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There are multiple techniques to treat tendon defects in the event end-to-end repair cannot be achieved after débridement. In general, the choice of treatment technique is based on size of the resultant gap. Although each treatment technique has literature to support its use, there are no data to support the use of one technique over another. Treatment should be based on the experience and discretion of the treating surgeon. This article proposes an algorithm for wound breakdown, infection, and rerupture after Achilles tendon surgery. This algorithm should be used as a guide.

Salvage arthrodesis for failed total ankle replacement can be a successful procedure. The decision to perform salvage arthrodesis is based on many factors, but the following are the most important indications: severe loss of bonestock (tibia, talus, or both), inadequate soft tissue coverage, or the inability to eradicate an infection. With few revision implants on the market, salvage arthrodesis is currently the most common treatment for failed replacement and justification for revision ankle replacement is limited when any of these factors are present.

The development of tendinitis and tendinopathy is often multifactorial and the result of both intrinsic and extrinsic factors. Intrinsic factors include anatomic factors, age-related factors, and systemic factors, whereas extrinsic factors include mechanical overload and improper form and equipment. Although tendinitis and tendinopathy are often incorrectly used interchangeably, they are in 2 distinct pathologies. Due to their chronicity and high prevalence in tendons about the ankle, including the Achilles tendon, the posterior tibialis tendon, and the peroneal tendons, tendinitis and tendinopathies cause significant morbidity and are important pathologies for physicians to recognize.

A cellular allogeneic bone graft can be used in patients at high risk for nonunion after arthrodesis surgery. This study explores the utility and efficacy of MAP3 in foot and ankle arthrodesis procedures. Map3 is a cellular allogeneic bone graft that contains osteogenic, osteoconductive, osteoinductive, and angiogenic properties. A total of 23 mostly high-risk patients were included in this study. The overall fusion rate was 83%. Univariate analysis demonstrated diabetic patients remain at risk of recurrent nonunion (P

Severe talar avascular necrosis has many etiologies and can cause bone loss/hindfoot deformity. Tibiotalar calcaneal arthrodesis is a salvage procedure after severe talar avascular necrosis. Large bone voids can present significant challenges. Modest successes have been reported with structural block allograft tibiotalocalcaneal arthrodesis using either plate and screws, intramedullary nail fixation, or a combination. The advent of 3-dimensional printed titanium trusses has given surgeons another option for filling voids and providing structural support to prevent collapse. Although these options expand the armamentarium, treating surgeons must adhere to principles of arthrodesis: stable constructs, thorough joint surface preparation, and correction of deformity.

The development of tendinitis and tendinopathy is often multifactorial and the result of both intrinsic and extrinsic factors. Intrinsic factors include anatomic factors, age-related factors, and systemic factors, whereas extrinsic factors include mechanical overload and improper form and equipment. Although tendinitis and tendinopathy are often incorrectly used interchangeably, they are in 2 distinct pathologies. Due to their chronicity and high prevalence in tendons about the ankle, including the Achilles tendon, the posterior tibialis tendon, and the peroneal tendons, tendinitis and tendinopathies cause significant morbidity and are important pathologies for physicians to recognize.

Interdigital neuralgia affects a significant number of individuals, with an average age of presentation in the sixth decade and a 4- to 15-fold increased prevalence in women. Historical descriptions date back to the 19th century. Nonoperative treatment with shoe modifications, metatarsal pads, and injections provides relief for most, but long term, 60% to 70% of patients eventually elect to have surgery. Although excision can be performed through a dorsal or plantar approach, we prefer the dorsal incision to prevent scar formation on the plantar aspect of the foot. Satisfactory results are common but not certain with reports of excellent or good ranging from 51% to 93%.

Recurrent or persistent symptoms following surgical neurectomy for an interdigital neuroma are quite common, because of incorrect initial diagnosis, true neuroma formation, nerve stump adhesions, accessory nerve branches, or an adjacent web space neuroma. The clinical presentation of a recurrent neuroma is similar to the initial presentation. Recurrent symptoms usually occur within the first 12 months after surgery. The physical examination coupled with diagnostic nerve blocks is critical for diagnosis. Conservative therapy, although not particularly effective in treating true recurrent neuromas, may help to alleviate pain. With proper isolation of the instigating neuroma, revision surgical excision can be effective.

When not properly treated, wounds of the foot and ankle can be devastating for both the patient and physician. Therefore, it is important to recognize treatment options best suited for a particular wound, as well as the underlying factors involved in preventing a wound from healing. The most common impediments to wound healing include wound hypoxia, infection, presence of debris and necrotic tissue, nutritional deficiencies, inhibitory medications, and metabolic disorders such as diabetes mellitus [1]. Only before minimization of these factors will wound healing agents be effective. Diabetes mellitus is a complex metabolic disorder that affects healing of wounds directly and indirectly. Specifically, diabetes causes alterations in microvasculature, nerve function, and the immune system. There are a multitude of wound healing agents available, with some correlation to the type of wound or underlying disease, but for the most part the use of these agents is based on inherited common practice, personal preference, or marketing activities. Currently, the medical literature is replete of high-quality, randomized, controlled trials pertaining to wound healing agents, especially in the setting of diabetes mellitus. Therefore, it is the goal of this article to educate the orthopedic surgeon on the proper use of wound healing agents that can be applied to foot and ankle wounds.