Aspect Of Foot Research Articles

Does the Radiographic Lateral View of Toes Matter? - A Retrospective Analyses of 378 X-Rays

Category: Lesser Toes; Trauma Introduction/Purpose: Because lateral toes are anatomically on the distal aspect of foot, they are more exposed to axial load (stubbed toe) and crushing injuries. In this context, correct obtainment of imaging exams is fundamental for proper diagnosis of MSI. In the X-ray room, however, due to overlapping of smaller fingers or because the patient`s pain, most common practice is to suppress the lateral view. The purpose of this study is to demonstrate the importance of toe radiographs in diagnosis of interphalangeal fractures and dislocations, emphasizing need for lateral view for diagnosis of these injuries. Methods: 378 radiographs of 126 patients treated between Jan/2018 and Mar/2018 in an emergency care clinic of a Brazilian hospital were retrospectively evaluated for presence of fractures. Patients were selected from a search on medical records using ICD. After, the radiographs of the same patient were duplicated and divided in two groups: standard group (AP and Oblique) and complete profile group (standard views plus lateral view). They were examined by four independent examiners of different degrees of experience. Each examiner randomly evaluated the same patient twice (1 in each group). Kappa index was used to evaluate intra and inter-examiner concordance, and the two-proportion equality test was used to calculate statistical significance. Results: Mean age of patients was 37,2 years (4-85yr). 144 fractures were diagnosed in standard group (28,6%) and 266 fractures (52,8%) in complete profile group (p < 0,001). Individually evaluating each examiner, everyone had had an improvement in number of fracture diagnostics when compared the complete profile group with the other (p < 0,001). Kappa index was superior to 0,60 for all examiners in pattern group. Conclusion: Addition of true lateral view was able to improve the number of diagnosed fractures on patients with lesser toes trauma.

Correlation of glycated haemoglobin status with the foot ulcer

Background: Diabetic foot ulcer is a well-documented complication of uncontrolled diabetes and its association with the variables involved in Diabetes like FBS, RBS and HBA1C has been thoroughly researched. This research aims to identify the association of diabetic foot ulcer under Wagner classification with HBA1C classes. Objectives were to determine the severity of diabetic foot ulcer at various level of HBA1C and determine the association. Methods: A observational cross-sectional study with 160 diabetic patients who after giving consent filled questionnaires. The information was analyzed using SPSS v26 (IBM) through Chi Square test. The results were tabulated and inferred from. Results: The study included Sample size of 160 Patients. Here in the study mean age for group A was 41.2 years, for group B it was 29.6 years and for group C it was 25.8 years. Majority 40% patients in group A had T2DM. In group B we found that 51.7% patients had T2DM followed by 48.2% patients with T1DM. In group C we found that majority 67.01% patients had T2DM. We found that site of ulcer was improving with increasing duration of follow up. Initially we found 30% patients with infection at dorsum aspect of foot. After follow up day 9 we found improvement in ulcer infection Conclusions: This research further supplemented an already strongly established association between uncontrolled diabetes and diabetic foot ulcer. We focused on specifically HBA1C and how increased lab values are linked with different grades of Diabetic Foot ulcer and found a strong association demanding a proactive approach towards patient care and education. HbA1c has a linear relationship with the grades of Wagner classification of diabetic foot.

Squamous cell carcinoma on the dorsal aspect of foot: a case report and literature review

Squamous cell carcinoma (SCC) is a rare condition of the foot. Its incidence has been described as roughly 0.6 to 3.0%. The disease was first described in 1828 by Marjolin, and its malignancy was recognized by Dupuytren. SCC originates in keratinocytes and may develop from a precursor lesion or de novo lesions. A case report of the occurrence of metastatic squamous cell carcinoma of the foot is presented. This metastatic lesion developed following trauma. The patient presented with a painful, ulcerative, non-healing wound on the dorsum of the left foot. A case study of squamous cell carcinoma on the dorsal aspect of the foot was done. Fine-needle aspiration of the lymph node and wedge biopsy of the lesion documented it as metastatic squamous cell carcinoma that was managed eventually by below-knee amputation. The clinical significance of our case study highlights the need for any non-healing wound to be viewed with suspicion and to assist in the prognosis, diagnosis, and management of patients with SCC along with a review of pertinent literature. In addition, this study has shown that early diagnosis and treatment are of vital importance to decrease the risk of recurrence and metastasis.

Navicular Tuberosity: A Surface Landmark for the Masterknot of Henry.

