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At least 289 records · Page 16Linked to original sources
PubMed2005

[Primary Ilizarov ankle fusion for nonreconstructable tibial plafond fractures].

OBJECTIVE: Ankle arthrodesis in a plantigrade position. In high-energy open injuries with segmental bone loss: proximal tibial metaphyseal corticotomy with distal Ilizarov bone transport for compensation of leg length discrepancy. INDICATIONS: Posttraumatic loss of the tibial plafond, usually resulting from open fracture type IIIC. CONTRAINDICATIONS: Ipsilateral foot injuries impairing ambulation after fusion. Severe injury to the posterior tibial nerve with absent plantar sensation. Soft-tissue injury not manageable surgically. Inadequate patient compliance. Advanced age. Severe osteoporosis. Acute infection. SURGICAL TECHNIQUE: Standard technique: anteromedial longitudinal incision. Removal of remaining articular cartilage. Passing of Ilizarov wires through the distal fibula, talar neck and body. Placement of 5-mm half-pins through stab incisions, perpendicular to the medial face of the tibial shaft. A lateral to medial 1.8-mm Ilizarov wire in the proximal tibial metaphysis is optional. Callus distraction/Ilizarov bone transport: exposure through an anteromedial incision or transverse traumatic wound. Removal of small residual segment of tibial plafond blocking transport. Retain small vascularized bone fragments not blocking transport. For Ilizarov external fixation, two rings in the proximal tibial region. Drill osteoclasis of the tibial metaphysis 1 cm distal to the tibial tuberosity and complete with Ilizarov osteotome. Secure the Ilizarov threaded rods or clickers. Weight bearing as tolerated. Begin distraction 14 days after corticotomy at a rate of 0.5-1 mm per day depending on patient's age. After docking: Ilizarov ankle arthrodesis. RESULTS: Between January 1993 and September 1996, four patients (two men, two women) with severe, nonreconstructable fractures of the tibial plafond were treated. Callus distraction and Ilizarov bone transport in three patients. Age range 19-68 years (average age 45.7 years). Mean follow-up 6.6 years (4 years 9 months to 7 years 4 months). Average duration of the entire treatment in external fixation 54.4 days/cm for the three bone distraction patients. Mean transport 6 cm (4.5-8.5 cm). One patient required repeat ankle arthrodesis.

Adult↗
PubMed1999

Radiologic case study. Fractures of the foot masquerading as ankle injuries.

An ankle radiographic series frequently is obtained when a patient presents with an acute ankle and foot injury. Although many fractures are confined to the ankle and are readily apparent, fractures of the foot can mimic ankle injuries. It is important to differentiate these fractures of the foot from the more common ankle sprain. Most ankle sprains are treated with ice, compression, and elevation, followed by range-of-motion exercises and progressive weight bearing as tolerated. When foot fractures are not identified, however, lack of appropriate treatment can result in late complications. Concentration on key areas as described here will reduce the incidence of missed fractures of the foot in these patients.

Adult↗
PubMed1996

The distally based superficial sural flap for reconstruction of the lower leg and foot.

We describe our experience with the use of distally based superficial sural flaps for coverage of defects in the lower leg and foot in 21 patients. In 18 patients the flap was successfully transferred, in 2 cases partial necrosis of the flap occurred and 1 flap failed completely. In 18 cases the flap was used as a fasciocutaneous flap and in 3 cases as a fascial flap only. The advantages of this flap are: easy and quick dissection, hence saving operating time, minimal morbidity of donor site and preservation of major arteries of the leg. Although the flap was described as reliable for covering defects around the ankle joint, we have been able to cover defects of the dorsum of the foot distally and up to the mid-third of the tibia proximally.

Adolescent↗
PubMed1999

Generalized tetanus in a patient with a diabetic foot infection.

Tetanus is a preventable disease that continues to affect people in the United States due to poor immunization practices in our health care system. A 57-year-old man with type 2 diabetes mellitus, hypertension, and end-stage renal disease with many hospital admissions came to the hospital emergency department because of a blackened great toe. He denied pain in the toe or knowledge of foot injury. The patient also complained of temporomandibular tenderness accompanied by inability to open his mouth completely. The man's problems progressed to generalized tetanus and required a long hospitalization. Clostridium tetani can flourish in the anaerobic environment of a diabetic foot infection. Practitioners should be aware of tetanus as a rare but potentially serious complication of diabetic foot infections.

