present the hallmarks for diagnosis of Charcot foot based on the clinical examination and imaging studies.

Predictors of postoperative complications of Ilizarov external ring fixators in the foot and ankle.

Our objective was to determine factors associated with complications of Ilizarov external ring fixator surgery for foot and ankle disorders in persons with diabetes mellitus. We reviewed the records of patients who underwent Charcot foot reconstruction or soft tissue offloading surgery over 1 year at a single institution. We compared the association of serious pin tract infection, pin fracture, and surgical wound dehiscence with the patient age, weight, duration device was used, preoperative glucose, preoperative hemoglobin, tourniquet time, and total operating time.

Asthma, sedation, and the podiatric patient.

Propofol is a common drug used for anesthetic induction of patients undergoing surgery. This popular drug has been around for many years and has been subjected to changes in formulation from its original patented formula. Once touted as safe, the newer propofol may possess hidden dangers, particularly for individuals suffering with hyperreactive airway disease.

Congenital transverse deficiencies: bilateral presentation of the foot.

Congenital transverse deficiency is a rare structural anomaly, primarily occurring in utero. Even though it is rare, congenital transverse deficiency is seen in the private practice setting, and many physicians may be unprepared to make the diagnosis or offer treatment. Furthermore, congenital transverse deficiencies, particularly of the lower extremity, are given little attention in literature.

Ankle fractures.

Although ankle injuries are common, it is imperative for the treating physician to be able to identify the mechanism of injury and accurately restore the normal anatomy of the ankle joint. Attention must be given to restoring the normal alignment and length of the fibula because of its dominant role in controlling talar stability. The medial ankle must not be overlooked, with the role of the deltoid taken into consideration.

Fractures of the forefoot.

Fractures of the forefoot are common injuries of various causes. Although not crippling, forefoot fractures can be debilitating if they go undiagnosed or are mistreated. Whenever patients complain of foot pain with ambulation or difficulty ambulating, radiographs should be taken as part of a standard routine to assess for bony pathology.

Pantalar arthrodesis.

Pantalar arthrodesis is a demanding procedure that serves a useful purpose for stabilization of the ankle, rearfoot, and midfoot. These fusions should be recognized as salvage procedures in the treatment of unstable and debilitating conditions as a result of severe degenerative joint disease, rheumatoid arthritis, neuropathic joint destruction, and paralytic or flail extremity dysfunction. As with all salvage-type procedures, patient and physician expectations must be the same to afford an acceptable and functional postoperative result.

Treatment of nonunited hindfoot fusions.

The management of delayed union and nonunion is complex and is contingent on appropriate diagnosis and classification. Detection techniques and treatment options, including cast immobilization, electrical stimulation, surgical repair, or a combination of regimens, are discussed in this article.

Management of osteomyelitis.

Osteomyelitis is an infection of the medullary or cortical bone that is becoming more difficult to cure with the increasing prevalence of methicillin- and vancomycin-resistant organisms. This article discusses the etiology of osteomyelitis and the effectiveness of various treatment options.

Pigmented villonodular synovitis. A literature review and unusual case report.

The literature contains various nomenclature and classifications regarding the pigmented villonodular pathology that have proven to be quite confusing. This article clarifies this and emphasizes the fact that there is a spectrum of inflammatory pathologies that may affect synovial tissue. The primary focus of this article is pigmented villonodular Synovitis (PVNS) which refers to joint pathology.

Behçet's disease: a case report.

While Behçet's disease is an uncommon presentation to a podiatric clinical setting, it is nonetheless a fascinating and poorly understood disease as demonstrated by the current and historical research available about the topic. Much debate remains about the disease cause, course and treatment goals. Only through further research into the specific components of this multisystem disease will medicine be more fully able to address the needs of the patient.

The use of cancellous screws as an alternative in plate fixation of fibular fractures.

Altering standard AO/ASIF techniques when performing open reduction with internal fixation of fibular fractures by using cancellous screws in place of cortical screws appears to be a viable option. By eliminating a few steps in screw application, the additive effect can lead to a significant decrease in operative and tourniquet time. Close inspection of hardware postoperatively has failed to show any signs of screw loosening or delay in fracture healing.

Current concepts of bone healing.

The intent of this article is to present the current understanding of fracture repair and offer investigative evidence to the use of exogenous growth factors enhancing fracture healing. The authors believe that exogenous growth factors have tremendous clinical applications and will continue to influence bone healing in the future. With the expanding knowledge of the intricate molecular and cellular biology of fracture repair being realized, surgeons will be able to enhance and ensure healing of surgical osteotomies, fractured bone ends, or delayed unions.

Articular cartilage. Anatomy, injury, and repair.

Articular cartilage plays a vital role in joint morphology. An understanding of articular cartilage anatomy and physiology will enable the physician to more fully appreciate its function and necessity. Articular cartilage is made up of four basic biological layers or zones.

The use of becaplermin (rhPDGF-BB) gel for chronic nonhealing ulcers. A retrospective analysis.

Chronic, nonhealing wounds have plagued health care practitioners for decades. New research and technology have allowed the wound healing process to be understood at a cellular and molecular level, including the vital role of growth factors. This article discusses the effects of platelet-derived growth factor-BB (PDGF-BB) on the wound healing process, emphasizing the inflammatory stage of wound healing and principles of wound care.