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- Author or Editor: S Plotkin x
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A case study of monozygotic twins with bilateral calcaneonavicular coalitions is presented. With the frequency of tarsal coalitions being approximately 1% to 2% and the frequency of monozygotic twins being 0.4%, it is a rare but predictable finding to see monozygotic twins with tarsal coalitions. This sheds additional light on the etiology of tarsal coalition that historically has been believed to be a defect in mesenchymal differentiation with indications of a genetic component. Despite the limited number of subjects used for various studies, tarsal coalitions have been considered to be an autosomal dominant defect with variable penetrance. In fact, inheritance of tarsal coalitions is more complicated than simple mendelian inheritance patterns and is likely to be a single error in a polygenic system. Because of this inheritance pattern, it is important to consider evaluating siblings and close family members of patients diagnosed with a tarsal coalition.
To minimize injection anxiety and discomfort, the podiatric surgeon can choose from a variety of topical anesthetics. Available modalities include skin refrigerants (also referred to as vapocoolants), needleless injection systems, iontophoresis, and eutectic mixtures of topical anesthetic cream such as EMLA Cream. Many of the vapocoolants contain chlorofluorocarbons, which are known to damage the ozone layer, a stratospheric layer that filters out harmful ultraviolet B radiation. In accordance with the 1992 Montreal Protocol, which banned the manufacture of certain chlorofluorocarbon compounds, many commonly used vapocoolants will no longer be available. Some newly marketed vapocoolants produce extremely cold temperatures, limiting their use. This article discusses the properties of various vapocoolants and other topical anesthetics and compares their effectiveness in patient trials.