Medial aspect of foot is unexplored due to its complex anatomy. Masterknot of Henry is an important landmark in this region, which plays a key role during tendon transfer procedures especially in those involving the flexor hallucis longus and flexor digitorum longus. We aim to determine the exact anatomical location of masterknot of Henry with respect to the bony prominences of the medial aspect of the foot and compare these measurements to the length of the foot. Twenty cadaveric below-knee specimens were dissected. Structures on the medial side of the foot were exposed. Distance of the masterknot of Henry from surrounding bony landmarks was measured. Depth of the masterknot from skin of the plantar aspect was also measured. Means of all parameters were calculated. Relation between measurements and the foot length was determined using correlation and regression analysis. P value of less than 0.05 was considered significant. Distance of masterknot of Henry from navicular tuberosity was found to be fairly constant of 19.965mm. Foot length was found to be correlating with the distance between masterknot of Henry and medial malleolus, navicular tuberosity and its depth from the skin. Navicular tuberosity can be considered an important surface landmark for the location of masterknot of Henry. Correlation of length of the feet with various measurements helps to find the masterknot considering the foot length to be an important variable. Good knowledge of surface anatomy leads to shorter operating time and less morbidity during procedures involving the flexor hallucis longus and flexor digitorum longus.

Importance of Foot and Leg Structure for Beef Cattle in Forage-Based Production Systems.

Understanding the relationship of foot angle and claw set to beef cattle structural soundness will be critical to the selection of animals that fit forage-based production systems. In an effort to address concerns about foot and leg structure, the American Angus Association's foot angle and foot claw set expected progeny differences (EPD) were developed in 2019. As a result, these relatively new EPD and associated guidelines have limited phenotypic data submitted thus far. While ample research has evaluated lameness and foot issues in the dairy breeds, less is known about the factors that affect foot structure in beef cattle. This review focuses on beef cattle foot and leg structure, selection factors that may have led to increased problems with feet and legs, and the importance of foot and leg structure in forage-based grazing production systems. Specifically, the importance of locomotion and freedom of movement in extensive rangeland environments is discussed relative to the current literature. In addition, environmental factors that may influence foot and leg structure are addressed as well as heritability of various aspects of foot and leg traits. Where possible, information gaps and research needs are identified to enhance further investigation and the improvement of foot and leg selection tools.

THE ROLE OF ULTRASONOGRAPHY IN THE MANAGEMENT OF RADIOLUCENT FOREIGN BODIES IN SOFT TISSUES OF EXTREMITIES

Aim: High Resolution ultrasonography has revolutionised the management of non-metallic foreign body removal. USG aids in measuring the depth and size of the foreign body, its depth from the skin surface and any associated collection to perform a less invasive, and easier surgery without the need for any additional radiologicalinvestigations like CT scan or MRI both of which are expensive and not easily available. Material and Methods:22 patients with mean age of 33.3 years were admitted in our department for foreign body exploration during the years 2020 to 2022. The affected sites were plantar aspect of feet in 9 patients, leg in 4 patients, palm of the hand in 4 patients, fingers in 5 patients. Preoperatively, all patients underwent USG of the affected part. Duration of the surgery and any complications were observed. Results: The mean patient age was 33.34 years (range 15 to 70). Intraoperatively, we were able to locate and remove foreign bodies in all 22 patients. The actual surgeries lasted less than 15 min in 14 (63.6 %) of the cases and from 15-20 min in 8(36.6%) cases. Foreign bodies retrieved were wood in 12 (63%), thorn in 4 (21%) and rubber pieces of slippers in 6 (10.5%) patients. No complications were observed in any of the patients. Conclusion: Ultrasonography is areliable, cheaper and an easydiagnostic tool for detection and localization of foreign body and should be included in evaluation for clinically suspicious retained non-radiopaque foreign body in soft tissue of extremities.

Minimally invasive surgery: has it come of age?

Open techniques for foot surgery are well established. Minimally invasive surgery (MIS) offers the potential of less morbidity, scarring and quicker recovery. Small incisions reduce surgical trauma, improving recovery and decreasing rehabilitation times. Evaluation of the literature enables us to assess the benefits of MIS over existing open techniques to support its widespread adoption. Our aim was to assess levels of evidence for the use of MIS surgery in various aspects of foot and ankle surgery. In the field of hallux valgus correction, randomized control trials, or prospective cohort studies have provided level 1 evidence for the use of MIS techniques. Other aspects of foot and ankle surgery are mainly dominated by technical descriptions or case series. MIS techniques have the opportunity to provide satisfactory outcomes in many fields, with many domains reporting promising results. However, more studies are required to provide good level 1/2 evidence for comparative analysis to equivalent open techniques and establish their true benefit. More trials, longer follow-up and larger patient series may provide more meaningful data to justify MIS's use. Comparative analysis of MIS's true benefit compared to open surgery in areas of foot and ankle surgery outside hallux valgus has yet to be established with higher levels of evidence lacking.

