Intra- and Interobserver Reliability of Three Classification Systems for Hallux Rigidus.

Background: There are over ten classification systems currently used in the staging of hallux rigidus. This results in confusion and inconsistency with radiographic interpretation and treatment. The reliability of hallux rigidus classification systems has not yet been tested.

Open Ankle Arthrodesis.

First described in 1879, ankle arthrodesis is a procedure that has undergone significant advancements not only in technique but also in technology and fixation. Surgeon preference has often dictated those changes with regard to incisional approaches, fixation methods, and use of bone graft and biologics but one constant has always remained: open ankle arthrodesis is a predictable, time-tested procedure with consistent results when performed in appropriate patients. This article highlights the changes that have occurred since the introduction of this procedure and provides a brief overview of the preferred technique.

Exercise and Diabetes: A Narrative Review.

Persons with diabetes might experience significant benefits through regular exercise. Not unlike the general population, those with diabetes could also lack motivation to participate in an exercise program. Often, those treating persons with diabetes lack training and/or interest in exercise prescription and are therefore unable to provide the needed information and encouragement.

A Possible Association of Diindolylmethane with Pulmonary Embolism and Deep Venous Thrombosis.

3,3'-Diindolylmethane is available as a supplement in the United States for "cancer prevention" and "augmentation of physical fitness." A derivative of indole-3-carbinol found in plants, diindolylmethane, binds to receptors associated with the sex steroid pathways and has unclear effects on estrogen and androgen physiology. We present a patient who had been taking diindolylmethane and developed right lower extremity deep venous thrombosis and bilateral pulmonary embolism.

A Modified Suture Bridge Technique for Application With Bone Anchors in Foot and Ankle Surgery.

We present a suture bridge technique for reattachment of tendon or ligament to bone for use in foot and ankle surgery. The method is a simple, strong, and reproducible technique that could decrease the risk of irritation of the overlying cutaneous barrier and minimizes the likelihood of tendon strangulation when combined with soft tissue bone anchors. The present report serves as a guide to the use of this suture technique for reattachment of the Achilles tendon.

Downbeat down south.

A 59-year-old woman with late-onset diabetes mellitus presented with a 4-week history of oscillopsia and vertigo. Physical examination revealed downbeating nystagmus in the primary position that worsened on right gaze and left gaze. Magnetic resonance imaging of the brain and orbits showed enhancement and signal abnormality in the right temporal lobe without evidence of a cervicomedullary junction lesion.

Flexible adult flatfoot: soft tissue procedures.

Classically, adult posterior tibial tendon dysfunction (PTTD) was considered primarily a tendon rupture and was treated as such with soft tissue repair alone. The understanding that PTTD involves more than simply an inflammatory condition or tendon rupture but also a muscle imbalance, leading to a flatfoot, osteoarthritis, and peritalar subluxation, led to surgeons advocating osseous procedures as well. The advancements in knowledge of the pathomechanics of the deformity have modified the role that soft tissue repair plays in surgical treatment, but the importance of soft tissue restoration in flatfoot repair should not be overlooked.

The flexible adult flatfoot: anatomy and pathomechanics.

Adult acquired flatfoot deformity is generally associated with a collapsing medial longitudinal arch and progressive loss of strength of the tibialis posterior tendon. It is most commonly associated with posterior tibial tendon dysfunction that can have an arthritic or traumatic cause. With an increasing population of obese patients, the often misdiagnosed and overlooked posterior tibial tendon dysfunction will only continue to present more often in the foot and ankle specialist's office.

An intraosseous lipoma of the calcaneus: a case report.

Intraosseous lipomas are one of the rarest bone tumors found in the body. The incidence has been reported to be <0.1% of all primary bone tumors.

Association of calcaneal and spinal fractures.

Calcaneus fractures are common injuries that often lead to chronic pain and long-term disability. Appropriate initial management of calcaneal fractures involves assessment for concomitant trauma (polytrauma), and the vertebral column, in particular, the lumbar spine, is known to be especially vulnerable to simultaneous injury when the os calcis has been fractured. We undertook a retrospective cohort study that included 208 consecutive patients with data recorded in a radiographic database to determine the incidence of concomitant vertebral fracture in association with fracture of the calcaneus.

Cadaveric limb analysis of tendon length discrepancy of posterior tibial tendon transfer through the interosseous membrane.

The posterior tibial tendon transfer through the interosseous membrane, as popularized by Watkins in 1954, is a procedure for treating reducible eversion and dorsiflexory paresis used by lower extremity foot and ankle surgeons. The posterior tibial tendon has been transferred to various locations on the midfoot for equinus and equinovarus deformities. Dorsiflexory paresis is a common symptom in equinovarus deformity, clubfoot deformity, Charcot-Marie-Tooth disease, leprosy, mononeuropathy, trauma to the common peroneal nerve, cerebrovascular accident, and Duchenne's muscular dystrophy.

