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- Author or Editor: Gerard V. Yu x
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Charcot’s neuroarthropathy is a relatively common disease in patients with diabetic neuropathy. If unrecognized or left untreated, Charcot’s neuroarthropathy can result in a severely misshapen and unstable foot and ankle. Ulceration, soft-tissue infection, and osteomyelitis frequently ensue, and partial or complete amputation of the foot is not uncommon. A high index of suspicion and proper interpretation of clinical and diagnostic findings are essential to establish a timely and accurate diagnosis and to institute appropriate treatment. The pathogenesis of neuroarthropathy is reviewed and diagnosis and treatment of the stage 0 diabetic Charcot foot are presented. (J Am Podiatr Med Assoc 92(4): 210-220, 2002)
Arthrodesis of the Interphalangeal Joint of the Hallux
A Simple and Effective Technique
The authors present a simple and effective technique to achieve arthrodesis of the hallucal interphalangeal joint. Stabilization is achieved by external fixation with crossing Kirschner wires joined together to create a single functional unit, a technique that avoids common problems often associated with Kirschner-wire fixation. The authors propose that this simple technique be considered for patients in whom it has been determined that screw fixation should not be used to obtain fusion of the interphalangeal joint. (J Am Podiatr Med Assoc 91(8): 427-434, 2001)
The Jones Compression Bandage
Review and Clinical Applications
Lower-extremity edema is a common condition that can be caused by many pathophysiologic processes. Control of edema associated with surgery or trauma is important and will help minimize pain and discomfort and prevent wound complications and blisters. Many techniques are used to control edema. The Jones compression dressing is an excellent tool that has been used successfully by the senior author for 18 years. It continues to be a primary treatment technique for the control of edema. (J Am Podiatr Med Assoc 92(4): 221-231, 2002)
Predislocation Syndrome
Progressive Subluxation/Dislocation of the Lesser Metatarsophalangeal Joint
Progressive subluxation/dislocation of the lesser toes resulting from idiopathic inflammation about one or more of the lesser metatarsophalangeal joints is a common cause of metatarsalgia that is frequently unrecognized or misdiagnosed. The disorder results from a failure of the plantar plate and collateral ligaments that stabilize the metatarsophalangeal joints and is typically associated with abnormal forefoot loading patterns. The authors refer to this condition as predislocation syndrome and have devised a clinical staging system that is based on the clinical signs and symptoms present during examination. A thorough review of predislocation syndrome and an overview of the conservative and surgical treatment options available for this disorder are presented. (J Am Podiatr Med Assoc 92(4): 182-199, 2002)
Syme’s Amputation
Surgical Technique, Prosthetic Considerations, and Case Reports
Amputation at the level of the ankle joint is a valuable but underused procedure for a variety of conditions affecting the foot and ankle. The procedure provides a comfortable and durable stump that allows the lower-extremity amputee to function with minimal disability. This article reviews the indications for Syme’s amputation, provides a detailed surgical description of the procedure, and discusses postoperative prosthetic considerations. In addition, three case reports are presented in which Syme’s procedure was successfully used as an alternative to higher-level amputation. (J Am Podiatr Med Assoc 92(4): 232-246, 2002)
Synovial Osteochondromatosis
A Case Report and Review of the Literature
Synovial osteochondromatosis is a benign disease of unknown etiology that involves the articular and periarticular structures. The disorder primarily affects men, and trauma is the most common predisposing factor. The authors review the literature, clinical findings, proposed etiology, classification, ancillary tests, histopathology, differential diagnosis, treatment options, and prognosis. A case report of this rare entity is also presented. (J Am Podiatr Med Assoc 92(4): 247-254, 2002)
Background: Sophisticated methods of cryotherapy, such as application of a water-circulating device, have recently been popularized to provide a constant or intermittent therapeutic source in the foot and ankle postoperative setting. In this study, the efficacy and safety of three selected cryotherapy devices (Iceman, EBIce, and Ankle Cryo/Cuff) were investigated.
Methods: Each cryotherapy unit, in the coldest setting, was applied over standard surgical dressings in group I, over one layer of Jones compression bandage in group II, and over two layers of Jones compression bandage in group III on four individuals in excellent overall health. The skin temperature was then recorded every 15 min for 180 min in each trial.
Results: In group I, the Iceman was the only device that required discontinuation in one subject, and the EBIce and Cryo/Cuff were tolerated in all of the subjects. However, the temperatures in all of the devices continued to decrease at the end of the trials. In group II, all of the cryotherapy devices controlled temperatures between 20°C (68°F) and 30°C (86°F). In group III, no device significantly lowered the initial surface skin temperature.
Conclusions: We achieved the safe and effective temperature range when the cryotherapy devices were applied over one layer of Jones compression dressing. The cryotherapy devices resulted in less predicable temperature declination when applied over the thinner surgical dressing. When the devices were applied over two layers of Jones compression dressing, surface skin temperature declination was minimal. (J Am Podiatr Med Assoc 97(6): 439–446, 2007)
Retrocalcaneal surgery is complex and difficult. Over the years, many different approaches to retrocalcaneal surgery have been described. Partial or total release of the tendo Achillis is often necessary, with reattachment being of paramount importance to allow for optimal function following surgery. Although numerous anchoring devices have been introduced for tendo Achillis reattachment, the authors have found the DePuy TiMAX Spider Plate (DePuy ACE, Warsaw, Indiana) to be superior. This article describes the Spider Plate and associated surgical technique, which have greatly enhanced the outcome of retrocalcaneal surgery. (J Am Podiatr Med Assoc 92(4): 200-209, 2002)
