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In diagnosing the etiology of tarsal tunnel syndrome, the practitioner must be aware of space-occupying lesions as a possibility. These masses, rarely found beneath the laciniate ligament, can occur. Satisfying results have occurred after removal of these lesions. Careful dissection will assure preservation of the nerve and prevent sensory or motor loss.
A case study has been presented where C. jeikeium was isolated as the causative bacterium of an osteomyelitis of the fifth metatarsal. Partial amputation, local wound care, frequent and aggressive debridement, and appropriate antibiotics were all used with apparent success. The lack of complete patient follow-up prohibits the authors from declaring the infection cured; however, all signs of infection were absent immediately prior to discharge. The authors believe this to be the first reported case of Corynebacterium species as the bacterial isolate in confirmed osteomyelitis.
It is unusual to find such extensive deformity of the navicular in a bilateral and symmetrical fashion. The apparent lack of significant trauma coupled with the patient's unremarkable medical history led the authors to an exclusionary diagnosis of spontaneous osteonecrosis. While changes are clearly evident on plain film radiography, computed tomography and magnetic resonance imaging provide the clinician with a more detailed picture of the extent of destruction.
The authors discuss the use of computers in medicine. A patient presenting with a condition requiring surgery is represented by a data file in a computer program. The user obtains data from the file by selecting items from a menu. Data are presented on the screen in pop-up windows. By examining the data and making judgments, the user may determine the pathology and make first a provisional and then a definitive diagnosis.