Bacterial Infections↗
PubMed1994

Management of Traumatic Foot Wounds.

The foot is frequently exposed to direct trauma due to its role in weight-bearing. The soft-tissue wounds that commonly result interfere with ambulation due to complications such as tissue necrosis, scar formation, infection, and deformity. The five most common categories of foot injury are (1) low-velocity blunt trauma, (2) high-velocity blunt trauma, (3) low-velocity penetrating trauma, (4) high-velocity penetrating trauma, and (5) thermal injuries. For major wounds, the treatment is early aggressive debridement, copious irrigation, and skeletal stabi-lization with early coverage of skin defects. Local and systemic antibiotics are adjunctive to debridement to prevent infection. Prompt recognition and release of compartment syndrome of the foot are extremely important. Close observation is appropriate for wounds that appear minor on initial evaluation.

Journal Article↗
PubMed1995

Lower extremity injuries in drivers of airbag-equipped automobiles: clinical and crash reconstruction correlations.

OBJECTIVE AND DESIGN: To determine the relationship between airbags and lower extremity injuries, 10 drivers admitted to a level-I trauma center with substantial lower extremity trauma incurred in crashes involving airbag-equipped vehicles were studied in depth with regard to their injuries, the circumstances of the crashes, and the medical charges for the acute management of those injuries. MATERIALS AND METHODS: During the clinical investigation portion of this study, we photographed lower extremity injuries, both soft tissue and radiographs, and performed a detailed surgical exploration during the debridement of open wounds or fracture fixation to treat them appropriately and to define the mechanism of injury, the fracture pattern, the pattern of soft-tissue insult, and the extent of periosteal stripping. We recorded the hospital and professional charges associated with the acute management not only of these injuries, but of the other injuries as well. The analysis performed for each case included a detailed crash reconstruction, including force, contact point, and vehicle intrusion data. Particular attention was paid to the dashboard and toe pan areas to determine deformation and intrusion and their association with thigh, leg, and foot injuries. Pertinent deformation and trajectory information was entered into the Calspan Reconstruction of Accident Speeds on the Highway (CRASH) computer program to generate a delta V or change in velocity measurement used as a measure of collision severity. When field data were incompatible with the limitations of the CRASH program, manual calculations such as "slide to stop" and conservation of momentum formulas were used. RESULTS: The seven male and three female drivers had a mean age of 39.4 years. Only four used seatbelt restraints. The mean delta V was 28.3 mph and the mean maximum crush was 32.4 inches. The mean Injury Severity Score of 13.2. Musculoskeletal injuries included 11 foot/ankle fractures, 6 tibial fractures, 2 patellar fractures, 6 femoral fractures, and two acetabular/pelvic fractures. Other trauma included abdominal, thoracic, head and upper torso injuries, it seems that these safety devices do not prevent injuries to the lower extremity.

Accidents, Traffic↗
PubMed1976

Nerve blocks of the foot.

Emergency treatment of foot injuries can be made less painful by regional block anesthesia. There is limited medical literature on these techniques and many physicians, while familiar with regional anesthesia of the upper extremity, are not experienced with nerve blocks in the lower extremity. Infiltration anesthesia of the plantar structures of the foot and toes can be very painful and may inhibit healing. Regional anesthesia avoids both of these problems and can prove effective and useful. This paper discusses the techniques and possible complications of nerve block anesthesia of the foot.

Ankle↗
PubMedDate not supplied

"Snowboarder's fracture": fracture of the lateral process of the talus.

BACKGROUND: As physicians caring for patients who sustain snowboarding ankle injuries, we have noted that fracture of the lateral process of the talus occurs frequently. The incidence of this fracture, however, is very low in other accounts of ankle injuries. We report a case of fracture of the lateral process of the talus and review the pertinent literature of this injury. METHODS: A literature review was performed using MEDLINE files from 1966 to the present. We found additional references from the bibliographies of available reports. RESULTS AND CONCLUSIONS: Physicians caring for snowboarders should look specifically for fracture of the lateral process of the talus in a snowboarder with a lateral ankle or foot injury. This fracture can mimic a lateral ankle sprain, yet the fracture is easily missed on plain radiographs of the ankle. Because displaced or comminuted fractures can cause long-term disability, primary care physicians and specialists alike need to be aware of the association of this fracture with snowboarding.

