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Intraosseous lipoma is a rare bone tumor that may be encountered in clinical practice. It is benign and is described as a well-defined, radiolucent lesion that must be differentiated from other lytic lesions. Most of these lesions may be treated without surgery; however, when surgery is needed, the classic approach involves curettage and packing using autologous bone grafts, allografts, or synthetic bone substitutes. This article reports two cases using a synthetic bone substitute, TheriLok, to fill the void made from surgical curettage of the intraosseous lipoma. Both patients tolerated the TheriLok bone substitute without developing adverse reactions and precluded the need for a secondary donor site. (J Am Podiatr Med Assoc 100(6): 487–492, 2010)

Symptomatic flatfoot is a prevalent disorder. We undertook a review of 50 feet in 39 patients with flexible flatfoot treated between August 2000 and January 2008 in order to evaluate the modified Kidner-Cobb procedure. Overall clinical results were rated as good in 48 (96%) feet and fair in 2 (4%) feet, and there were no poor results. Average follow-up was 4.6 years, and total recovery time was 5.7 months in older patients and 3.7 months in children. Manual muscle-strength testing revealed no difference in tibialis anterior strength between the operated and contralateral extremity. All patients visually demonstrated postoperative elevation of the medial longitudinal arch height. Complications included 2 feet with wound dehiscence and 1 foot with fractured hardware. The results of this review indicate that the modified Kidner-Cobb procedure is a useful treatment option for patients with symptomatic flexible flatfoot with posterior tibial tendon dysfunction stage 2.

The authors report on the retrospective follow-up of 9 patients (6 women and 3 men) who underwent a mini-arthrotomy ankle arthrodesis by means of small incisions for exposure, cartilage resection, and internal fixation with crossed interfragmental compression screws. Patients were kept non-weight-bearing in a short leg cast for 12 weeks postoperative. At a mean follow-up of 55 months, outcomes were assessed by clinical examination, radiographs, and patient satisfaction questionnaires. Fusion was obtained in all patients, and there were no cases of delayed union, infection, or cutaneous compromise. Modified American Orthopaedic Foot and Ankle Society ankle and hindfoot rating scale scores significantly improved (P.001) from a mean of 38 points preoperatively to 72 points at follow-up. A categorical assessment of functional ability in the postoperative period revealed 6 patients graded as excellent, 2 as good, and 1 as fair. In regard to a categorical assessment of clinical outcome in the postoperative period, 7 patients were graded as excellent and 2 as good. All of the patients stated that they were satisfied with their results and would undergo the procedure again. The mini-arthrotomy ankle arthrodesis with crossed interfragmental compression screw fixation appears to be a useful alternative to traditional open arthrodesis for selected patients with ankle arthritis.

Ossification of the Achilles tendon is a rare condition to be distinguished from the more frequently occurring tendon calcification. Achilles tendon ossification is more common in males and is usually associated with prior surgery or trauma to the tendon. A case history of a ruptured ossified Achilles tendon in an elderly diabetic female is presented. Although Achilles tendon rupture with subsequent ossification and fracture of the ossified Achilles tendon have been reported individually, there is evidence to suggest that this patient may have both ruptured and fractured an ossified Achilles tendon.

Surgical treatment for clubfoot has been largely directed at finding the best one-stage operation for the resistant clubfoot. Eighteen patients with 27 clubfeet (average follow-up 11 years since first surgery; range, 3.5-24 years) were reviewed. More than one clubfoot operation was required in 56% of cases. Forty-six percent were corrected after one surgery; 33% required a second surgery and 14% required a third operation. One patient with particularly severe feet required a fourth operation on each foot. The mean age at the time of surgery was 1.26 years, 5.12 years, and 8 years for the first, second, and third operations, respectively. The first operation consisted of a soft-tissue release. The second and third operations consisted of more extensive soft-tissue release and various rearfoot and forefoot procedures. Radiographic values revealed an AP talocalcaneal angle of 18 degrees, AP talo-first metatarsal angle of 6 degrees, lateral talocalcaneal angle of 29.6 degrees, lateral talo-first metatarsal angle of 15 degrees, and calcaneo-first metatarsal angle of 143 degrees. At follow-up all patients had adequate function as determined by personal interview and clinical examination. We conclude that correction of resistant congenital clubfoot often requires more than one surgery, not because of a "failed first operation," but due to dynamic muscle imbalances that may not be fully recognized in infancy and early childhood. Thus, the need for a second operation should not be perceived as a failure of the first, but as part of the natural history of congenital clubfoot.

The authors review four cases of Kaposi's sarcoma that were presented to the Foot Clinics of New York and affiliated North General Hospital during a 1-year period from the fall of 1987 to the fall of 1988. The authors conclude that it is sometimes difficult to diagnose Kaposi's sarcoma and to differentiate between the acquired immunodeficiency (AIDS) form and the classic form. Guidelines for diagnosis and a profile of the AIDS-related and non-AIDS-related Kaposi's sarcoma patient are discussed.

