Advancements in methods of imaging infection have surpassed their worth. Although scientifically substantiated, their clinical pertinence is frequently disappointing. Diabetic infections, postoperative or traumatic sequelae, rheumatologic conditions, and Charcot disease are difficult to differentiate from osseous infection because they all manifest as inflammation. As this country struggles to contain health care costs, a critical investigation regarding the practical benefits of imaging osteomyelitis in the foot is overdue.
The authors present an overview of post-traumatic foot compartment syndrome with an emphasis on the importance of relieving vascular compromise immediately. The incisional approach selected should not only effectively decompress the foot, but also allow for repair of concomitant osseous and soft tissue injury as well. Vascular considerations may dictate the course of simultaneous fracture management.
Iatrogenic metatarsus primus elevatus is an infrequent but devastating complication of first ray surgery. The authors address their clinical and radiographic evaluation of metatarsus primus elevatus, and describe a surgical treatment with emphasis on the sagittal plane Z-osteotomy. This osteotomy provides predictable and versatile correction for the treatment of iatrogenic deformities of the first metatarsal. It allows for plantarflexion and lengthening of the first metatarsal while avoiding an interpositional bone graft. The technical aspects of the procedure are thoroughly discussed.
Cases must be treated on an individual basis, appreciating the complexity of the syndactyly, considering the patient compliance, and understanding the goals of the surgical correction. Extensive discussion with the patient and parents must occur to clarify the goals of the surgery, the expectations, and possible complications. Careful preoperative planning and incision design is paramount in obtaining satisfactory results. Skin grafting may be required, either full-thickness from a variety of donor sites or split-thickness grafting as in one case study reported. Adjunctively, manipulation and stretching of the web space for 2 to 3 months preoperatively may be helpful to achieve more laxity of the soft tissues. The choice of suture material is of particular concern when dealing with a small child. It is usually wise to use an absorbable suture material for skin closure in a small child to prevent undue emotional stress to the child or even further anesthesia upon suture removal. Vascular compromise caused by soft tissue tension in not an infrequent occurrence. As with any surgery that addresses largely cosmetic deformities, there is no substitute for exact prior planning, meticulous technique, and surgeon experience to optimize results.