A Case of Recurrent Epiploic Appendagitis Treated With Conservative Management.

Epiploic appendagitis is a rare and commonly misdiagnosed cause of acute abdominal pain. Treatment for the initial presentation of epiploic appendagitis is conservative management with anti-inflammatory medications. There is no consensual treatment algorithm for recurrent appendagitis as some studies recommend conservative management and others recommend surgical excision.

Nurse Residency Programs: Key Components for Sustainability.

The purpose of this integrative literature review was to identify commonalities among nurse residency programs deployed for greater than 3 years, showing improved job retention and satisfaction. The Johns Hopkins Nursing Evidence-Based Practice Model guided this review. Successful, sustainable nurse residency programs have a strong foundation with committed leadership to support transition; a structured program with defined outcomes to promote clinical competence, safe patient care, and professional development; and an evaluation process to guide continual improvement and meet organizational needs.

Hallux Valgus.

Hallux valgus is a common condition that results from a complex positional deformity of the first ray. The bunion or medial prominence that results from the lateral deviation and pronation of the hallux is only one component of the 3-dimensional deformity. Hallux valgus can lead to considerable pain and altered joint mechanics.

Progression of Healing on Serial Radiographs Following First Ray Arthrodesis in the Foot Using a Biplanar Plating Technique Without Compression.

A review of 195 first ray arthrodeses fixated with a twin-plate biplanar construct, without interfragmentary compression, is presented. This fixation construct was evaluated in a consecutive cohort of patients undergoing first metatarsophalangeal joint (MTP) arthrodesis or the first tarsometatarsal joint (TMT) arthrodesis. Multiple radiographs were used to assess the progression of healing at the following postoperative time frames: 4 to 9 weeks, 10 to 12 weeks, >12 weeks, and the final follow-up.

Understanding Frontal Plane Correction in Hallux Valgus Repair.

Hallux-abducto-valgus or "bunion" surgery is one of the most common surgical procedures for the foot and ankle specialist. As our understanding of the hallux-abducto-valgus deformity has grown, it is becoming clear that the anatomic CORA of the deformity may lie at the tarsometatarsal joint. There is also the component of the 3-dimensional nature of the deformity that may be best addressed at this CORA.

Acute Achilles Tendon Rupture: Clinical Evaluation, Conservative Management, and Early Active Rehabilitation.

The Achilles tendon (AT) is the strongest, largest, and most commonly ruptured tendon in the human body. Physical examination provides high sensitivity and specificity. Imaging studies are not recommended unless there are equivocal findings in the physical examination.

Comparison of Transverse and Coronal Plane Stability at the First Tarsal-Metatarsal Joint With Multiple Screw Orientations.

Unlabelled: Intercuneiform instability has been recognized as a potential cause of hallux valgus recurrence following tarsal-metatarsal joint (TMTJ) fusion. Recommendations have been made for additional screw placement between the metatarsals and/or the cuneiforms to improve stability. The screw orientation that provides the best stability has not been documented.

Quantitative Analysis of the Degree of Frontal Rotation Required to Anatomically Align the First Metatarsal Phalangeal Joint During Modified Tarsal-Metatarsal Arthrodesis Without Capsular Balancing.

The data from 35 consecutive patients with hallux valgus undergoing triplane arthrodesis at the first tarsal metatarsal joint were studied to determine the amount of first metatarsal frontal plane rotation (supination) needed to anatomically align the first metatarsal phalangeal joint on an anterior posterior radiograph without soft tissue balancing at the first metatarsal phalangeal joint. Radiographs were measured both pre- and postoperatively to assess the 1-2 intermetatarsal angle, hallux abductus angle, and tibial sesamoid position (TSP). The mean amount of varus (supination) rotation performed during correction was 22.

Is our current paradigm for evaluation and management of the bunion deformity flawed? A discussion of procedure philosophy relative to anatomy.

Of the >100 procedures that have been proposed to treat hallux valgus or the "bunion" deformity, most have focused on correction through metatarsal osteotomies at various levels combined with soft tissue balancing procedures at the first metatarsophalangeal joint. This paradigm of metatarsal osteotomy and soft tissue balancing has been so commonplace, any argument for a fundamental change to the approach becomes uncomfortable and seems unwarranted to most foot and ankle surgeons. However, the simple fact that so many procedures exist, with so many modifications of these procedures, can be interpreted as a failure of our basic paradigm of metatarsal osteotomy and soft tissue balancing.

Reduction of the intermetatarsal angle after first metatarsal phalangeal joint arthrodesis: a systematic review.

Arthrodesis of the first metatarsophalangeal joint (MTPJ) has commonly been used for the treatment of a variety of first MTPJ disorders, including hallux valgus. We undertook a systematic review of the electronic databases and other relevant sources to identify material relating to the reduction of the first intermetatarsal angle (IMA) after first MTPJ arthrodesis. Fifteen studies with a total of 701 first MTPJ arthrodesis procedures were identified that met the inclusion criteria.

Technique for minimally invasive reduction of calcaneal fractures using small bilateral external fixation.

Soft tissue complications are well known after extensile exposure of the calcaneus for open reduction internal fixation of fractures. A variety of recommendations have been proposed to reduce soft tissue healing issues and infection. Despite these recommendations, some surgeons believe that soft tissue complication rates have remained unacceptably high with lateral extensile incisions.

Observed changes in radiographic measurements of the first ray after frontal plane rotation of the first metatarsal in a cadaveric foot model.

