Diana Fernández Morato

Analysis of Gastrocnemius Recession and Medial Column Procedures as Adjuncts in Arthroereisis for the Correction of Pediatric Pes Planovalgus: A Radiographic Retrospective Study

UNLABELLED The radiographic outcomes of 28 feet in 20 pediatric patients with pes planovalgus treated with subtalar arthroereisis, arthroereisis combined with gastrocnemius recession, or arthroereisis combined with gastrocnemius recession and medial column reconstruction were retrospectively analyzed. Preoperative and postoperative radiographic angles for talar declination, calcaneal inclination, and first metatarsal declination in the lateral view, and the angle formed between the longitudinal axis of the talus and the longitudinal axis of the lesser tarsus in the anteroposterior view were compared. Overall, analyses revealed statistically significant differences in the preoperative and postoperative radiographic angles for the 4 measured angles. Analysis by treatment group revealed statistically significant differences in correction of the angle measured in the anteroposterior view. Arthroereisis with gastrocnemius recession showed the greatest correction of this angle (median 19 degrees, range 11 degrees to 34 degrees) compared with the other treatment groups. There were no statistically significant differences in the degree of correction of the calcaneal inclination or talar declination angles, whereas a statistically significant difference in the correction of first metatarsal declination was observed. The greatest degree of angular change was achieved with medial column reconstruction (median 7 degrees, range 0 degrees to 9 degrees). Gastrocnemius recession displayed a notable effect on the correction of transverse plane deformity when used as an adjunct to arthroereisis. However, medial column reconstruction has a negative impact on the degree of correction in the transverse plane when it is used as an adjunct to arthroereisis and gastrocnemius recession. LEVEL OF CLINICAL EVIDENCE 4.

A proposed subungual exostosis clinical classification and treatment plan.

Subungual exostosis is a slow-growing, benign outgrowth of normal bone under the nail that affects the nail unit. The most common location in the foot is the dorsal surface of the distal phalanx of the big toe. Clinically, it can appear in combination with a variety of nail disorders, masking the underlying bone condition, which is frequently unrecognized or misdiagnosed. A new classification system for these lesions is proposed on the basis of the clinical signs and symptoms present during examination and the associated disorders of the nail plate. Also, a therapeutic algorithm that describes surgical approaches to the different presentations of this disorder is presented. (J Am Podiatr Med Assoc 99(6): 519-524, 2009)

Cirugía de la exostosis subungueal

ETIOLOGIA Y PATOGENIA No se conoce con exactitud los factores etiologicos que dan lugar a la aparicion de la exostosis subungueal. La mayoria de los autores consultados coinciden en afirmar que se debe a una enfermedad adquirida, aunque las causas por las que se desarrolla no estan bien definidas. Los hallazgos histopatologicos hacen pensar que la exostosis podria desarrollarse como consecuencia de un proceso cronico de irritacion del periostio3,10,11, que iria produciendo la excrecencia osea. Algunos factores relacionados con el desarrollo de este proceso son los siguientes: practica de deportes traumaticos12 (futbol, danza, gimnasia), uso de calzado estrecho de puntera y de tacon alto10, historia de antecedentes quirurgicos de la una5, historia de traumatismos directos sobre el dedo afectado12, alteraciones mecanicas del pie5 y alteraciones en el primer radio, como el hallux limitus funcional y el hallux rigidus. Para otros autores, la aparicion de la exostosis subungueal radica en factores congenitos13, que la asocian con malformaciones en el cartilago de la region distal de la falange distal del hallux.

Cirugía del osteocondroma subungueal

El osteocondroma se considera el tumor oseo benigno mas frecuente del esqueleto1,2, y se reconoce por la presencia de hallazgos histopatologicos y radiologicos distintivos3. Se trata de un tumor de desarrollo lento, que aumenta de tamano con el crecimiento del individuo hasta el cierre epifisario4. Este tumor se ha descrito como un crecimiento anormal del cartilago y hueso que se caracteriza por la aparicion de una lesion con una base osea y un casquete cartilaginoso, producida por una placa de cartilago epifisario aberrante, que se desarrolla en la metafisis de crecimiento de los huesos. Pueden afectar a cualquier hueso con osificacion encondral, aunque, en el pie, su hallazgo es mas inusual (Murphey et al5 senalan la aparicion en los huesos de las manos y los pies en el 10% de los casos).