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An Improved Technique for Medial Malleolar Osteotomy
The medial malleolar osteotomy has been a time-tested technique to approach the medial and anterior aspects of the talus for cases of talus fractures and the osteochondral lesions of the talus. The precision of osteotomy, safety to the inherent articular cartilage, and maintenance of vascularity to the talus are prime concerns of the procedure, failing which instability, early ankle osteoarthritis, or avascular necrosis of the talus become inevitable. Here we describe a couple of modifications to decrease the chances of such complications. (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - August 21, 2021 Category: Orthopaedics Tags: Techniques Source Type: research

Tibialis Anterior Tendon Partial Release and Plantar Implant Placement for Midfoot Arthrodesis: Technique Tip
Midfoot arthrodesis is generally a reliable and commonly performed operative procedure for deformity correction and pain relief. Biomechanical studies suggest the superior strength of plantar-based plates compared with traditional dorsally placed plates and screws. Multiple structures must be considered when accessing the medial column on the plantar surface, including the saphenous neurovascular bundle and the tibialis anterior tendon insertional footprint. Some skeptics are concerned over possible tibialis tendon rupture after placing plantar-based plates. This novel technique demonstrates the ability to safely apply for...
Source: Techniques in Foot and Ankle Surgery - August 21, 2021 Category: Orthopaedics Tags: Techniques Source Type: research

Evaluation of Anatomic Relationship Between Sural Nerve and Instrumentation During Mini-Open Achilles Tendon Repair: A Cadaveric Study
The purpose of this study was to determine the relationship of the sural nerve to the Arthrex Percutaneous Achilles Repair System (PARS) jig and repair sutures. We performed cadaveric dissection on 10 unpaired above-knee amputation specimens (6 were right legs and 4 were left legs). In all but 1 cadaver, all of the sutures either punctured the nerve or passed anterior to it. Only 1 cadaver had sutures that were posterior to the sural nerve. In all cases, removal of the jig pulled the sutures through the nerve and the nerve was completely free after locking the sutures, and the sural nerve was within 1 cm of the lateral a...
Source: Techniques in Foot and Ankle Surgery - August 21, 2021 Category: Orthopaedics Tags: Techniques Source Type: research

Controversies in the Treatment of Acute Compartment Syndrome of the Foot
Acute compartment syndrome of the foot remains a controversial topic. The diagnosis, management, and reported sequelae remain largely supported by low level evidence and expert opinion. Ischemic plantar flexion contractures resulting in cavus and claw toe deformities, acute and chronic neuropathic pain, sensory deficits and paresthesias, neuropathic ulceration, and odynohyperkeratosis are sequelae of both conservative and operative management of acute compartment syndrome of the foot. Further research on the outcomes of acute fasciotomy versus delayed management is necessary to support therapeutic strategies. Level of Evid...
Source: Techniques in Foot and Ankle Surgery - August 21, 2021 Category: Orthopaedics Tags: Special Focus Source Type: research

Challenges in Managing Charcot Arthropathy
This article presents case scenarios that are commonly seen in the orthopedic foot and ankle clinic to demonstrate the challenges the clinician faces in dealing with this difficult diagnosis. (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - August 21, 2021 Category: Orthopaedics Tags: Special Focus Source Type: research

Management of Bone Defects of the Foot and Ankle
This article serves as an overview and technical guide for the indications and applications of these techniques with demonstrative case examples. (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - August 21, 2021 Category: Orthopaedics Tags: Special Focus Source Type: research

Controversies in Limb Salvage in Patients With Diabetes Mellitus
Diabetic foot ulcers are the most feared complications among patients with diabetes mellitus because these are frequently a harbinger to major lower extremity amputation after failed attempts at treatment or limb salvage. Though most of these ulcers go on to heal, there is a sizeable proportion that goes on to develop gangrene, deep infections, osteomyelitis, and unstable deformities. These cohorts of patients often require repeated, costly, and controversial attempts at limb salvage surgery. Considering the growing cost of care of these patients worldwide, controversies abound in the literature regarding the best approach...
Source: Techniques in Foot and Ankle Surgery - August 21, 2021 Category: Orthopaedics Tags: Special Focus Source Type: research

A Retrospective Review of Calcaneal Fractures Treated With Minimally Invasive Sinus Tarsi Approach for Open Reduction and Internal Fixation
This study analyses patients that have undergone open reduction and internal fixation of the calcaneus, through a minimally invasive sinus tarsi approach. The primary outcome measure of this study was the degree to which the architecture of the calcaneus was restored, with the secondary outcome measure being the rate of complications attributable to the surgery. Patients were identified retrospectively from theater records. Demographic information was gathered. Outcome measures included: (1) the accuracy of reduction achieved and (2) complication rates. Preoperative and postoperative radiographic measurements, were recorde...
Source: Techniques in Foot and Ankle Surgery - May 27, 2021 Category: Orthopaedics Tags: CME Article Source Type: research

