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1) Two cases of medial peritalar dislocation with accompanying foot injuries considerably altering prognosis are presented. 2) Although most cases of this uncommon injury respond well to treatment, a careful investigation for accompanying injuries should be performed. 3) The mechanism of injury is discussed.
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In 1988, a total of 990 work-related injuries to the foot of employees from private-sector companies were characterized in an occupational injury/illness surveillance system maintained by a network of occupational health centers. The mean age of the worker with a foot injury was 34.2 years (+/- 12.0), with 83% occurring among men; 22.3% of the cases were fractures or sprains/strains. Jobs involving extensive manual material handling or vehicular operations were the most often listed occupations among those with work-related foot injuries. Across occupational groups, being struck by an object accounted for 58.4% of the foot injuries. Regardless of industry group, metal items and vehicles were related to 50.7% of all work-related foot injuries. Specifically, foot injuries were found to be associated with being struck by boxes, metals, or vehicles, or to being caught in, under, or between vehicles or machinery. A peak of work-related injuries involving the foot is observed during the summer months.
Tendon injuries are often caused by direct trauma or overuse. Pathology may consist of inflammatory lesions external to the tendon sheath or inflammation of either the peritenon, sheath, or tendon. This article reviews the diagnosis and treatment of injuries to the peroneal, peroneus brevis, peroneus longus, anterior tibial, flexor hallucis longus, and posterior tibial tendons.
In a randomized prospective study among 390 recruits, the hypothesis that improved shoe shock attenuation could lessen the incidence of overuse injuries was tested. During the 14 weeks of training, 90% of the recruits sustained overuse injuries. Recruits training in a modified basketball shoe had a statistically significant lower incidence of metatarsal stress fractures and foot overuse injuries, compared with standard infantry boots, but their overall incidence of overuse injuries was not reduced. The effect of improved shoe shock attenuation was limited to those overuse injuries resulting from vertical impact loads.
A series of 27 successful Superficial Inferior Epigastric Artery free flaps were analysed for a number of clinical and surgical variables. The anatomy and surgical technique of the flap are detailed and its advantages and disadvantages relative to other free flaps used for soft tissue contour are considered. Analysis of the variety of recipient sites of this flap is presented, as are details of the vascular pedicle and our experience with its constancy. It has been found to be a safe flap in experienced hands, with an aesthetic donor site scar, no functional loss and it lends itself to subsequent recontouring with suction assisted lipectomy or open techniques.
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.
Magnetic resonance imaging (MRI) has provided an ideal means, unmatched by other preexisting modalities, of examining musculoskeletal abnormalities, particularly those involving tendons and ligaments in the lower extremities. Lack of motion artifact, convenience of application of surface coil, and absence of overlying structures have made the lower extremities ideally suited to MRI. In addition, the abundance of adjacent adipose tissue provides a superb contrast background. Although evaluation of trauma remains the most common reason for MRI examination, many other conditions may also affect tendons and ligaments. As in other soft-tissue, chondral, and osteochondral lesions, MRI provides exquisite details of abnormalities in these structures. Part II of this review systematically reviews the abnormalities of tendons and ligaments in the pelvis and lower extremities.
Each section of this article has been discussed in severe brevity. Potential pitfalls have been expanded in an attempt to be helpful to the general surgeon who attends patients with these clinical problems. Making the relatives aware of a potential complication in its broadest sense is the responsibility of the surgeon and can only be done if there is cognizance of these problems. The author hopes that this article has accomplished this purpose, albeit in a brief format.
Managing nonhealing foot wounds in diabetic patients requires an understanding of the wounds' multiple contributing causes, including neuropathy, vascular occlusive disease, infection, and impaired wound healing. Proper attention to each cause may require consultations with vascular or orthopedic surgeons, diabetic education nurses, podiatrists, orthotists, and pedorthists. Wounds that fail to heal may respond to topical application of growth factors as part of a comprehensive clinical approach to the diabetic foot wound. An aggressive approach to diagnosis and treatment can result in improved wound healing and limb salvage.
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Trauma to the extremities is sometimes dismissed as relatively unimportant in certain radiologic circles. In many instances, radiologic responsibility is denied and relegated to the orthopedist. Although the radiologic manifestations of much trauma to the extremities is clear cut and does not require sophisticated techniques or interpretation, there are many diagnoses which require innovative techniques and a knowledge of mechanisms of injury as well as the subtle oseous and soft tissue manifestations which may be confronted radiologically. The above factors will be stressed along with the need for the fundamental knowledge of radiologic anatomy which is required in order to appreciate some of the more subtle changes of extremity trauma.
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