Closed degloving injury involving a toe represents a rare phenomenon in which the bones of the toe dislocate but the soft-tissue envelope remains intact. It has been described sparingly throughout the medical literature, and outcomes have been poor. This article presents a case report of the unique injury while also investigating trends through a detailed review of the literature.
The etiology of chronic venous insufficiency is typically neglected or misunderstood when treating lower-extremity edema and venous ulcerations. Despite the high prevalence of venous compression syndromes, it is rarely considered when treating venous ulcers and unresolved venous disease. We report a case of bilateral iliac vein outflow obstruction that prohibited venous ulcer healing until properly treated. This case highlights the importance of properly identifying and treating venous compression syndromes to enhance ulcer healing and decrease the risk of venous ulcer recurrence.
Reconstruction of large bone defects of the metatarsals, whether resulting from trauma, infection, or a neoplastic process, can be especially challenging when attempting to maintain an anatomical parabola and basic biomechanical stability of the forefoot. We present the case of a 42-year-old man with no significant medical history who presented to the emergency department following a severe lawnmower injury to the left forefoot resulting in a large degloving type injury along the medial aspect of the left first ray extending to the level of the medial malleolus. The patient underwent emergent debridement with application of antibiotic bone cement, external fixation, and a negative-pressure dressing. He was subsequently treated with split-thickness skin graft and iliac crest tricortical autograft using a locking plate construct for reconstruction of the distal first ray. Although the patient failed to advance to radiographic osseous union, clinically there was no motion at the attempted fusion site and no pain with ambulation, suggestive of a pseudoarthrosis. The patient has since progressed to full nonpainful weightbearing in regular shoes and has returned to normal activities of daily living. The patient returned to his preinjury level of work and has had complete resolution of all wounds including his split-thickness skin graft donor site. This case shows the potential efficacy of the Masquelet technique for spanning significant traumatic bone defects of the metatarsals involving complete loss of the metatarsophalangeal joint.
A case presentation of an adolescent with tarsal navicular avascular necrosis is presented. External fixation with tarsal navicular diastasis is a simple, straightforward management option to allow osseous regrowth and bone healing. In this case, the external fixator was well tolerated and the patient demonstrated a quick return to function without pain or discomfort. The external fixation technique with tarsal navicular diastasis is an uncommon but effective means of reversing the tarsal navicular avascular process and avoiding an open technique such as arthrodesis.
Retronychia, the posterior embedding of the nail bed into the proximal nail fold, can be a complex clinical dermatologic diagnosis that may mimic other inflammatory ungual diseases or tumors of the nail. It has been related to a history of severe systemic conditions that secondarily affect the nail matrix and is commonly associated with onychomadesis. We present a case of retronychia of the foot with a purely traumatic origin, nonconcomitant with onychomadesis, that was diagnosed by color Doppler ultrasound in a long-time practitioner of martial arts who was otherwise healthy. Color Doppler ultrasound is an excellent imaging technique for supporting the diagnosis of retronychia. It provides information on the exact location and morphology of the nail plate as well as the presence of inflammatory signs in the ungual and proximal periungual regions. Additionally, this imaging technique can support the differential diagnosis with other nail conditions. Since there are many sports or activities that can potentially injure the toenails, retronychia may be an underestimated entity and the present case can raise the awareness of this condition and show the usefulness of color Doppler ultrasound.
Talar extrusion in a 13-year-old child was treated by means of open reduction and 10 weeks of cast immobilization. At 1.5 years of follow-up, the patient had full range of motion in the ankle and no signs of avascular necrosis or arthritis. (J Am Podiatr Med Assoc 99(5): 431–434, 2009)
Triamcinolone acetonide is a synthetic glucocorticoid used to treat numerous acute and chronic inflammatory conditions. The various side effects of this drug from parenteral administration are well documented in the literature. In this study, three patients present with a rare side effect of violaceous dermal pigmentation. To the best of the authors' knowledge, this finding is rarely presented in the current literature. The purpose of this study is to provide awareness of a less-documented, delayed side effect from triamcinolone acetonide administration. Although all patients presenting in this study had a known history of autoimmune disease (eg, lupus, psoriatic arthritis) further research is needed to suggest a possible association between dermal violaceous change and the use of triamcinolone.
We report a case of a 40-year-old woman with synovial sarcoma who presented with neural symptoms in the medial aspect of the right foot and ankle. The radiographic appearance of the foot and ankle was unremarkable, but magnetic resonance imaging showed a relatively well-defined enhancing lesion in the plantar soft tissues extending from the master knot of Henry to the posterior tibialis tendon. After orthopedic oncologic evaluation and workup, the patient was ultimately treated with a transtibial amputation, and no evidence of recurrence or metastatic disease was seen at 6-month follow-up. (J Am Podiatr Med Assoc 100(3): 216–219, 2010)
A schwannoma is a solitary benign tumor composed of Schwann cells occurring anywhere in the peripheral nervous system. The diagnosis of a schwannoma is often difficult to make by clinical presentation and advanced imaging modalities. We present a case report of a 61-year-old Hispanic woman with a left-foot, third-digit, soft-tissue mass. The diagnosis of a schwannoma of the proper digital nerve was made postsurgically by means of histopathologic and immunohistochemistry parameters. This is a rare location for a schwannoma, and neurogenic tumor should be included in the differential diagnosis of soft-tissue mass, as there have been prior case reports.
Anesthetics containing epinephrine have long been thought unsuitable for use in the foot and, particularly, the digits. However, research suggests that epinephrine use is beneficial in the appropriately selected patient. These benefits include a decreased local anesthetic plasma concentration; an increased duration of anesthesia, with a decreased need for additional narcotic use after surgery; decreased development of hemorrhage and postoperative hematoma, without occlusion of vessels; and a lack of complications (in millions of patients reported on in the literature). A retrospective review of more than 150 patients receiving local anesthetics containing epinephrine revealed no complications in the foot and ankle. (J Am Podiatr Med Assoc 93(2): 157-160, 2003)