Persistent Foot Research Articles

Osteoid Osteoma of the Calcaneus: Percutaneous Radiofrequency Ablation

Osteoid osteoma of the foot can pose particular problems in diagnosis, especially when positioned in a juxta-articular location. It can cause reactive synovitis and simulate arthritis without periostitis. An atypical presentation may delay diagnosis and thus delay treatment. Different modes of treatment have been described including medical management with nonsteroidal, antiinflammatory drugs, and open surgical resection with intralesional, marginal, or wide surgical margins. In recent years, several computed tomography-guided percutaneous techniques have been used to achieve ablation of the nidus with minimal tissue invasion. We report a case of a 39-year-old man with an 8-month history of persistent foot pain who underwent percutaneous radiofrequency ablation of an osteoid osteoma involving the calcaneus. The patient related an immediate relief of pain and had no recurrence of symptoms or the lesion at 3-year follow-up.

First metatarsophalangeal joint arthrodesis using a vitallium plate with a mean two year follow up

Abstract Twenty-four patients (33 feet) underwent metatarsophalangeal joint arthrodesis using a vitallium plate with an additional oblique screw. The mean age was 55 years (range, 37–68) with a mean follow up of 28 months (range, 16–45). Patients were evaluated using the American Foot and Ankle Society clinical and radiographic guidelines. Twenty-three patients (32 feet) went on to complete fusion within 12 weeks, one patient had a non-union, the fusion was repeated successfully. One patient had deep infection and two patients had persistent foot pain. Hallux valgus angle was reduced by a mean of 12 degrees and intermetatarsal angle by a mean of 2 degrees. Patient satisfaction was high with relief of symptoms and improved appearance of the foot. First metatarsophalangeal joint arthrodesis using a vitallium plate with an oblique interfragmentary screw is a successful procedure with a high fusion rate, low complication rate and a high level of patient satisfaction.

The Localization of Persistent Foot and Mouth Disease Virus in the Epithelial Cells of the Soft Palate and Pharynx

After contact with foot and mouth disease virus (FMDV), cattle may become persistently infected, regardless of their pre-existing immune status or whether they develop clinical disease. The cellular sites of FMDV persistence have not previously been determined. The use of in-situ hybridization in combination with tyramide signal amplification (TSA) provided the first direct evidence that FMDV RNA is localized within the epithelial cells of the soft palate and pharynx during persistent infection, indicating that these cells remain persistently infected after contact with FMDV.

Intermediate-term outcome of primary digit amputations in patients with diabetes mellitus who have forefoot sepsis requiring hospitalization and presumed adequate circulatory status

Purpose: The intermediate success and outcome of primary forefoot amputations in patients with diabetes mellitus who have sepsis limited to the forefoot and presumed adequate forefoot perfusion, as determined by means of noninvasive methods, was studied. Methods: Cases of a university hospital-based practice from January 1984 to April 1998 were retrospectively reviewed. Patients included had diabetes mellitus with forefoot sepsis requiring immediate hospitalization for digit amputations who had adequate arterial circulation for healing based on noninvasive and clinical assessment: palpable pedal pulses (29%), “compressible” ankle pressure of 70 mm Hg or higher (48%), pulsatile metatarsal waveforms (67%), and/or toe pressure higher than 55 mm Hg (36%). All patients underwent a primary single- or multiple-digit amputation (through the interphalangeal joint, metatarsal head, or metatarsal shaft). Additional forefoot procedures (debridement, digit amputation) were performed during the follow-up period as needed for persistent or recurrent infection. The main outcome variables were recurrent or persistent foot infection (defined as requiring rehospitalization for antibiotics, wound care, and/or reoperation), the number of repeat operations and hospitalizations for salvage of limbs with recurrent or persistent infections, and time to complete forefoot healing or foot amputation. Results: Ninety-two patients who had diabetes mellitus with 97 forefoot infections comprised the study group. Ninety-seven primary digit amputations (34 through interphalangeal joints, 28 through metatarsal heads, 35 through metatarsal shafts) were performed. The median length of hospital stay was 10 days. There were no operative deaths. The mean follow-up period was 21 months (range, 3 days to 105 months). The primary amputation healed (without persistent infection) in only 38 limbs (39%), at a mean time of 13 ± 10 weeks. Twenty-three limbs (24%) had not healed the primary amputation without evidence of persistent infection at last follow-up (mean, 12 weeks). Infection persisted in 35 limbs (36%), and infection recurred in 15 of 38 (40%) healed limbs. An average of 1.0 reoperations (range, 0 to 3) and 1.6 rehospitalizations (range, 1 to 4) were involved in salvage attempts in these recurrent/persistent infections. Five persistent and five recurrent infections ultimately healed (mean, 53 weeks). Complete healing was achieved in only 33 of 97 limbs (34%). Twenty-two foot amputations (20 transtibial, two Syme’s) were performed (mean, 49 ± 74 weeks; 20 for persistent infection). Eighteen persistent/recurrent infections remained unhealed at the last follow-up examination (mean, 105 weeks). Conclusion: Patients with diabetes mellitus who have sepsis limited to the forefoot requiring acute hospitalization and undergoing primary digit amputations have a high incidence of intermediate-term, persistent, and recurrent infection, leading to a modest rate of limb loss, despite having apparently salvageable lesions and noninvasive evidence of presumed adequate forefoot perfusion. (J Vasc Surg 1999;30:509-18.)