Rare presentation of Ulcerative Lichen Planus (Bars-e-Aswad Quroohi) – A Case Study

Introduction: Lichen planus is a T-cell-mediated autoimmune inflammatory disorder of the skin and mucous membranes. It appears as pruritic, violaceous papules and plaques most found on the wrists, lower back, and ankles. This paper presents the case of 32 years old married female patient, who came to the National Institute of Unani Medicine OPD Bengaluru. Clinical presentation: Her chief complaints were severe pain, itching, and ulcerated lesions on the dorsal and plantar aspects of feet with loss of all the toenails for eight years. The lesions appeared as erythematous papules on dorsal surface of both big toes of feet and spread to the plantar aspect. Initially, lesions were violaceous, scaly and dry. Later, painful fissures developed with oozing of blood. As disease progresses, nails of feet are involved leading to anonychia. Diagnosis: The patient was diagnosed clinically as ulcerative lichen planus resembled to Bars-e-Aswad Qroohi in the Unani system of medicine. Interventions: The patient was treated with Joshanda Munzij Sauda (decoction) and Majoon Ushba (compound formulation) orally and Marham Asfeedaj for local application after foot bath from Safoofe Zaj. Outcome: Assessment of efficacy was done by physician global assessment (PGA) scales in three parameters (pruritus, pain, and fissure) before and after treatment. Conclusion: This Unani formulation effectively improves pruritus, pain, scaling, and fissures in Ulcerative lichen planus and may be considered for complimentary management of ULP.

Sacral dome resection and single-stage posterior reduction in the treatment of high-grade spondylolisthesis in a young girl

Introduction: The treatment of high-grade spondylolisthesis remains controversial in terms of in situ fusion versus reduction. The aim of operation in this patient is to restore the spino-pelvic alignment, sagittal profile of the spine and prevention of progression of slip with a minimal neurological risk.
 Case presentation: 18 years old schooling girl referred with a history of backache and right lower limb numbness over lateral aspect of foot for four years duration. She also had intermittent lower back pain, produced by long distant walking and relived by rest. It was aggravated by standing for long duration. There was no radiation of pain, no red flag sign or no cauda equina symptoms. Apart from her right lower limb neurology which was her power MRC grade IV in L5 and S1 myotome, other examinations were normal. X-Ray revealed grade V spondyloptosis. MRI showed evidence of right exiting L5 nerve root entrapment with grade V spondyloptosis. She underwent single stage posterior instrumentation of L4 - S1vertebrae, sacral dome resection, reduction of L5 over S1, interbody fusion of L5 - S1 and posterolateral intertransverse fusion of L4 to S1 vertebrae. She was ambulated on post-operative day one without brace. There was no worsening of neurology.
 Conclusion: Lumbosacral spondylolisthesis grade V can be treated using posterior approach alone to obtain reduction, decompression, and solid fusion. The sacral dome resection is a shortening osteotomy of the lumbosacral spine which allows a single-stage reduction of L5 without lengthening of lumbosacral region in high-grade spondylolisthesis, which helps to avoid neurological complications.

Emergency Foot Fillet Free Flap Based on Posterior Tibial Vessels for Reconstruction of Contralateral Heel and Sole: A Unique Spare Part Surgery

