Avascular necrosis of the first metatarsal head has been reported as a potential complication associated with osteotomies at the first metatarsal head for repair of hallux abducto valgus deformity. However, most if not all of the radiographic and clinical findings associated with avascular necrosis at this level may also be explained by other processes. A critical review of avascular necrosis of the first metatarsal head is presented in conjunction with a discussion of alternative etiologies for the radiographic and clinical findings that may be noted following capital osteotomies.
The authors conducted a retrospective study of the release of the first branch of the lateral plantar nerve in the treatment of chronic heel pain unrelieved by conservative treatment modalities. A total of 17 patients (18 feet) were evaluated following external neurolysis for heel pain caused by entrapment of the first branch of the lateral plantar nerve. The average postoperative follow-up time was 32.8 months, with a range of 10 to 72 months. Every patient deemed the surgery successful. At the time of follow-up examination, nine feet were asymptomatic and nine feet experienced mild pain after extended activity. There was one postoperative complication, medial calcaneal nerve entrapment; it was successfully treated with neurectomy.
An updated and thorough review of the gastrocnemius equinus deformity and its surgical correction is presented. For the first time, a long-term retrospective study documents the overall improvement in the symptoms and architecture of the lower extremity and foot following gastrocnemius recession. Additionally, numerous associated concerns and the surgical procedure are examined retrospectively.
Successful management of the Charcot foot is one of the most challenging undertakings faced by physicians. However, many times such patients undergo prolonged and attentive care only to develop further deformity, and in many cases succumb to amputation. Research in the past few years has yielded a new understanding of the Charcot process that should serve as the basis for improved therapeutic measures. The authors discuss these more recent developments and how this knowledge may be applied to better serve the patient. In addition, surgical reconstruction of the diabetic Charcot foot is introduced and discussed.
Sixteen patients were evaluated following excision of recurrent intermetatarsal neuroma. Each underwent removal of a segment of nerve through an incision on the plantar aspect. The nerve stump was buried in the flexor digitorum brevis muscle. At the time of follow-up examinations, six patients were asymptomatic, seven experienced mild pain after extended activity, one suffered mild consistent pain with activity, and two suffered pain that limited activities.