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Phenol matrixectomy is commonly used to treat onychocryptosis. The podiatric medical community has been progressively improving the technique of phenol application to avoid cases of burns. We describe a modification that uses gauze to provide a safe way for the phenol to be applied and prevents skin lesions due to phenol burns. (J Am Podiatr Med Assoc 98(5): 418–421, 2008)
Evaluation for limb-length discrepancy is an important part of the biomechanical work-up in the podiatric musculoskeletal exam. By understanding the foot's contribution to such a discrepancy, the podiatric clinician will have better insight regarding treatment strategy. This technique will provide the clinician with a simple method to gain such insight.
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)
Ingrown toenails are one of the most common pathologic conditions encountered in podiatric medical practice. Many methods of treatment for ingrown toenails have been used and studied, including chemical matrixectomies, surgical approaches, and CO2 laser ablation. This study is a retrospective review of a new technique that consists of resection of the involved nail matrix using a No. 15 blade and controlled cauterization using a CO2 laser. The technique was performed on 381 painful ingrown toenails, and all of the patients were followed up postoperatively for an average of 34 months. The results showed minimal pain, a low recurrence rate, rapid return to activity, and good cosmesis. (J Am Podiatr Med Assoc 95(2): 175–179, 2005)
Onychocryptosis is a common pathology treated by podiatry medical services, and in a considerable percentage, surgical procedures are required to achieve a solution. There are multiple surgical approaches for ingrown toenails, both incisional procedures and nonincisional procedures, such as chemical matrixectomies and physical matrixectomies using carbon dioxide laser. This study presents a surgical procedure for onychocryptosis using a physical matrixectomy with a 1064-nm laser applied by means of a 400-μm optical fiber and surgical removal of the posterior cauterized tissue to achieve healing by primary intention. This technique was performed on 30 patients with onychocryptosis affecting the great toe (Mozena stages I and IIa), and all of the patients were followed up postoperatively for 12 months. The patients reported minimal postoperative pain, quicker surgical postoperative healing, rapid return to activities of daily living, and minor postoperative recurrence compared with previous studies using incisional procedures and chemical matrixectomies.
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)
The author proposes a novel use of redundant bone resulting from the lateral transposition of the first metatarsal head upon the shaft during a distal osteotomy bunionectomy. The bone, which is usually discarded, may be transposed to the lateral side of the shaft, fixated in place, and used to buttress the metatarsal head, thereby increasing the amount of transpostional shift that can safely occur with stability. By doing this, one could extend the range of intermetatarsal angles suitable to a distal osteotomy.
Few studies exist investigating surgical hammertoe correction salvage procedures regarding poor outcomes secondary to silastic implant failure. We present a case of a patient who presented to our clinic with a grossly deformed digit after undergoing several silastic implant procedures. The patient wanted to salvage the toe and elected for surgical intervention. Surgical planning consisted of a V-Y skin plasty with interposition of calcaneal autograft. This allowed restoration of anatomic dimensions and function of the patient's digit. We present this operative technique as a viable method of salvaging failed hammertoe correction procedures.
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)
This article presents a new nail block technique that constitutes an alternative local block for procedures involving the hallux nail and nail fold. It has significant advantages in terms of simplicity, effectiveness, safety, and economy over the traditional hallux block in selected procedures. (J Am Podiatr Med Assoc 95(6): 589–592, 2005)
