Babak Baravarian

Subtotal calcanectomy for the treatment of large heel ulceration and calcaneal osteomyelitis in the diabetic patient

Diabetic, neuropathic patients are often at risk for ulceration. Those that are temporarily or permanently limited in ambulation and restricted to a supine position are over time very susceptible to heel decubiti. Twelve patients with heel ulceration and calcaneal osteomyelitis who underwent subtotal calcanectomy are presented. Aggressive debridement of all nonviable tissue was coupled with a thorough antibiotic course in all cases. Ten of the 12 were completely healed at follow-up of 13 months. Two patients died of cardiac complications unrelated to their surgery. Postoperatively, the 10 patients were placed in an ankle-foot orthosis combined with a custom-molded shoe. All patients who were ambulatory preoperatively were able to resume their function after surgery. Subtotal calcanectomy is a relatively simple procedure to perform. In the presence of adequate vasculature, it is a good alternative to below-the-knee amputation and the accompanying sequelae.

Lapidus bunionectomy: arthrodesis of the first metatarsocunieform joint

Fusion of the first metatarsocunieform (MC) joint allows for correction of the first metatarsal in three planes, including adduction, plantarflexion, and rotation. It also allows for decreased jamming of the great toe joint and increased medial column stability. As knowledge about other medial column procedures grows, fusion of the first MC joint will continue to grow in popularity. It is an excellent procedure for hallux limitus and also for metatarsus primus elevatus cases.

Use of the Cobb procedure in the treatment of posterior tibial tendon dysfunction.

Numerous surgical procedures have been described for the treatment of the adult acquired flatfoot deformity. The surgeon should review in detail all the clinical, radiographic and imaging tests and propose the best surgical procedure for the patient. Although flexor tendon transfer has shown excellent results, the split anterior tibial tendon transfer is a second option. If used properly, the Cobb procedure results in less functional loss, since only half of the anterior tibial tendon is transferred. Furthermore, the flexor tendon is not disrupted and continues its primary function in the foot and ankle. Ultimately, the goals of the surgical procedure are to alleviate the patients symptoms and pain, restore a normal foot alignment, and limit the loss of foot and ankle function without causing any complications.

Soft-tissue disorders of the ankle: a comprehensive arthroscopic approach.

Ankle arthroscopy has dramatically advanced in the past decade. Many ailments of the ankle joint that were previously treated through open approaches are today treated with arthroscopic techniques. Arthroscopy allows for a more rapid recovery, better visualization of soft tissue lesions within the ankle joint and a more thorough examination of intracapsular ankle pathology. This article describes current arthroscopic treatments of ankle pathology limited to soft tissue structures. Additionally, a perspective is presented for the comprehensive treatment of lateral ankle pain including arthroscopic lateral ankle stabilization.

Arthrodesis techniques, part II

One of the tested and retested approaches to the treatment of foot and ankle ailments is through arthrodesis procedures. Arthrodesis allows for increased stability, deformity correction, and limited reoccurrence potential. Although attempts should be made to retain motion at a joint as much as possible, in certain cases, arthrodesis of the joint is the only option. With the advent of internal fixation, arthrodesis of the forefoot and midfoot has improved and healing time has been reduced. I am grateful to our authors who have taken time out of their busy schedules to share their knowledge. Arthrodesis is considered a destructive procedure, yet it has the potential to correct dramatic deformity and decrease pain. However, it is not without complications and may cause further pain and underlying problems if not done properly. It is the goal of this issue of the Clinics in Podiatric Medicine and Surgery to show the reasoning behind forefoot andmidfoot arthrodesis as well as its uses and complications. I hope that this issue serves as a guide to those in need of a teaching aide and helps expand the possible therapies that are offered to patients. I would like to thank my wife Yas, my daughter Haley, and my child on the way for their understanding while I spent time away from them to do this project. I live each day knowing that you are my pillars and I truly love you all.