Adult↗
PubMed2003

Spinal dorsal horn cell receptive field size is increased in adult rats following neonatal hindpaw skin injury.

Local tissue damage in newborn rats can lead to changes in skin sensitivity that last into adulthood and this is likely to be due to plasticity of developing peripheral and central sensory connections. This study examines the functional connections of dorsal horn neurons in young and adult rats that have undergone local skin damage at birth. Newborn rat pups were halothane anaesthetised and received either a unilateral subcutaneous plantar injection of 1 % lambda-carrageenan or a unilateral plantar foot injury made by removal of 2 mm x 2 mm of skin. At 3 weeks, (postnatal day (P) 19-23) and 6 weeks (P40-44) in vivo extracellular recordings of single dorsal horn cells with plantar cutaneous receptive fields were made under urethane anaesthesia (2 g kg-1) and responses to mechanical and electrical stimulation of the skin were assessed. Following neonatal carrageenan inflammation, dorsal horn neuron properties and receptive field sizes at 3 weeks were the same as those of controls. In contrast, following neonatal skin injury, dorsal horn cell receptive field sizes were significantly greater than those of controls at 3 weeks (2.5-fold) and at 6 weeks (2.2-fold). Mechanical thresholds, mechanical response magnitudes and evoked responses to single and repeated A and C fibre stimulation remained unaffected. These results show that early skin injury can cause prolonged changes in central sensory connections that persist into adult life, long after the skin has healed. Enlarged dorsal horn neuron receptive field sizes provide a physiological mechanism for the persistent behavioural hypersensitivity that follows neonatal skin injury in rats and for the prolonged sensory changes reported in human infants after early pain and injury.

Animals↗
PubMed1980

Plantar fascial spaces of the foot and a proposed surgical approach.

This study identified five plantar fascial spaces of the foot. The first space lies superficial to the calcaneus, the second lies between the plantar aponeurosis and the flexor digitorum brevis, the third lies between the flexor digitorum brevis and the quadratus plantar, the fourth lies above the quadratus, and the fifth lies above the adductor hallucis. A plantar incision is proposed for exploration and drainage of foot injuries and infections. With this incision, the plantar neurovascular bundles, along with the five plantar spaces through which infection spreads, are visualized clearly. In our experience, the incision heals without a sensitive scar.

Cadaver↗
PubMed2000

Medial plantar flap based distally on the lateral plantar artery to cover a forefoot skin defect.

The authors report a simple, single-step procedure to promote the distal transfer of the instep island flap for coverage of the submetatarsal weight-bearing zone. First described in 1991 by Martin et aI, this procedure remained unknown. As opposed to the medial plantar flap, this technique proposes an instep island flap based on the lateral plantar artery. The inflow and outflow of blood is assured by the anastomosis between the dorsalis pedis and lateral plantar vessels. This approach allows for the transfer of similar tissue and provides adequate coverage of the weight-bearing zone of the distal forefoot.

Adult↗
PubMed2002

[Application of pre-fabricated free flap in reconstruction and repair of skin defect of foot in weight-bearing area].

OBJECTIVE: To investigate the clinical effect of pre-fabricated free skin flap in reconstruction and repair of skin defect of foot in weight-bearing area. METHODS: Eight cases of skin defect of foot in weight-bearing area, due to trauma, were repaired by such an approach; free skin flap was designed and pre-fabricated at the contralateral plantar center, and 3 weeks later the free skin flap, with sensory nerve was transplanted to the site of skin defect, fixed by stitches through drilled holes in the calcaneous bone. All of 8 cases were followed up for 15 to 23 months before clinical evaluation. RESULTS: The wound healed well with no ulcer or deformity. According to American AOFAS scoring standard, it was more than 80 in 5 cases, more than 75 in 2 cases and 70 in one case. CONCLUSION: The pre-fabricated free skin flap from the contralateral plantar center is a good option to reconstruct and repair the skin defect of foot in weight-bearing area, with low ulcer occurrence and good contour.

Adolescent↗
PubMed2003

Intra-articular calcaneal fracture in a 14-year-old competing skier: case report.

