Injury. 2015 Apr;46(4):536-41. Epub 2014 Dec 10.
West J Med. 1997 Feb;166(2):126-8.
J Foot Ankle Surg. 1994 Nov-Dec;33(6):561-6.
Int Orthop. 2013 Sep;37(9):1845-50.
Foot Ankle Int. 2012 Jun;33(6):507-12.
Gastrocnemius recession is becoming a common procedure for recalcitrant plantar fasciitis as shown by DiGiovanni et al and shown to be more effective than plantar fasciotomy by Monteagudo et al. Maskill et al also show in their series good outcomes (better than previously reported outcomes of plantar fasciotomy) for gastroc recession in treating isolated foot pain, including recalcitrant plantar fasciitis. While nonoperative management is the primary treatment and other procedures like biologic injections and shock wave are becoming more popular, gastrocnemius recession is becoming much more common, particular in the setting of gastroc contracture with plantar fasciitis.Chronic plantar fasciitis: plantar fasciotomy versus gastrocnemius recession.Monteagudo M, Maceira E, Garcia-Virto V, Canosa RInt Orthop. 2013 Sep. doi: 10.1007/s00264-013-2022-2. 37. (9). :1845-50PMID: 23959221 (Link to Abstract)Preferred management of recalcitrant plantar fasciitis among orthopaedic foot and ankle surgeons.DiGiovanni BF, Moore AM, Zlotnicki JP, Pinney SJFoot Ankle Int. 2012 Jun. pii: 50062314. doi: 10.3113/FAI.2012.0507. 33. (6). :507-12PMID: 22735325 (Link to Abstract)Gastrocnemius recession to treat isolated foot pain.Maskill JD, Bohay DR, Anderson JGFoot Ankle Int. 2010 Jan. pii: 50035122. doi: 10.3113/FAI.2010.0019. 31. (1). :19-23PMID: 20067718 (Link to Abstract)
Great summary on a great website. May I suggest moving "gastroc recession" to the bottom of the list of surgical options, since it is the lest well-established?
Foot Ankle Clin. 2011 Mar;16(1):1-12.
Plantar plate deficiency is most commonly associated with which of the following deformities shown in Figures A-E?
This is a poor question. The question states 'association' - claw toe is clearly associated with plantar plate insufficiency.
How does one get from heel strike to mid stance without hip extensor (glute max) concentric contraction? The subject portion of the topic suggests hip extensor contraction, yet the muscle activity table at the bottom states the glute max remains inactive? Could someone please comment? Thanks
What is the most appropriate management of the injury shown in Figures A and B?
Achilles tendon repair
Repair of superior peroneal retinaculum and deepening of the fibular groove
Posterior tibial tendon reconstruction with flexor hallucs longus transfer
Peroneus longus repair
Peroneus brevis repair
I thought it looked ruptured in that one view, but how can you know for sure that the next view won't show the subluxed PL a little more anterior than what is seen on this cut? Initially I thought rupture, then I overthought it with the subluxation answer saying to deepen the groove, which on this guy definitely looks shallow. So I convinced myself that the tendon was still intact but just not all present on this one view, sorta like ACL and PCL showing up on subsequent MRI views. I guess that why in practice we don't get one view MRI's!!!!!!!
Which of the following best describes the physical examination test demonstrated in Figure A?
Silfverskiöld test used to differentiate gastrocnemius tightness from achilles tendon contracture
Thompson test used to differentiate soleus tightness from achilles tendon contracture
Coleman test used to differentiate soleus tightness from achilles tendon contracture
Silfverskiöld test to differentiate soleus tightness from achilles tendon contracture
Thompson test to differentiate gastrocnemius tightness from achilles tendon contracture
I understand how to perform and interpret the test, but what is the clinical/ practicing difference? Are stretching ex better for one than the other. It seems the correct answer is always TAL. Has there ever be a question regarding the different lengthening techniques?
Hi AMR,The deformity is at the IP joint and most patients complain from callosities & corns at the IPJ together with tenderness and rubbing of the dorsal aspect of the toe against the shoe. In order to address this you need to excise the corn formed at the PIPJ, using the same incision you can Resect the HEAD & NECK of the proximal phalanx to correct the deformity. If you want to Resect the Base of the PP (which may work) but then you will need another incision which is totally unnecessary.
Peroneal tendon subluxation
Demonstrates the snapping/subluxation of a peroneal tendon
what a great video!
Main pathology at the MTPJ, so in surgical management why its resection of "head and neck" of proximal phalanx not the "base" , as for Stainsby procedure?
Medial Displacement Calcaneal Osteotomy
This is an osteotomy of the calcaneus for a flatfoot deformity to correct the hindfoot. This cutting of the heel bone allows the back half to be shifted back under the leg instead of being turned out. This is part one of two parts.
xr not clearly presented medializatiom technique not clear
Clin Podiatr Med Surg. 2017 Jan;34(1):53-67. Epub 2016 Sep 2.
A 65-year-old diabetic female presents with a two-month history of mild ankle pain and subjective instability. She denies any specific injury and she does not have any foot ulcerations or wounds; her foot and ankle are edematous with erythema that resolves upon elevation. Her ESR, CRP, and WBC levels are within normal limits. Her radiographs are shown in Figures A and B. What is the most appropriate initial treatment?
Modification of shoe wear
Use of a total contact cast
Spanning external fixation of the ankle and hindfoot
Dr. Lescheid - thanks for the post. The question options do not include hindfoot arthrodesis, which would be necessary for this patient. The ankle joint itself is involved to a much more limited extent than the subtalar joint and inferior talus. This would be considered a late stage arthropathy per Pinzur's article, and total contact casting/AFO/CROW would be indicated as first line treatment. If this patient's case described plantar ulcers or significant instability, an attempt at hindfoot arthrodesis would be indicated in this patient.Surgical Treatment Options for the Diabetic Charcot Hindfoot and Ankle Deformity.Ögüt T, Yontar NSClin Podiatr Med Surg. 2017 Jan. pii: S0891-8422(16)30073-8. doi: 10.1016/j.cpm.2016.07.007. 34. (1). :53-67PMID: 27865315 (Link to Abstract)Charcot neuroarthropathy of the foot and ankle.Schon LC, Easley ME, Weinfeld SBClin Orthop Relat Res. 1998 Apr. (349). :116-31PMID: 9584374 (Link to Abstract)
From discussion on QID4727:"Rogers et al. reviewed the evaluation and management of Charcot foot in diabetes. They report indications for surgery include cases refractory to offloading and immobilization, recalcitrant ulcers, or severe Charcot neuropathic arthropathy of the ankle." "Pinzur (Aug 2007) reviewed the management of Charcot arthropathy. He recommends total contact casting for early stage arthropathy, and commercially available depth-inlay shoes with accommodative orthoses or rocker-bottom shoes combined with an AFO or CROW for late stage arthropathy. He recommends operative intervention for persistent plantar ulceration that cannot be managed nonoperatively, and unstable Charcot ankle arthropathy."I should read the articles myself, but the summaries above seem to indicate there is a role for early arthrodesis in "severe" or "unstable" cases, both of which would describe this case.Can you comment?
Posterior Tibial Tendon Insufficiency (PTTI)
in foot and ankle deformity the next joint moves into oposite direction, compensating , thus in planus you have supination and in cavovarus the forefoot is pronated. if the deformity is fixed you have to take care of it after your hindfoot correction, usualy with plantifkexion of the first ray in planus and dorsiflexion in cavus