IntroductionReconstruction of the sole is an extremely challenging problem for a reconstructive microsurgeon. The specialized nature of its skin and subcutaneous tissue makes reconstruction arduous. When posed with complex bilateral lower extremity trauma where one limb was nonsalvageable, we harvested the uninjured foot fillet flap for free flap cover to reconstruct the contralateral sole. We report two such cases with follow-up assessment. Patients and MethodsTwo cases of sole reconstruction with emergency foot fillet free flap scavenged from the amputated contralateral limb were retrospectively analyzed. In both the patients, foot fillet free flap based on the posterior tibial neurovascular bundle was used. The follow-up assessment data collected included flap status, presence of any complications and prosthesis use, and functional status of the limbs at final follow-up. ResultsBoth the free flaps survived. Postoperative period was uneventful. No complications such as wound infection, delayed healing, flap necrosis, or scar breakdown were noted. The plantar flaps had recovery of protective sensation. Both the patients are ambulant; the first man with a fitted prosthesis and the second woman with the aid of a walker. ConclusionThe opportunity to utilize spare tissue from the amputated limb should be seized. Loss of the plantar aspect of foot poses a real challenge. The plantar foot fillet free flap is a durable flap with preservation of plantar sensations. It is probably the best choice as it replaces “like with like.” Prerequisites for utilizing the “spare part surgery” concept are meticulous initial debridement as well as emergency free tissue transfer, which require senior input and excellent infrastructure.

Erythematous Pedunculated Plaque on the Dorsal Aspect of the Foot.

A 13-year-old adolescent girl presented for evaluation of a lesion on the dorsal aspect of the right foot of 1 week’s duration. She previously had noticed a persistent, small, flesh-colored bump of unknown chronicity in the same location, which had been diagnosed as a skin tag at an outside clinic.

A rare case of bilateral plantar fibromatosis (Ledderhose’s disease): A case report

Ledderhose’s disease, also known as plantar fibromatosis is a rare, benign hyperproliferative disorder affecting plantar fascia with unknown etiology. Clinical presentation of the disease varies according to the stage of the disease and individual characteristics. Diagnosis of the disease is usually based on clinical findings. Histopathological examination, Ultrasound or MRI can be used to rule out other conditions and for confirmation of the disease. Plantar fibromatosis can mimic the features of plantar fasciitis especially in early stages of the disease, hence it should be considered as a differential diagnosis in patients with pain and nodules in plantar aspect of foot. In this case report, we present a case of 24-year-old male with bilateral plantar fibromatosis, which was managed by surgical excision of the nodules due to unresponsive conservative management.

Transient weakness of extensor hallucis longus after proximal fibular osteotomy for the management of medial compartmental osteoarthritis of knee

Aim: To evaluate the reason behind the extensor hallucis longus weakness transiently after proximal fibular osteotomy for the management of medial compartmental osteoarthritis of the knee, and to determine the correct level of osteotomy below the level of tip of fibular head. Materials and Methods: A prospective study from October 2019 to October 2021 at Rajah Muthiah Medical College and Hospital, in 15 patients who underwent proximal fibular osteotomy for medial compartmental osteoarthritis of the knee, three patients postoperatively develops EHL weakness transiently analysed and evaluated in this study. All postoperative complications are noted and evaluated periodically for all patients, recovery of power of EHL muscle and other motor sensory status is also noted. Results: Out of 15 patients surgically managed with PFO, only three patients developed transient EHL weakness and one patient developed transient numbness over the lateral aspect of foot. Among those three patient two patient recovered from neuropraxia within 6 weeks and one patient recovered after 8 months .transient numbness over lateral aspect of foot in a patient recovered within 3 weeks. Commonly fibula resected within or at the level of 6cm below the fibular head develops EHL weakness. Post operative EMG and NCS also done to confirm neuropraxia. later on fibula resected 24% length of total fibula below the fibular head, not encountered the immediate postop EHL weakness. Conclusion: The optimal site for fibular osteotomy for PFO in medial compartmental osteoarthritis of knee is at the junction of 24% of fibular length above and 76% below the osteotomy location. Provides good pain relief and functional recovery without transient EHL weakness and other complications. EHL weakness occurs mostly due to traction neuropraxia to the nerve which supplying the EHL muscles, more likely to occur in very high osteotomy less than 6cm from tip of fibular head.

Reconstruction of posterolateral heel defect with lateral calcaneal flap: An experience at Burns at plastic surgery center Peshawar

Coverage of soft tissue defect around ankle has always been a daunting job for a reconstructive surgeon. Numerous flaps have been described for the Coverage of soft tissue defect around posterior heel and lateral calcaneum ranging from local arrangement of tissue to regional and distant flaps with variable results in terms of flap success and its durability to with stand pressure and shoe wear. In this context, we share our experience of lateral calcaneal artery flap for the coverage of such defects. This study was conducted at Burns and Plastic Surgery center, Hayatabad, Peshawar from July 2019 to June 2020. Ten patients with soft tissue defects, with or without visible calcaneus or Achilles tendon in posterior heel of various etiologies were treated with lateral calcaneal artery flap. This axial flap was designed as a transposition flap based on lateral calcaneal artery and donor site is covered with partial thickness skin graft. In nine patients flap survived completely however one flap has epidermal loss which heels completely with moist dressing subsequently. Two patients had partial loss of STSG at donor site which was managed conservatively with local application of topical steroidal ointment. Sensory loss was observed at lateral aspect of foot in all patients with minimal patient concerns. All patients used regular normal shoes after 6 weeks after surgery with no notable adversity.