Intra-articular calcaneal fracture as a skiing injury in children is extremely rare. We report on what we believe is a unique and previously unreported mechanism of a skiing injury, which caused intra-articular calcaneal fracture in a young competing skier, a member of the Croatian national ski team. This 14-year-old boy sustained a heel injury while training for giant slalom. There was no fall on the heel or obvious axial force that could have caused this type of calcaneal fracture. The skier had sophisticated equipment and used carving skies. We speculated that, when the skier tried to establish the lost balance during the fall, a violent contraction of triceps muscle occurred. Instead of an injury of a well-protected tuber or Achilles tendon, the strong pulling force of the Achilles tendon was transmitted more distally and anteriorly, generating axial compression force, which caused an intra-articular fracture of the calcaneus bone. Obviously, the existing ski boot did not sufficiently protect the calcaneus bone. We postulate that the calcaneal tuber and Achilles tendon were protected on the expense of the intra-articular calcaneal fracture. Our case warns of the possibility of a serious foot injury in young top skiers in spite of extensive improvement in the ski equipment. Sophisticated carving skis could be a contributing factor to an injury.

Adolescent↗
PubMed1991

Wound dressings of the nineties: indications and contraindications.

A revolution in wound management has occurred over the past 3 decades. A plethora of wound care dressings appear to enhance the wound repair process in acute and chronic wounds. However, extensive research is needed to discriminate between the beneficial effects of increased attention to all aspects of patient care, including wound management, and the salutary effects of dressing materials.

Algorithms↗
PubMed1997

[Diabetes and travel].

With the continuing expansion in international air travel, increasing numbers of diabetic patients consult physicians for advice before going abroad. Careful planning is required taking into account climatic and medical conditions at the destination. Diabetic travelers should pack an appropriate treatment kit and contract special insurance coverage for medical evacuation. Precautions are necessary to limit the effects of motion sickness and time differences on diabetes control and especially the risk of hypoglycemia. Special attention is needed to avoid digestive problems and prevent foot injuries which can lead to serious complications in diabetic patients. Diabetic patients cannot forget their health problem during vacation and must be especially cautious when traveling. However with proper training, the risks of foreign travel can be reduced to acceptable levels.

Diabetes Complications↗
PubMed1980

[Therapy and results of a treatment for fresh injuries of the foot distal to the Chopart joint (author's transl)].

The traumatic lesion of the foot is very often a severe and not a negligible injury. The results of 100 patients, treated during 1973--77, with fresh injuries distal the Chopart Joint are pointed out. A high rate of infection and amputations has to be reported. Nearly 1/3 of all the patients are suffering from foot-deformities, loss of function, posttraumatic dystrophy and arthrosis. More than 1/2 of all the patients need orthopaedic aids. Therefore consistent therapy of these often neglected injuries seems to be very important and general directions are given.

Adult↗
PubMed1991

A community-based study of diabetes-related skills and knowledge in elderly people with insulin-requiring diabetes.

An open cross-sectional study of elderly (age greater than 65 yr) patients with insulin-requiring diabetes mellitus (n = 57) was undertaken to audit safety of self-management. Levels of knowledge and management skills of hypoglycaemia, hyperglycaemia, and foot care were determined. The prevalence of hypoglycaemia, visual impairment, and at-risk feet and the ability to perform practical procedures (insulin injection and self-monitoring) were assessed. Drawing up insulin and self-injection was correct in 84% and 76% of patients, but 53% of self-monitored urine or blood tests were performed incorrectly. Twenty-six per cent experienced hypoglycaemia at least monthly and 25% had been seen at the hospital with hypoglycaemia in the last year. Eighteen per cent did not know what action to take with hypoglycaemia. Forty-six per cent did not know any hyperglycaemic symptoms or signs. Prompted with symptoms, 35% still did not know what to do and 21% would take inappropriate action when self-monitored tests read high. Fifty-one per cent had impaired vision, 61% peripheral neuropathy and 24% peripheral vascular disease, with the result that 78% had at-risk feet. Fifteen percent inspected or washed their feet infrequently, 40% walked barefoot occasionally, and 47% would take potentially dangerous action in the event of foot injury. This study demonstrates serious deficiencies in the basic education and management skills in our elderly insulin-requiring diabetic population that could result in morbidity and mortality. Greater effort and vigilance by health care professionals must be directed towards this group.

Aged↗