1/4. Correction of complex foot deformities using the Ilizarov external fixator.There are many drawbacks to using conventional approaches to the treatment of complex foot deformities, like the increased risk of neurovascular injury, soft-tissue injury, and the shortening of the foot. An alternative approach that can eliminate these problems is the Ilizarov method. In the current study, a total of 23 deformed feet in 22 patients were treated using the Ilizarov method. The etiologic factors were burn contracture, poliomyelitis, neglected and relapsed clubfoot, trauma, gun shot injury, meningitis, and leg-length discrepancy (LLD). The average age of the patients was 18.2 (5-50) years. The mean duration of fixator application was 5.1 (2-14) months. We performed corrections without an osteotomy in nine feet and with an osteotomy in 14 feet. Additional bony corrective procedures included three tibial and one femoral osteotomies for lengthening and deformity correction, and one tibiotalar arthrodesis in five separate extremities. At the time of fixator removal, a plantigrade foot was achieved in 21 of the 23 feet by pressure mat analysis. Compared to preoperative status, gait was subjectively improved in all patients. Follow-up time from surgery averaged 25 months (13-38). Pin-tract problems were observed in all cases. Other complications were toe contractures in two feet, metatarsophalangeal subluxation from flexor tendon contractures in one foot, incomplete osteotomy in one foot, residual deformity in two feet, and recurrence of deformity in one foot. Our results indicate that the Ilizarov method is an effective alternative means of correcting complex foot deformities, especially in feet that previously have undergone surgery.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/4. Functional hallux rigidus in the rheumatoid foot.hallux rigidus results from arthritic involvement of the first metatarsophalangeal joint. The authors have observed loss of motion at this joint in patients with rheumatoid arthritis in the absence of hallux valgus or joint destruction. A hyperextension deformity of the interphalangeal joint has also been observed, with a painful callus beneath it. The first metatarsophalangeal joint appears normal on roentgenograms, and passive motion of the joint is normal when it is examined clinically. The loss of first metatarsophalangeal motion is functional, and stems from muscle spasm of the great toe intrinsic muscles in an effort to relieve pressure on the lesser metatarsal heads. The interphalangeal hyperextension may develop secondary to "functional hallux rigidus."- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/4. The short foot syndrome--an unfortunate consequence of neglected raised intracompartmental pressure in a severe hemophilic child: a case report.The vast majority of bleeding episodes in hemophilia occur in the musculoskeletal system. When bleeding occurs, within a closed compartment, the possibility of neurovascular compromise must be suspected. We present an interesting case where this danger was overlooked in a young hemophiliac boy and resulted in bone growth retardation and permanent deformity.- - - - - - - - - - ranking = 4keywords = pressure (Clic here for more details about this article) |
4/4. Use of an in-shoe pressure measurement system in the management of patients with neuropathic ulcers or metatarsalgia.Many injuries to the foot appear to be caused by repeated, excessive plantar pressures. In-shoe pressure systems are capable of measuring pressures at the interface between the shoe or orthotic and the plantar foot during a given functional activity. The purpose of this article is to describe the use of an in-shoe pressure system as a tool to aid physical therapists in the management of patients with foot problems as a result of excessive plantar pressures. Case histories are provided that describe the application of an in-shoe pressure device in the management of one patient with a neuropathic ulcer and one patient with metatarsalgia. A discussion of the primary clinical and equipment considerations of using this type of device is included.- - - - - - - - - - ranking = 10keywords = pressure (Clic here for more details about this article) |