Achilles tenotomy is performed for the residual equinus deformity in the Ponseti method of clubfoot treatment. In the present article, we describe a mini-open Achilles tenotomy technique to prevent complications that could occur during tenotomy. This technique was performed on 15 patients (25 feet) during a 3-year period in our clinic on patients whose equinus deformities could not have been corrected by manipulations. Clear improvement (mean angle, 30°) was observed in equinus in our patients, and we have not seen any complication in this method. We conclude that direct visualizing of the tendon with mini-open incision may reduce the risk of neurovascular injury, especially for surgeons who are not experienced. (J Am Podiatr Med Assoc 98(5): 414–417, 2008)
Reconstruction of bone and soft-tissue defects after an open reduction and internal fixation of a severly comminuted calcaneal fracture presents a challenge to the treating surgeon. We present a case report in which an abductor digiti minimi muscle flap was used to cover a complicated wound with calcaneal osteomyelitis and wound dehisence at the surgical incision. This muscle flap provides an easy, reliable, and quick method to cover open wounds at the lateral aspect of the foot and ankle. (J Am Podiatr Med Assoc 98(2): 139–142, 2008)
Malignant melanoma is responsible for more than three-fourths of skin cancer deaths in the United States. Melanomas presenting on acral surfaces are frequently misdiagnosed initially, leading to progression of disease and worse prognosis. This case is presented to reinforce the significance of careful physical examination and early biopsy of atypical ulcerations of the foot.
A rare and unusual case of plasma cell dyscrasia of the calcaneus is presented. Clinically, the patient had a draining and painful ulcer that was treated with appropriate antibiotics and wound care but failed to show any signs of healing. Radiographic images showed cystic changes of the calcaneus in the vicinity of the ulcer. Blood work was negative for bone and soft-tissue infection, but uric acid and alkaline phosphatase levels were elevated. Nuclear bone scan showed increased uptake in the calcaneus suggestive of osteomyelitis. One possible differential diagnosis was an intraosseous gouty tophus deposit. Not convinced that this was either a bone infection or gout, the author performed a bone biopsy. Pathologic evaluation indicated plasma cell dyscrasia. Continued wound care healed the ulcer completely, with resolution of pain of his heel. Oncology/hematology was consulted, and 16 months after biopsy, he remains asymptomatic.
A 13-year-old girl presented to the emergency department in stable condition with a retained penetrating knife wound injury in her right foot. Routine radiographs taken of the foot revealed deep tissue penetration by the knife without frank bony involvement. It was decided to remove the object in the operating room. Simple removal was performed, followed by wound exploration. The patient was admitted to the hospital for one night of observation and then was discharged without further complications.
The use of bioengineered tissue and topical subatmospheric pressure therapy have both been widely accepted as adjunctive therapies for the treatment of noninfected, nonischemic diabetic foot wounds. This article describes a temporally overlapping method of care that includes a period of simultaneous application of bioengineered tissue (Apligraf, Novartis Pharmaceuticals Corp, East Hanover, New Jersey) and subatmospheric pressure therapy delivered through the VAC (Vacuum Assisted Closure) system (KCI, Inc, San Antonio, Texas). Future descriptive and analytic works may test the hypothesis that combined therapies used at different and often overlapping periods during the wound-healing cycle may be more effective than a single modality. (J Am Podiatr Med Assoc 92(7): 395-397, 2002)
The number of people with diabetes is expected to reach 592 million in the year 2035. Diabetic foot lesions are responsible for more hospitalizations than any other complication of diabetes. The aims of this study were to examine for the first time a new biocompatible and biodegradable tridimensional collagen-based matrix, GBT013, in humans for diabetic foot ulcer wound healing and to evaluate its ease of use to better define a protocol for a future clinical trial. Seven adult patients with a diabetic foot ulcer of grade 1A to 3D (University of Texas Diabetic Wound Classification) were treated using GBT013, a new collagen-based advance dressing and were monitored in two specialized foot care units for a maximum of 9 weeks. Five of seven wounds achieved complete healing in 4 to 7 weeks. Nonhealed ulcers showed a significant reduction of the wound surface (>44%). GBT013 was well tolerated and displayed positive wound healing outcomes as a new treatment strategy of chronic foot ulcers in diabetic patients.
Osteomyelitis of the distal tibia with involvement of the distal physis can lead to various deformities around the ankle and foot. Calcaneus deformity of the foot is usually secondary to paralytic disorders. A 14-year-old boy presented with calcaneus deformity as a result of osteomyelitis of the distal tibia. Involvement of the distal tibial epiphysis as a result of osteomyelitis of the distal tibia can lead to calcaneus deformity. This deformity has not been reported in the literature. Osteomyelitis of the distal tibia should also be included as a differential diagnosis of calcaneus deformity.
Neuropathic foot ulcers are a common complication in patients with diabetes. These ulcers are often slow to heal and can lead to infection, further tissue destruction, osteomyelitis, and amputation. These patients pose a challenge to clinicians who must determine the best treatment options while balancing the risks, benefits, and costs. Conservative therapies often present disappointing results, and a number of newer “biologic bandages” have been developed to better assist the healing process. We describe results from diabetic patients with neuropathic foot ulcers treated with a new amniotic membrane–based allograft.
Soft-tissue tumors in the foot include a range of benign and malignant pathologies. In the clinical setting, the list of differential diagnoses can be exhausting, and the treatment plan is not always straightforward. In this article, we present a case of a 22-year-old female with a soft-tissue mass on her plantar foot that has been slowly growing since adolescence and is now causing increased pain with ambulation. Her pathology results demonstrated an intramuscular hemangioma. Intramuscular hemangiomas are rare benign tumors that tend to present in youth or early adulthood. Diagnosis is often delayed for months to years, depending on the patient's symptoms. Treatment varies from conservative to surgical, depending on size, location, and proximity to vital structures. Literature on intramuscular hemangiomas is very limited. Intramuscular hemangiomas provide a diagnostic and treatment quandary for the clinician and must be considered in the differential diagnoses when presented with a soft-tissue mass.