We present a unique case of congenital bilateral simple syndactyly of the first and second toes that was surgically treated using a full-thickness skin graft harvested from the same foot at the lateral aspect of the ankle. This surgical approach eliminates the potential need to involve another surgical team to harvest a donor graft from above the ankle, saving operating room time, anesthesia time, and overall cost to the patient. Cosmetically, scar formation above the ankle is also eliminated. (J Am Podiatr Med Assoc 96(6): 513–517, 2006)

The geriatric patient has a high incidence of foot deformities and may be considered a good surgical candidate if healthy and psychologically ready for the surgical procedure. Foot problems in the geriatric population that may require surgical intervention can be grouped into approximately five categories, including (1) localized orthopedic disorders (ie, bunions, hammer toes, and so on); (2) skin and nail problems (ie, onychomycosis); (3) degenerative and inflammatory arthritis; (4) diabetic foot disorders; and (5) neuromuscular disease. However, age-related changes in cardiovascular, pulmonary, and renal function increase the risk of perioperative complications. The higher rates of complications seen in the older surgical patients result in part from existing comorbidity and age-associated changes in organ function. Extensive procedures depending on good bone healing for success should usually not be attempted on older patients. Office surgery for the geriatric patient should involve only the simplest procedures and should be kept to a minimum because of the increased possibility of postoperative complications. In the hospital there is better preoperative evaluation, operating room conditions, and postoperative care.

A case of dislocated first and second metatarsophalangeal joints was reported along with the mechanics and mechanism of injury. The practitioner must be familiar with the mechanism of injury and radiographic classification to determine the proper indications for closed versus open reduction. The authors' review of the literature did not reveal a similar case involving a dislocation of the first and second metatarsophalangeal joints.

A comparative retrospective study of 48 open heel spur surgeries and 20 endoscopic plantar fasciotomies was conducted involving 59 patients over a 10-year period. There was a significant reduction in heel pain at the time of follow-up (average, 3 years) for both groups. Overall, 85% of procedures were associated with patient satisfaction with the results, and patients said that they would recommend heel spur surgery for relief of severe heel pain in 94% of cases. Factors influencing the postoperative outcome, such as duration of preoperative symptoms, extent of conservative care, and obesity, are discussed.

Neuromuscular disease commonly affects the rearfoot as equinus, equinovarus, and equinovalgus deformity. Spastic hemiplegia caused by stroke, head injury, and cerebral palsy results in equinovarus deformity of the rearfoot. Spastic diplegia, most frequently caused by cerebral palsy, results in equinovalgus rearfoot deformity. Problems in ambulation, footwear, and bracing, as well as their orthopedic management, in patients with neuromuscular disease are discussed in a case-report format.

A retrospective analysis was conducted of 32 patients (33 ankles) who had undergone surgical ankle arthroscopy for chronic ankle pain that was recalcitrant to conservative treatment. All patients were examined clinically and completed a written questionnaire. Intraoperative ankle arthroscopy showed hypertrophic synovitis, adhesive bands, chondral bands with synovitis, osteophytes, and abnormalities in the talar dome. Results of treatment after an average follow-up time of 1.4 years (range: 0.33 to 12.5 years) showed ankle scores of 15 excellent, 11 good, 5 fair, and 2 poor. Obesity was significantly related to the outcomes of arthroscopy procedures. Obese patients were more likely to be rated as fair or poor, while nonobese patients were significantly more likely to be rated excellent or good. Those patients who received physical therapy postoperatively for one or more months had significantly better ankle ratings than those who did not elect to have physical therapy.

The longitudinal epiphyseal bracket is a rare ossification defect of bones of the hands and feet and results in an abnormal epiphysis that is C-shaped, longitudinally oriented, and vertically extends into the diaphysis. The longitudinal epiphyseal bracket may exist as an isolated deformity, but is commonly associated with digital deformities such as polydactyly, duplicated digits, congenital hallux varus, and clinodactyly. Five case histories of children with the longitudinal epiphyseal bracket in different bones of the foot are described with three distinct clinical presentations. The development of the longitudinal epiphyseal bracket and implications for treatment are considered.

Surgical correction of the neglected, and severely deformed clubfoot in the adult is necessary to achieve plantigrade, pain free, and cosmetically acceptable feet. Also, it is important that the patient is able to wear shoes and participate in a more active and normal life. Three adult immigrants with neglected clubfoot underwent surgical correction for the first time. Posterior medial plantar soft tissue release and a double arthrodesis involving calcaneal cuboid wedge resection with talonavicular fusion have been effective in removing rearfoot varus, providing minimal shortening, and restoring the foot to a normal plantigrade position.

Ten patients with 12 symptomatic severe flatfeet were treated with a combined surgical technique. Patients 10 years or older were treated with Evan's calcaneal osteotomy, Young tenosuspension, and tendo achillis lengthening. Patients under age 10 were treated with modified Young tenosuspension, talonavicular desmoplasty and subtalar arthroereisis. Eight of the 10 patients had marked relief in pain and fatigue and were able to perform all physical activities. Radiographic criteria showed improvement for all patients in all categories.

The literature reports that 70% of the cases of sinus tarsi syndrome are post-traumatic, following an inversion sprain, and that 30% result from inflammatory disorders, such as rheumatoid arthritis, ankylosing spondylitis, and gouty arthritis. However, in the case presented, talipes equinovarus deformity and sinus tarsi syndrome coexisted. One of the corrective goals in the management of the talipes equinovarus deformity is the realignment of the articulation between the medial plantarly deviated talar head and the anteromedial segment of the calcaneus. The calcaneus must be rotated from a plantarflexed position into a dorsiflexed position. The posterior tubercle will be moved down and in, with the anterior process moved up and out away from the talar head. By correcting the plantarflexed varus attitude of the calcaneus, it is put in a valgus position that often closes down the sinus tarsi upon weightbearing. This compression may result in pain over the lateral aspect of the midfoot with hindfoot instability, as seen in the case presented. As a result of the abnormal anatomical relationship of the talus and calcaneus, the patient developed severe pain in the sinus tarsi. Based on the medical history and present postoperative results, the authors find a long-term sequela of talipes equinovarus deformity to be sinus tarsi syndrome.