1/11. Localized tetanus in a child.The majority of physicians in practice today in developed countries have never seen a case of tetanus. The last pediatric case reported in canada occurred in 1992. We present the case of a child who had localized tetanus despite previous partial immunization.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/11. Retained digital foreign body after a pellet gun injury.A symptomatic foreign body embedded in the human body can be a frustrating problem for physician and patient alike. A unique case of a retained foreign object resulting from a pellet gun injury has been presented. Although the course of treatment in this case was uncomplicated, it is important to understand the complexities of the human body's response to foreign bodies.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/11. Full-thickness burn of the foot: successful treatment with Apligraf. A case report.Burn wounds, although uncommon in the foot, present a uniquely challenging opportunity to physicians. The keys to successful management include a proper and specific initial evaluation of the burning agent, the location, the TBSA affected, and the depth. Ultimately, proper recognition and meticulous wound care with skin grafting, when necessary, bring about the desired results. A case report of a patient with a third-degree burn over the dorsum of the left foot is presented. This case is unique in that Apligraf, a human skin equivalent, was used to gain coverage and eventual resolution of the wound. It is the authors' opinion that the use of Apligraf in this application is a viable alternative to traditional methods of skin harvesting and grafting. To the authors' knowledge, there have been no other cases reported of Apligraf use in burn wound coverage of the foot.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/11. Pushing the envelope. Case studies on how fast you can and cannot return the elite athlete to running.When treating an elite athlete, a physician always must keep in mind the status of the athlete in training, upcoming sports events, and the athlete's financial status. If the treatment requires the athlete to withdraw from regular training or sports events, a modified training program should be considered. This modified training must be balanced with returning the athlete back to full form and keeping him or her physically fit.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/11. Determining foot and ankle impairments by the AMA fifth edition guides.The fifth edition of the Guides has been criticized for its failure to provide a comprehensive, valid, reliable, unbiased, and evidenced-based system for rating impairments and the way in which workers' compensation systems use the ratings, resulting in inappropriate compensation [8]. The lower extremity chapter utilizes numerous functional and anatomic methods of assessment, as well as diagnosis-based estimates. Though this process of using multiple approaches to measure impairment increases the chances that an underlying physical impairment may be detected, it is time-consuming and may increase rating variability [9]. McCarthy et al studied the correlation between measures of impairment for patients with fractures of the lower extremity. They found that the anatomic approach of evaluation was better correlated than functional and diagnostic methods with measures of task performance based on direct observations as well as the patient's own assessment of activity limitation and disability. Also, muscle strength assessment as described in the Guides was a more sensitive measure of impairment than range of motion [9]. The most elusive part of the foot and ankle evaluation is the inability to capture the added impairment burden caused by pain. The assessment of pain is the most problematic part of any evaluation. Pain is considered and incorporated into the impairment ratings found in the foot and ankle section, as well as the other individual chapters. chronic pain is often not adequately accounted for, however, and the examiner must evaluate permanent impairment from chronic pain separately. The examiner has the ability to increase the percentage of organ system impairment from 1% to 3% if there is pain-related impairment that increases the burden of illness slightly. If there is significant pain-related impairment, a formal pain assessment is performed. Chapter 18 provides guidance in making these determinations. Impairments for Complex Regional Pain syndrome (CRPS), type 1 (reflex sympathetic dystrophy), and CRPS, type 2 (causalgia) should incorporate the use of a formal pain assessment in addition to the standard methods of assessment. The formal pain evaluation relies mostly on self-reports from the individual and is most heavily weighted for ADL deficits. The physician must make assessments of the individual's pain behavior and credibility for this evaluation. The formal pain assessment classifies the pain-related impairment into categories of mild, moderate, moderately severe, or severe and determines whether this impairment is ratable or not. These categories do not have impairment percentages associated with them. The individual's symptoms or presentation should match known conditions or syndromes in order to be ratable. If not ratable, the examiner should report that the individual has apparent impairment that is not ratable on the basis of current medical knowledge. In the end, pain evaluations are used administratively and, depending on the situation, may be given equal weight with the standard evaluation or may be totally disregarded.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/11. Chronic high velocity projectile injury to the foot.Acute projectile injuries to the foot can present a challenge for the podiatric physician, especially in terms of their chronic effects. The case of a shrapnel wound to the right foot and ankle that resulted in recurrent episodes of soft tissue infection and disability is presented. Treatment consisted of excision of the shrapnel fragment, debridement, and primary closure of the sinus tract created by the projectile. The authors discuss the acute and chronic effects of projectile injuries, factors responsible for determining the severity of these wounds, and various methods of treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/11. Complications of deep puncture wounds of the foot.Eleven cases of deep puncture wounds of the foot and their complications are reviewed. More than half of the patients had foreign materials introduced at the time of the injury which was not completely removed initially. The morbidity with these "simple puncture wounds" may be quite prolonged. The authors conclude that attention to details when the patient is first seen in the emergency room or the physician's office and aggressive treatment of these wounds will prevent serious sequelae in many instances.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/11. Puncture wounds of the foot.Most puncture wounds of the foot heal satisfactorily even without treatment. Nonetheless, serious complications such as osteomyelitis can occur. Early cleansing and debridement are important in preventing complications. Penetration of cartilaginous areas is a common prelude to osteomyelitis. Puncture wounds can serve as a reminder to both patients and physicians to update tetanus immunizations.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/11. Occult foreign bodies of the foot.This article illustrates several case reports of occult foreign bodies of the foot. The patients came for treatment from weeks to years after the inciting incident with chronic, sterile, draining wounds. The diagnosis of these foreign bodies can be quite difficult. Several radiographic and clinical clues are included, yet the single most valuable tool for the physician remains a high index of suspicion.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/11. Three-dimensional computed tomography reconstruction. A presurgical adjunct in the severely traumatized rearfoot.The use of computed tomography in visualizing the complex anatomy of the foot is well documented in current literature. However, one difficulty with CT films, as well as those of other imaging modalities, is that three-dimensional anatomy is represented in two dimensions. The observer is thus required to assimilate the consecutive film slices into an accurate mental picture of the patient's anatomical structure. Many physicians may find the results of this process unacceptable and inaccurate in select cases of severely abnormal patient anatomy. The authors present a solution, three-dimensional computed tomography reconstruction, and its clinical usefulness in a case presentation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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