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Peripheral neuropathy manifests as a painful syndrome in a significant number of individuals suffering from diabetes mellitus. Painful diabetic neuropathy may interfere with sleep, work, and activities of daily living. Patients and practitioners alike often view this challenging disorder as incurable. A broad spectrum of therapeutic alternatives and physiologic approaches to this complex clinical problem are available. Careful assessment and a rational approach based on the nature and location of pain will lead to success. The authors review the etiology, clinical presentation, and diagnosis of diabetic peripheral neuropathy. Available therapeutic alternatives are emphasized and an original treatment algorithm is presented.
Distal saphenous vein cutdown is an excellent method for intravenous access. It allows for a rapid infusion of fluids. Although the saphenous vein cutdown is not commonly performed, the podiatrist should be familiar with this procedure, as it may be necessary during an emergency situation.
The authors present three cases of a rare calcaneal tumor, intraosseous lipoma. The differentiation of intraosseous lipoma from other benign tumors is discussed. The diagnosis and treatment are reviewed.
The stepwise approach to the treatment of painful diabetic peripheral neuropathy allows the practitioner to use a broad spectrum of therapeutic modalities and physiologic approaches to this complicated clinical problem. The authors review the etiology and clinical presentation of diabetic neuropathy. Available therapeutic alternatives are discussed and an original stepwise algorithm is presented. Pharmacologic profiles of the most commonly used drugs are also described.
The authors describe the anatomical necessity and functional significance of torsion of the tendon of tibialis posterior. A wooden model of the right lower extremity has been constructed which includes representations of the ankle, subtalar, and oblique midtarsal joints. The model is used to show that the presence of torsion within the tendon of tibialis posterior eliminates the need for any longitudinal slippage between individual tendon fibers during triplane movement of the joints of the lower extremity.