The distal metatarsal osteotomy for the treatment of hallux valgus.

This article discusses various forms of distal metatarsal osteotomy for the treatment of hallux valgus. The techniques for the various osteotomies have evolved over the years to allow the surgeon to match a procedure and its modifications to the individual patient's deformity, thus optimizing outcomes. Fixation techniques continue to evolve, and meticulous surgical technique to prevent complications remains a must.

Mechanical comparison of fixation techniques for the offset V osteotomy: a saw bone study.

Four different techniques for the fixation of an offset V bunionectomy were tested on solid-foam saw-bone models for the purpose of determining the strongest form of fixation for the osteotomy. Twenty identical models were placed into 4 different groups. Groups varied as to the placement and caliber of fixation.

Aeromonas hydrophilia infections after penetrating foot trauma.

The bacterium Aeromonas hydrophila is an anaerobic gram-negative bacillus commonly found in natural bodies of water and can cause infection in patients who suffer water-associated trauma or in immunocompromised hosts. The authors present 5 cases of penetrating wound trauma that did not involve any aquatic environment and developed rapidly forming infections. All patients presented with severe pain, cellulitis, ascending lymphangitis, fever, and pain on range of motion of the joint near the traumatic site.

Percutaneous injuries in a high-volume podiatric surgical residency program.

Percutaneous injuries (i.e., needlesticks) are a possible occupational hazard to all residents performing invasive procedures.

Mechanical comparison of two extensor tendon repairs of ankle tendons.

Complete disruption of the extensor tendons is commonly encountered with lacerations to the dorsal aspect of the ankle. The purpose of this study was to compare two tendon repairs (modified Krackow and Kessler-Tajima) to determine which repair was stronger in an anatomical cadaver model. Twenty tendons (10 extensor hallucis longus and 10 tibialis anterior tendons) from 10 fresh-frozen cadaver legs were lacerated and then repaired with either a modified Krackow or Kessler-Tajima repair.

Proximal shortening lesser metatarsal osteotomy: a mathematical-geometric basis.

Reconstruction and restoration of the lesser metatarsal parabola after an iatrogenic complication of a lesser metatarsal osteotomy provides a difficult surgical dilemma for the foot and ankle surgeon. This study's purpose was to determine if a formula could be developed, through a geometric and mathematical basis, for the proximal shortening lesser metatarsal osteotomy to aid the surgeon in determining the amount of bone needed to be resected to correct the deformity. This study was divided into three parts.

Is glass visible on plain radiographs? A cadaver study.

Eighteen randomly selected pieces of nonleaded glass from a collection of 30 pieces from broken bottles of four known color types found on the streets of Houston were sorted into four sets with one control. The purpose of this study was to determine if regular glass is visible on plain radiographs and whether color, location, or volume of these fragments had any effect on the detection of nonleaded glass. These sets were then placed into a fresh-frozen cadaver foot and ankle with a history of insulin-dependent diabetes and peripheral vascular disease.

The use of ultrasound in the foot and ankle.

Ultrasonography is an underutilized tool in the armamentarium of the foot and ankle surgeon. The purpose of this article is to review and illustrate the different applications of musculoskeletal ultrasonography of the foot and ankle. The advantages and disadvantages of this imaging modality are described.

Enchondroma as a cause of midfoot pain.

Enchondroma is a common bone tumor of the foot. It is often reported in the phalanges and distal metatarsals. The authors, however, present a rare case study of two patients with enchodromas as the cause of midfoot pain.

Bilateral intraosseous cystic formation in the talus: a complication of subtalar arthroeresis.

Intraosseous cystic formation in the talus is a complication of subtalar joint arthroereisis which has not been previously reported. The authors present a case whereby STA-peg implants were utilized to correct a bilateral flatfoot deformity in an adolescent girl. The surgical procedure was successful in treating the structural deformity of the foot; however, the formation of talar cysts occurred.

Morton's neuroma. Update on diagnosis and imaging.

The diagnosis of Morton's neuroma is usually made from evaluation of a patient's subjective complaints, clinical findings, and exclusion of other differential diagnoses. Occasionally, when other neurological conditions exist or when the clinical findings are atypical, various imaging techniques may be helpful in the diagnosis of interdigital neuromas. This article will discuss these techniques and briefly review this common lower extremity disorder.

A flexible system for combined retrograde and antegrade delivery of blood or crystalloid cardioplegic solution.

A flexible but simple cardioplegic delivery system has been designed that offers the advantages of alternating antegrade and retrograde delivery or blood and crystalloid (Plegisol¿ solution) cardioplegia to optimize myocardial preservation. Initial antegrade delivery of crystalloid cardioplegic solution achieves rapid cardiac arrest while subsequent retrograde delivery with blood cardioplegia improves myocardial protection due to uniform distribution of the solution. Occasionally, temporary transferral from blood to crystalloid is indicated to clarify the surgical field.