Possible clinical efficacy and tolerability of platelet-rich plasma in the treatment of patients with recalcitrant plane warts: The first clinical study.

Plane warts are prevalent cutaneous diseases, caused by different serotypes of human papillomavirus. This study aimed to assess the possible clinical efficacy and tolerability of platelet-rich plasma (PRP) in the treatment of patients with multiple recalcitrant plane warts. This prospective cohort clinical study was carried out on 25 patients with clinical and dermoscopic evident multiple recalcitrant plane warts. The patients were treated with autologous intralesional PRP injections every month until a complete clearance or for a maximum of two sessions. Then, patients were clinically evaluated one month after every session and after a six-month follow-up from the last injection. Of the included patients, 20 (80%) patients had facial plane warts, 3 (12%) patients had plane warts in the dorsum of hands, and 2 (8%) patients had plane warts in the dorsal aspect of feet. 60% of the patients have more than 100 plane warts, and all the patients had plane warts than 1cm in size. The complete improvement was observed in 20% and 100% of the patients after the first and second sessions, respectively. No recurrence was detected after a six-month follow-up. No side effects were recorded after the treatment sessions. Intralesional injection of PRP could be potentially effective and well-tolerated immunotherapy for the treatment of multiple recalcitrant plane warts. Whatever, more studies are needed with a larger sample size and a longer period of follow-up. Also, randomized and controlled studies are required to evaluate its efficacy in treating different clinical types of warts.

S2300 Henoch-Schönlein Purpura Induced Terminal Ileitis Mimicking Crohn's Disease

INTRODUCTION: Henoch-Schönlein purpura (HSP), also known as immunoglobulin A (IgA) vasculitis, is an acute generalized immune complex-mediated small-vessel vasculitis. It characteristically presents with palpable purpura on buttocks and lower extremities. Renal dysfunction, joint involvement and gastrointestinal (GI) symptoms are also frequently seen. Although gastrointestinal involvement is common, it primarily shows up in the form of nonspecific symptoms such as abdominal pain, nausea, vomiting, diarrhea or constipation. Terminal ileitis associated with HSP has rarely been reported in the medical literature. CASE DESCRIPTION/METHODS: A 22-year-old male presented with bilateral knee arthralgia, abdominal pain and intractable nausea and vomiting accompanied by a non-blanching erythematous coalescing maculopapular rash on the dorsal aspect of the feet and around the ankles bilaterally (Figure 1). CT (Figure 2) showed fold thickening of proximal loops of jejunum and wall thickening and luminal narrowing of the terminal ileum extending several centimeters proximally. Fluid-filled mildly dilated small bowel loops measuring up to 3 cm in diameter were visualized. Additionally, significant abdominal and pelvic ascites was noted. There was no evidence of bowel obstruction. During colonoscopy (Figure 3), granular, erythematous, ulcerated, hemorrhagic and ecchymotic mucosa was visible in the terminal ileum. There was blood in the terminal ileum and the colon. However, no discrete areas of bleeding were identified. These findings were consistent with moderate to severe active terminal ileitis. A skin biopsy was performed which confirmed the diagnosis of HSP. Methylprednisolone was commenced and the patient experienced relief in his GI symptoms. DISCUSSION: Although terminal ileitis is the pathognomonic hallmark of Crohn’s disease, it is important to consider alternative causes such as HSP in the differential diagnosis of ileitis indicative of Crohn’s disease. The resemblance between inflammatory lesions in the terminal ileum in HSP and those seen in Crohn’s disease hints at a potential pathophysiological link between the two disorders which is supported by an emerging body of literature.Figure 1.: Non-blanching erythematous coalescing maculopapular rash on the dorsal aspect of both feet and around the ankles.Figure 2.: CT Abdomen & Pelvis Coronal Section: small bowel inflammatory changes involving the jejunum and ileum.Figure 3.: Colonoscopy showing moderate to severe active terminal ileitis.

GENU VALGUM.

