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Osteomyelitis of the calcaneus combined with a pathologic fracture is a rare and difficult presentation for any practicing foot and ankle surgeon. Treatment for achieving an aseptic nonunion involves a variety of steps, including surgical debridement, antibiotic administration, and fracture stabilization. In this case series, we report a novel technique for the treatment of a tongue-type calcaneal fracture in the setting of chronic osteomyelitis using the Biomet JuggerLoc bone-to-bone system for fixation.
True Pathologic Abnormality versus Artifact
Foot Position and Magic Angle Artifact in the Peroneal Tendons with 3T Imaging
Magnetic resonance imaging is a commonly ordered examination by many foot and ankle surgeons for ankle pain and suspected peroneal tendon pathologic abnormalities. Magic angle artifact is one of the complexities associated with this imaging modality. Magic angle refers to the increased signal on magnetic resonance images associated with the highly organized collagen fibers in tendons and ligaments when they are orientated at a 55° angle to the main magnetic field. We present several examples from a clinical practice setting using 3T imaging illustrating a substantial reduction in magic angle artifact of the peroneal tendon in the prone plantarflexed position compared with the standard neutral (right angle) position.
Reconstructive surgery for hindfoot, ankle, and leg deformities is facilitated by proper radiographic analysis. The long leg calcaneal axial and hindfoot alignment views have been proved to be useful in deformity planning at The Foot and Ankle Institute at The Western Pennsylvania Hospital. These radiographic views can be attained in an office setting or in any hospital radiology department. The details provided herein of this radiographic technique will be useful to physicians, office staff, and radiology technicians to facilitate proper imaging of hindfoot, ankle, and leg deformities. (J Am Podiatr Med Assoc 98(1): 75–78, 2008)
Numerous hallux proximal phalanx osteotomies have been described, but the Akin-type varisation or adduction osteotomies are currently the most commonly used by foot and ankle surgeons. This article describes the hallux proximal phalanx Akin-Scarf osteotomy. This osteotomy combines the inherent stability of the Scarf-type osteotomy with the versatility of the Akin-type osteotomies to correct pathologic hallux abductus interphalangeus, hallux equinus, or an abnormal digital length pattern, and it is an invaluable tool during the global surgical approach used for hallux valgus repair. (J Am Podiatr Med Assoc 94(1): 70-72, 2004)
NuGen Fx Bioabsorbable Screws
A Preliminary Report of Their Use in Foot Surgery
A single prospective group study in adults was performed using a new bioabsorbable screw, the NuGen Fx screw (Linvatec Biomaterials Ltd, Tampere, Finland). This multisite study included five sites and 50 patients (10 patients per site). The goal of this study was to evaluate the efficiency and safety of the NuGen Fx screw system in the fixation of osteotomies, arthrodeses, and fractures in the foot and ankle. We discuss our own results from 12 patients treated at the Kentucky Podiatric Residency Program at Norton Audubon Hospital, Louisville. The number of patients in the study, screw sizes, instrumentation, radiologic evaluation findings, and our overview of this implant are presented. (J Am Podiatr Med Assoc 96(1): 73–77, 2006)
Chronic plantar fasciitis is often treated by surgical plantar fasciotomy when conservative treatments have been exhausted. This article presents an ultrasound-guided Weil percutaneous plantar fasciotomy technique used to successfully treat persistent plantar fasciitis in a 48-year-old woman. Five weeks after the procedure, the patient had resumed normal activity, with an excellent clinical outcome. This ultrasound-guided technique can be performed in an office or hospital surgical setting. This technique may be useful to podiatric physicians and surgeons who treat chronic plantar fasciitis. (J Am Podiatr Med Assoc 100(2): 146–148, 2010)
By using three-dimensional magnetic resonance image reconstruction, lateral displacement of the flexor hallucis longus tendon and sesamoid bones was made clearly visible in a living patient. This finding supports a biomechanical model related to disturbed muscle balance at the first metatarsophalangeal joint, which could play an important role in the pathogenesis of hallux valgus and metatarsus primus varus. (J Am Podiatr Med Assoc 95(4): 401–404, 2005)
Presented here is a preliminary report of 102 patients who underwent first metatarsocuneiform joint arthrodeses performed with external fixation for the correction of hallux valgus. The advantages of using external fixation are the ability to initiate early weightbearing, predictable fusion, and removal of all of the hardware postoperatively. In the 102 patients reported here, the average time to initiation of unassisted full weightbearing was 13.1 days. The average time to fusion was 5.3 weeks, with removal of the external fixator at an average of 5.5 weeks postoperatively. There was no incidence of delayed union or nonunion. There was one case of pin-tract irritation, which resolved with appropriate pin care and a short course of oral antibiotics. External fixation is an effective alternative to traditional internal fixation techniques in metatarsocuneiform joint arthrodesis. (J Am Podiatr Med Assoc 95(4): 405–409, 2005)
We describe a simplified capsular interpositional technique for the Keller bunionectomy that uses a Kirschner wire to interpose the capsule into the first metatarsophalangeal joint without requiring sutures. The capsule acts as a biologic spacer in the first metatarsophalangeal joint, allowing for fibrosis to fill the void created, with the Kirschner wire maintaining the distance between the metatarsal head and the stump of the proximal phalanx. This creation of a nonpainful pseudarthrosis prevents shortening of the hallux and retraction of the base of the proximal phalanx on the metatarsal head.
Hyperhidrosis is defined as excessive and uncontrollable sweating due to overactivity of the eccrine sweat glands. The first line of treatment for plantar hyperhidrosis consists of conservative therapies such as topical solutions (ie, antiperspirant applications and aluminum chloride preparations) and iontophoresis. When the patient has failed these standard treatments, the other available medical options are rather limited and not well tolerated. Botulinum toxin type A (Botox, Allergan Inc, Irvine, California) is a purified neurotoxin complex approved by the US Food and Drug Administration in 2004 for multiple medical conditions, including severe primary axillary hyperhidrosis that failed conservative topical therapies. Few recent clinical studies have suggested that botulinum toxin is effective in the treatment of plantar hyperhidrosis. In this case study, two patients received intradermal injections of botulinum toxin type A into the plantar aspect of both feet. A 3-month follow-up evaluated the efficacy of botulinum toxin type A by subjectively assessing the amount of residual sweating. In these two patients, botulinum toxin type A was an effective and safe treatment for plantar hyperhidrosis. (J Am Podiatr Med Assoc 98(2): 156–159, 2008)
