Surgical repair of an acute, distal, tendo Achillis rupture in a 59-year-old diabetic male is described in which the Mitek Anchor System was used. The injury described is a distal tear of the insertion of the tendon into the calcaneus without avulsion fracture of the calcaneus. Sixteen months of postoperative follow-up care, including casting for equinus deformity, progressive weightbearing, range of motion exercises, and physical therapy, have been free of complications. The authors include a brief overview of historical and current reparative techniques for comparison. The authors conclude that the use of the Mitek Anchor System affords the surgeon a simple and effective method for the repair of acute, distal, tendo Achillis rupture when other methods cannot be used because of the location of the rupture.
Recent advances in the technical aspects of tissue expanders for closure of skin deficits have led to an overall reduction in the high rate of complications typically associated with their usage. The authors provide a review of the recent refinements in the technique of the tissue expansion process. A discussion of current and future applications using this technique in the treatment of various lower extremity pathologies, including clubfoot, is presented. A case report on the use of a subcutaneous tissue expander for the treatment of a failed skin graft of the medial ankle is included.
Leiomyomas are benign soft tissue tumors originating in smooth muscle. They present clinically as a soft tissue mass causing a well localized, paroxysmal pain. Treatment of choice for such lesions is total excision. Recurrence or malignant transformation of these tumors is rare. Calcific leiomyomas, as diagnosed in this study, have seldom been reported in the foot. When treating lesions involving atopic calcification, it is important to maintain a high level of understanding of the various etiologies, both metabolic and nonmetabolic, which may lead to calcium deposition in the soft tissues.
The authors provide a review of the principles of talectomy as a surgical treatment option for severe, rigid, and resistant clubfoot deformities. Such deformities are associated with a high recurrence rate and frequently involve a large number of surgical interventions to attain a satisfactory result. Talectomy has been successfully used as both a primary and salvage procedure to treat such deformities, often eliminating the need for subsequent surgeries. A discussion of the operative technique, indications, advantages, and common complications associated with the procedure is presented. In addition, a case report of talectomy used to treat a severe, bilateral clubfoot deformity in a 4-year-old boy is included.
The authors present a case of bilateral middle facet talocalcaneal coalitions with peroneal spasm producing a fixed valgus heel. They introduce a corrective procedure used at the Fountain Valley Regional Hospital and Medical Center and discuss its application in podiatric surgery. Correction included resection of the synostosis and lateral opening wedge heterogenous bone graft in the calcaneus to redistribute the body's weight on the heel and centralized over the axis of the subtalar joint.
An introduction to the biodegradable Biofix rod for use in podiatric surgery is presented. Its application for Austin-type bunionectomies is described. The advantages and shortcomings are compared to traditional internal fixation. For procedures necessitating osteotomy stability, the Biofix rod is another option for the podiatric surgeon.
Subcutaneous fungal infections are relatively uncommon in the lower extremity. Mycetoma begins as painless papules or nodules that increase in size and progresses to involve the connective tissue. Diagnosis is based on biopsy, with definitive identification of the organism needed for effective treatment. Treatment consists of antifungal medications and surgical debridement. This article provides an overview of this disorder and reports on a case of recurrent mycetoma in a 70-year-old woman.