Genu valgum or "knock knees" are deformities of the lower limb that occur in the coronal plane.[1] Though most patients are asymptomatic and are fully functional, these conditions are sometimes indicated by a flat feet and medial aspect of foot and knee pain. The normal alignment of the knee joint is at a minimal valgus position ,attained at around 7 years of age, giving the knee the stability required for mobilization. However, in the paediatric age group, the alignment of the knee joint changes from physiological genu valgum by 2 years to varus at about 7 years of age.[2]

Comparison of Patient Reported Outcomes (PROs) for Major Pathologies of the Forefoot, Midfoot, Hindfoot, and Achilles Using PROMIS

Category:Other; Hindfoot; Midfoot/ForefootIntroduction/Purpose:Many legacy patient reported outcomes (PROs) lack sufficient validity and reliability for the evaluation of clinical outcomes following foot and ankle procedures. Patient-Reported Outcomes Measurement Information System (PROMIS) is a newly developed PRO that has been validated for the general foot and ankle surgical population. It has since been used to assess the clinical outcomes of a variety of specific foot and ankle procedures. However, there is little data regarding clinical outcomes of patients at a more intermediate subgroup level. There has been some preconceptions that the different anatomic aspects of foot and ankle surgery have disparate functional and pain improvement. Thus, our study utilizes PROMIS to assess postoperative outcomes based on anatomical location in patients undergoing forefoot, midfoot, hindfoot, and Achilles procedures.Methods:Preoperative and one year postoperative PROMIS Physical Function (PF) and Pain Interference (PI) were prospectively collected from a cohort of patients undergoing a foot and ankle procedure at a tertiary medical center. The cohort was split into forefoot, midfoot, hindfoot, and Achilles procedure groups with 355, 95, 356, and 135 patients, respectively. Paired-t tests were used to compare preoperative versus postoperative outcomes within operative groups, while a one-way ANOVA was used to detect differences in PROMIS scores between operative groups.Results:Paired t-tests indicated that all four operative groups had significantly improved PROMIS PF and PI scores preoperatively versus one year postoperatively (all P <.001)(see attached figure). One-way ANOVA demonstrated that there were no differences in postoperative PROMIS PF and PI scores between the groups. A majority of patients achieved the minimal clinically important difference (MCID) level of improvement in PROMIS PF and PI scores following surgery.Conclusion:All four operative groups (forefoot, midfoot, hindfoot, Achilles) had significantly improved PROMIS PF and PI scores postoperatively compared to preperatively, indicating an improvement in physical function and pain outcomes in each of the operative groups. However, there were no differences in physical function and pain outcomes between the groups.

MYXOID PLEOMORPHIC SARCOMA IN A NON-HEALING ULCER POST-BURN OF THE LEFT FOOT: A RARE CASE REPORT

Myxoid pleomorphic sarcoma is categorized as a soft-tissue sarcoma that most commonly appears in the lower extremities during adulthood, but rarely in the feet. We present a rare case of a primary myxoid pleomorphic sarcoma in the foot of a 45-year-old female which was rare in females. On examination, a ulceroproliferative growth of around 10 cm × 12 cm size was seen over the posterior aspect of foot involving the whole ankle region, with a thickened scar over the plantar and medial aspect of the right foot. Magnetic resonance imaging of the mass revealed a high signal intensity on T1-weighted images and heterogeneously high signal intensity on T2-weighted images without fat suppression. Histology showed variable cellularity, myxoid granular to the filamentous background, and round to spindled tumor cells. The immunohistochemistry showed positive for vimentin, acid mucins, CD34, and negative for S100. Hence, these findings were consistent with myxoid pleomorphic sarcoma. The patient was treated with below-knee amputation.

Fifth toe Fillet Flap for Wound Coverage of Non-Healing Ulcer of the Foot: Surgical Technique and a Case Report

Fillet flap is one of the options in the treatment of diabetic non-healing ulcers. The advantages of the fillet flap include the absence of donor site morbidity, excellent durability and preventing the need for more proximal amputation. A 56-year-old farmer presented to the out-patient department with complaints of a non-healing ulcer on the sole of the right foot for the past 7 months which was managed conservatively. A fifth ray partial amputation and a rotational flap of the redundant fifth finger for wound coverage were done. The wound healing was uneventful and the sutures were removed after two weeks. At the latest follow-up of 2 years, the patient was able to walk independently without pain and without any functional limitations. This case report describes the surgical technique of the lateral lesser toe fillet flap for wound closure on the plantar aspect of foot as an alternative to secondary healing or more proximal amputations.