Common pediatric foot dermatoses

The pediatric foot dermatoses known as tinea pedis, shoe dermatitis, and juvenile plantar dermatosis are seen commonly in clinical practice. A knowledge of the clinical presentations and causes of these disorders can help pediatric and family nurse practitioners identify, diagnose, and treat childhood rashes of the feet. The conventional view in pediatrics is that small children rarely have tinea pedis. However, a 1992 study disputes this claim. Any child who has an atypical or persistent foot rash will need a referral or consultation.

Aggressive treatment of acute limb ischemia due to thrombosed popliteal aneurysms

Objective: The absence of infra-popliteal runoff in patients with acute limb ischemia and thrombosed popliteal aneurysms carries a high risk of amputation. A combined treatment method involving thrombolysis and surgery is reported. Material and methods: Information regarding six patients was reviewed. Ankle brachial indices and degree of ischemia were recorded. All patients underwent digital subtraction angiography. In five patients thrombus dissolution was achieved using a combination of mechanical and pharmacologic therapy. One patient was judged incapable of withstanding any delay in reperfusion and was treated with isolated limb perfusion using a thrombolytic agent. All patients underwent surgical revascularization. Follow-up (1–3 years) consisted of duplex examinations at 6 months and yearly thereafter. Results: Five patients had no measurable ankle-brachial index (ABI), while one patient had an ABI of 0.4. Initial angiography noted all patients to have no runoff in continuity to the pedal arch. Following thrombolytic therapy, an adequate bypass vessel was noted in all cases, with reconstitution of the plantar arch in five patients. Distal revascularizations included one peroneal, and five below knee popliteal arterial bypasses. Fasciotomies were performed in four of the six patients. There were no amputations. One patient developed a persistent foot drop. Two patients developed bypass grafts occlusions; one of which required therapy. Conclusion: The pre-operative use of thrombolytic therapy is a safe and effective method to achieve limb salvage in this patient population. Patients must be capable of withstanding an additional period of ischemia allowing for reconstitution of distal runoff. Isolated limb perfusion is of use when a delay to reperfusion cannot be tolerated.

The too-long anterior process calcaneus: a report of 39 cases in 25 children and adolescents.

We observed 39 feet with a "too-long" anteromedial process of the calcaneus (TLAP) in 25 children and adolescents. The abnormality was diagnosed from symptoms (ankle sprains or persistent ankle or foot pain) in 33 cases. Six cases of TLAP were noted on radiographs taken of the patient's opposite, asymptomatic foot. Initial treatment by 3 weeks of strapping failed in seven of seven cases, and 3-6 weeks of primary plaster immobilization failed in 10 of 25 feet. Primary immobilization treatment failed in 17 of 33 symptomatic feet. Resection of the TLAP provided good results in 14 of 15 feet when used as a secondary procedure after failure of immobilization treatment and in one foot in which it was used as primary treatment. We believe that this abnormality is an anatomic variant that becomes symptomatic because of inversion stress with impingement of the abnormally long process between talus and cuboid.

