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Malignant melanoma, the leading cause of death from diseases of the skin, often is found on the lower extremity. When encountered by the podiatric physician, a thorough understanding of the disease entity is essential, as misdiagnosis or delayed diagnosis can have fatal consequences. The authors present the first of a two-part comprehensive clinical and surgical review of malignant melanoma. Part I reviews etiology, risk factors, signs, symptoms, clinical features, and growth patterns. In Part II, a pictorial lower extremity differential diagnosis will be provided, along with diagnostic and surgical criteria for the podiatric surgeon.
Malignant melanoma, the leading cause of death from disease of the skin, often is found on the lower extremity. A thorough understanding of the disease entity is essential, because misdiagnosis or delayed diagnosis can be fatal. In Part I of this two-part clinical and surgical review of malignant melanoma, the authors discussed etiology, risk factors, signs, symptoms, clinical features, and growth patterns. Part II places special emphasis on diagnosing malignant melanoma and differentiating it from other lesions of the lower extremity. Clinical staging of the tumor and the corresponding surgical criteria are presented from a podiatric medical standpoint.
The authors review the properties and podiatric applications of biodegradable internal fixation devices. These devices include sutures, rods, and screws. Fixation of fractures and osteotomies with absorbable materials has been shown to be as effective as fixation with more traditional means, and it also provides several advantages.
A review of medical literature reveals that there is inconsistency in the reported incidence of Charcot joint disease or neuroarthropathy in the diabetic foot. There is also controversy as to which articulations are most commonly afflicted. Radiographs of 21 patients with bilateral diabetic neuroarthropathy were reviewed to determine the distribution of joint disease in the foot and ankle. Many patients had multiple sites of joint involvement. The results of this study show that the incidence of metatarsophalangeal joint involvement has been greatly underestimated.
The effect of diabetes on the lower extremity can be devastating. Surgical intervention on the diabetic foot must be carefully planned, and long-term results must be anticipated. The authors present a case history of a patient with multiple previous amputations of the forefoot, resulting in a severe deformity and a nonfunctional foot. Transmetatarsal amputation, if performed correctly, should provide a relatively functional extremity.
Keloids and hypertrophic scars may complicate elective foot surgery. Differentiation between these two entities is important before treatment is contemplated. The authors review current theories on the etiology of these lesions and outline various treatment options.