Reconstruction of Neglected Peroneal Tendon Dislocation Associated With a Large Lateral Malleolar Avulsion Fragment: A Case Study
Peroneal tendon dislocation not infrequently passes undiagnosed, even in the presence of a lateral malleolar avulsion fragment, which can be small or large. The surgical treatment of a symptomatic dislocation without a bony avulsion or with a small bony avulsion consists simply of incising the superior peroneal retinaculum and reattaching it to the posterolateral margin of the fibula. In case of a large bony avulsion, the superior peroneal retinaculum must be left intact and must not be incised. Instead, the periosteum overlying the acute fracture site or over the healed fracture site in a neglected case as presented herei...
Source: Techniques in Foot and Ankle Surgery - May 27, 2021 Category: Orthopaedics Tags: Techniques Source Type: research

Retrocalcaneal Spur Removal and Achilles Tendon Reattachment for the Treatment of Haglund Deformity
Insertional Achilles tendinopathy frequently involves intratendinous calcification of the Achilles tendon insertion and a prominent superolateral calcaneus tuberosity known as a Haglund’s deformity. The incidence of insertional Achilles tendinopathy is up to 30%, affecting both recreational and elite athletes. The indications for surgical treatment of insertional Achilles tendinopathy is appropriate when a patient’s symptoms are recalcitrant to nonoperative therapies. Advancements in surgical treatment include the utilization of the midline longitudinal incision, improved soft tissue handling, and minimizing the detach...
Source: Techniques in Foot and Ankle Surgery - May 27, 2021 Category: Orthopaedics Tags: Techniques Source Type: research

Controversies in Surgical Treatment of Recalcitrant Plantar Fasciitis
Plantar fasciitis is a common cause of heel pain that is seen by both orthopedic surgeons and primary care providers. It is a condition that was previously thought to be because of inflammation of the plantar fascia but has more recently been linked an equinus contracture of the gastrocnemius muscle. The condition can be handled both conservatively and surgically, with the primary management being nonoperative. For operative interventions, the treatment of choice was classically a plantar fasciotomy. Over the past several years, the gastrocnemius recession has become an operative treatment of choice. The gastrocnemius rece...
Source: Techniques in Foot and Ankle Surgery - May 27, 2021 Category: Orthopaedics Tags: Special Focus Source Type: research

Achilles Tendon Rupture Treatment: Operative Versus Nonoperative
Acute Achilles tendon ruptures are common injuries with increasing incidence. Management of acute ruptures is controversial. Early evidence suggested that nonoperative treatment led to a significantly higher rerupture rate; however, operative modalities have also been shown to have a higher risk of wound complications. Advances in therapeutic protocols have normalized the rerupture rate between operative and nonoperative modalities, and many have recommended nonoperative treatment becuase of the mitigated complication profile. The purpose of this review is to report contemporary management of Achilles tendon ruptures and p...
Source: Techniques in Foot and Ankle Surgery - May 27, 2021 Category: Orthopaedics Tags: Special Focus Source Type: research

Controversies in the Treatment of Hallux Valgus
Hallux valgus is a common deformity encountered by the foot and ankle specialist. The treatment options are many for this deformity. Both single and double corrective osteotomies as well as arthrodesis procedures are commonly utilized to obtain correction. The approach to management, procedures as well as outcomes are reviewed and compared highlighting the optimal treatment for the hallux valgus deformity. (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - May 27, 2021 Category: Orthopaedics Tags: Special Focus Source Type: research

Lisfranc Injuries
Lisfranc injuries represent a heterogenous group of ligamentous and combined osseous-ligamentous injuries to the tarsometatarsal/midtarsal articulations. Higher-energy Lisfranc injuries rarely present delayed. Operative treatments have included percutaneous reduction internal fixation, open reduction internal fixation, and primary arthrodesis (PA). Outcomes in higher-energy injuries can be poor and salvage by secondary arthrodesis, if not performed as primary treatment, remains an option. Subtle, lower-energy injuries, or purely ligamentous Lisfranc injuries may be commonly overlooked. These injuries frequently require mul...
Source: Techniques in Foot and Ankle Surgery - May 27, 2021 Category: Orthopaedics Tags: Special Focus Source Type: research

Controversies in Foot and Ankle Surgery: Progress Through Open Debate
No abstract available (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - May 27, 2021 Category: Orthopaedics Tags: Special Focus Source Type: research