Plantar incisions on the feet have been a controversial subject for many years because of the potential untoward effects of scarring. The author presents a variety of techniques and the rationale for the use of plantar foot incisions, along with discussion on the prevention of complications.
Surgical matrixectomies and phenol alcohol matrixectomies have been effective in eliminating certain nail conditions. The complication rate is at an acceptable level; however, there is a need for comparison to other techniques, such as negative galvanism, trephine, osteotripsy, and laser ablation. Of the 353 patients in this study, two were known diabetics who were seen preoperatively by a vascular surgeon for vascular studies and by their internist. Both consultants agreed that the patients would heal. Both patients healed without complications. The author described the use of a modified Frost partial matrixectomy and modified Fowler total matrixectomy in this review. The phenol alcohol technique had a total complication rate of 9.6%, as did the partial matrixectomy. The total matrixectomy had an overall complication rate of 10.9%.
A retrospective study was conducted on the use of the ROC (Radial Osteo Compression) soft-tissue anchor in foot and ankle surgery. This article describes how the anchor is deployed, problematic aspects of using the anchor, and complications and success rates associated with the anchor in ankle stabilizations, posterior tibial tendon reconstruction, peroneus brevis tendon reconstruction after fracture of the base of the fifth metatarsal, and detachment and reattachment of the Achilles tendon. The ROC anchor consists of the anchor with nonabsorbable suture attached to the shaft, the deployment handle, and drill bits. The anchor and shaft are snapped into the deployment handle and inserted into the drill hole. Compression of the trigger deploys the anchor into the hole. The ROC anchor was found to be reliable, useful, and relatively easy to deploy, with outcomes similar to those of other soft-tissue anchors.
Current surgical treatments for Achilles tendon rupture are thoroughly discussed. New repair techniques, such as the use of soft-tissue anchors, are reviewed, as is the use of synthetic mesh to augment the surgical repair. A classification system devised by the author is presented to make it easier to select the appropriate surgical procedure or combination of procedures in delayed rupture repair. Postoperative physical therapy is paramount in the return to preinjury level of activity for these patients.