We observed the changes in the angular measurements commonly used in the evaluation of the first metatarsal and first metatarsophalangeal joint in cadaveric specimens before and after frontal plane rotation of the first metatarsal. Measurements of the first and second intermetatarsal angle (IMA), hallux abductus angle, proximal articular set angle, and tibial sesamoid position (TSP) were taken after varying degrees of varus and valgus rotation of the first metatarsal. Standard dorsoplantar radiographs were taken at 0°, 10°, 20°, and 30° of valgus rotation of the first metatarsal and repeated at 10°, 20°, and 30° varus rotation of the first metatarsal.

Reduction of intermetatarsal angle after first metatarsophalangeal joint arthrodesis in patients with hallux valgus.

We present a radiographic review of 94 patients who underwent first metatarsophalangeal joint arthrodesis. The main focus of our review was to assess the change in the intermetatarsal angle (IMA). The change in the IMA was measured for the entire group and for 2 subgroups (IMA 11° to 15° and IMA >15°).

Observed changes in first metatarsal and medial cuneiform positions after first metatarsophalangeal joint arthrodesis.

The first intermetatarsal angle (IMA) is known to decrease after first metatarsophalangeal joint arthrodesis, although the exact mechanism by which this decrease occurs is not known. We measured the first IMA and obliquity of the medial cuneiform on anteroposterior weightbearing preoperative and postoperative radiographs in 86 feet and analyzed the statistical correlation between the IMA and the medial cuneiform angle. A change in the first IMA after first metatarsophalangeal joint fusion showed a strong positive correlation with a change in cuneiform obliquity (p < .

Principles of management of growth plate fractures in the foot and ankle.

Providers treating pediatric injuries must understand the properties of the pediatric skeleton and be sensitive to the psychological and social expectations of patients and their families. Immediate needs must be addressed, and the long-term prognosis must be explained. Detailed understanding of fracture mechanism and fracture patterns is essential for diagnosis and treatment.

Does postoperative showering or bathing of a surgical site increase the incidence of infection? A systematic review of the literature.

Infection is one of the many postoperative complications a surgeon must attempt to control during the perioperative period. Surgeons have used a variety of modalities to prevent surgical site infection and have adhered to a variety of protocols. It has been common for foot and ankle surgeons to recommend that a patient keep the surgical incision covered and dry and to instruct the patient to avoid bathing and showering until the sutures have been removed.

Relationship of frontal plane rotation of first metatarsal to proximal articular set angle and hallux alignment in patients undergoing tarsometatarsal arthrodesis for hallux abducto valgus: a case series and critical review of the literature.

Rotation of the first metatarsal, as a component of hallux abducto valgus, is rarely discussed and is not addressed as a component of most hallux valgus corrective procedures. We believe frontal plane rotation of the first metatarsal to be an integral component of hallux abducto valgus deformity (the "third plane of deformity") and believe de-rotation is necessary for complete deformity correction. We observed the change in angular measurements commonly used in the evaluation of hallux valgus deformity in patients who underwent a modified lapidus procedure.

Measurement of mid-calcaneal length on plain radiographs: reliability of a new method.

The authors present a new method to reliably measure the length of the mid-portion of the calcaneus. The authors defined the "mid-calcaneal length" as the line connecting the high point of the convex arc of the posterior subtalar joint facet and the low point of the concave arc of the calcaneocuboid joint. Statistical analysis of 810 measurements taken by 6 observers confirmed high intraobserver reliability, interobserver reliability, and internal consistency (Cronbach coefficient α = .

A user-friendly method of pin site management for external fixators.

Unlabelled: Pin tract inflammation and/or infection are common with the use of external fixation devices. Pin sites need to be managed to help prevent complications. There are a variety of regimens proposed for pin care in the literature.

Hallux varus as complication of foot compartment syndrome.

Hallux varus can present as a congenital deformity or it can be acquired secondary to trauma, surgery, or neuromuscular disease. In the present report, we describe the presence of hallux varus as a sequela of calcaneal fracture with entrapment of the medial plantar nerve in the calcaneal tunnel and recommend that clinicians be wary of this when they clinically, and radiographically, evaluate patients after calcaneal fracture.

The extended knee hemilithotomy position for gastrocnemius recession.

The focus of this communication is to share an alternative positioning method that we have used over the past 3 years for gastrocnemius recession with the patient supine on the operating table. The technique uses a candy-cane leg holding system to situate the patient in the extended knee hemilithotomy position. We have found that this position provides excellent visualization of the surgical site, furnishes the anesthesiologist with optimal access to the patient, negates the need to turn the patient from prone to supine when adjunct procedures are to be undertaken, and allows the involved extremity to remain sterile throughout the operation, without an increase in complications or cost.

A descriptive study of lutein and zeaxanthin in optometric practice.

Purpose: The purpose of this study was to describe the perceptions, recommendations, and educational or informational materials of licensed Wisconsin optometrists on lutein and zeaxanthin and eye health.

Methods: A 20-item original survey with letter of consent was mailed to 300 randomly chosen licensed optometrists followed by a reminder postcard 11 days later. A reminder to complete the survey was published in the Wisconsin Optometric Association newsletter.

Dorsal suspension stitch: an alternative stabilization after flexor tenotomy for flexible hammer digit syndrome.

The focus of this communication is to share an alternative form of positional maintenance for use after correction of flexible hammer digits via flexor tenotomy. The toe is maintained in a corrected position by means of a wide, horizontal mattress stitch with the suture passing through the extensor apparatus both proximal and distal to the interphalangeal joints. This suture prevents recurrence of plantarflexion contracture of the toe during the postoperative period without the use of Kirschner wire fixation.