Correction of persistent clubfoot deformities with the Ilizarov external fixator. Experience in 10 previously operated feet followed for 2-5 years.

We reviewed the outcome in 10 idiopathic clubfeet in 7 patients treated with the Ilizarov external fixator (IEF) for persistent foot deformities after previous surgery. After follow-up of a median of 40 (25-56) months, 6 patients/parents were satisfied with the results and most of them reported better walking capacity and fewer problems finding shoes that fit. Severe equinus deformity was seen in 9/10 feet prior to treatment in the IEF and in no foot at follow-up. However, persistent reduction of ankle joint motion, limited walking capacity and intermittent pain were commonly found.

Persistent Foot and Ankle Pain in Young Athletes.

In brief When young athletes experience brief Persistent foot or ankle pain, the differential diagnosis includes overuse syndromes, exacerbated chronic or congenital conditions, and poor healing of earlier acute injuries. Often, prompt diagnosis and treatment of an acute injury might have prevented a chronic condition. Conditions discussed in this article include distal fibular epiphyseal fracture, lateral ligament sprain, tibiofibular ligament sprain, peroneal tendon dislocation, Achilles tendinitis, Se- ver's disease, talar dome osteochondral fracture, and tarsal coalition.

距骨外側突起骨折の１例

Fracture of the lateral process of the talus is an uncommon lesion and there fore this diagnosis is frequently initially overlooked.We report one case, a 19 year-old female, who was injured in an auto accident in August, 1990. She had no clear history of severe dorsiflexion of the foot. Since initial X-rays showed a simple fracture, primary treatment was performed conservatively using a plaster cast for 3 weeks and an ankle brace for 8 weeks. However she had persistent foot pain, and excision of the osteophyte was carryed out 5 months after injury. Evaluation using Hawkins criteria showed a good result. Early diagnosis and treatment are important for avoiding prolonged disability and pain.

Problematic Fractures and Dislocations in the Foot and Ankle of Athletes

Foot fractures can significantly compromise an athlete's career. Early recognition and treatment of occult fractures will reduce lay-off time and decrease the likelihood of prolonged impairment of performance. The appropriate treatment of radiographically obvious fractures will have a similar effect. The key to making an early diagnosis is the recognition of characteristic patterns on physical examination and the aggressive investigation of persistent foot pain in the athlete, whether it follows an injury or not. When a fracture is not apparent on routine radiographs, special diagnostic techniques, particularly technetium bone scanning, can effectively screen for bony injury. In the competitive athlete there is no reason to adopt a "wait-and-see" attitude. The approach in treating these injuries in athletes should be similarly definitive. If continued participation will delay healing or resolution of the symptoms, it should not be tolerated.

Bone scanning of the foot for unexplained pain.

This paper reports the results of bone scans on 78 painful feet. Scanning helped in the diagnosis of persistent foot pain following injury and it enabled stress fractures, fractures of the sesamoids and subtalar arthritis to be diagnosed earlier. It reliably excluded bone infection and was useful as a screening test when radiographs were normal.

Nerve Entrapment of the Foot and Ankle in Runners

In the 10 years 1972 through 1982, the senior author performed 21 operations on 15 runners with persistent foot and ankle pain. The operative procedures involved decompression of peripheral nerves in the foot and ankle, consisting of release of soft tissues in the tarsal tunnel and foot or removal of abnormal bony excrescences that were irritating these nerves. All 15 runners had good to excellent results and all returned to their preinjury running status, including the competitive athletes. Foot and ankle pain is best treated conservatively, but when signs and symptoms culled from a careful history and physical examination reflect a nerve entrapment syndrome, surgical intervention has its place in the armamentarium of the surgeon.

Shoe dermatitis.

SummaryFoot dermatitis can be an extremely disabling problem. Blistering and weeping feet may become secondarily infected and painful fissuring often occurs, resulting in inability to walk. The diagnosis of contact dermatitis due to shoes should be considered in every case of persistent foot dermatitis. It is only by careful patch testing that this diagnosis can be made. The so‐called typical clinical pattern of shoe contact dermatitis is often not present. A shoe contact dermatitis can be superimposed on an endogenous foot dermatitis.