The Ponseti method for the treatment of congenital club foot: review of the current literature and treatment recommendations

The Ponseti method has become the gold standard of care for the treatment of congenital club foot. Despite numerous articles in MEDLINE reporting results from around the globe there are still crucial details of the Ponseti method which seem to be less commonly known or considered. The Ponseti method is not only a detailed method of manipulation and casting but also of preventing and treating relapse. Recommendations on how to correct complex club foot have resulted in an almost 100 % initial correction rate. The foot abduction brace is crucial for preventing relapse and is still a challenge for families and sometimes doctors alike. Experience and knowledge on how to support the parents, how to set and apply the brace in the best possible way and how to solve problems that can be encountered during the bracing period are essential to ensure compliance. Regular follow-up visits are necessary to be able to detect early signs of recurrence and prevent full relapse by enforcing abduction bracing, recasting or performing tibialis anterior tendon transfer. Recent midterm outcome studies have shown that by following the Ponseti treatment regime in all aspects it is possible to prevent open joint surgery in almost all cases. The body of literature of the last decade has evaluated many steps and aspects of the Ponseti method and gives valuable answers to questions encountered in daily practice. This review of the current literature and recommendations on the different aspects of the Ponseti method aims to promote understanding of the treatment regime and its’ details.     

Diabetic foot ulcers treated with hyperbaric oxygen therapy: a review of the literature

Hyperbaric oxygen therapy (HBO) has been used as an adjunct for healing diabetic foot ulcers (DFUs) for decades. However, its use remains controversial. A literature search was conducted to locate clinical studies and assess the available evidence. Ten prospective and seven retrospective studies evaluating HBO for DFUs were located. These were reviewed and the outcomes were discussed. One study reported no difference in outcomes between patients receiving hyperbaric oxygen and the control group. However, their regime differed from all other studies in that the patients received hyperbaric oxygen twice rather than once daily. Reduced amputation rates and improved healing were the most common outcomes observed.     

Mirror foot and our surgical experience: A case report and literature review

Preaxial mirror polydactyly of foot is a rare congenital anomaly with even fewer documentations for definitive treatment. To provide a sensate, near normal foot with ability to wear shoes is difficult to achieve in this variant with fibular dimelia and calcaneal duplication, with a delayed presentation at 6 years. Our case obtained satisfactory cosmetic and functional outcome upon excision of accessory calcaneum and the medial three toes along with covering the defect with local full thickness skin flap: a first of its kind mentioned in literature. We report this case because of its rarity and to share our surgical experience and its acceptable outcome.     

Synovial chondromatosis of the foot: Two case reports and literature review

BACKGROUND Primary synovial chondromatosis(PSC) is a rare arthropathy of the synovial joints characterized by the formation of cartilaginous nodules, which may detach and become loose bodies within the joint and may undergo secondary proliferation. PSC of the foot and ankle is exceedingly rare, with only a few cases reported in the literature. The diagnosis may be difficult and delayed until operative treatment, when it is confirmed by histological assessment. PSC may degenerate into chondrosarcoma. Operative treatment is the gold standard aiming to minimize pain, improve function, prevent or limit progression of arthritis. Surgical treatment consists in debridement by arthrotomic or arthroscopic management, but there is no consensus in the literature about timing of surgery and surgical technique. Thus, the aim of this study is to report the outcomes of the surgical treatment of two cases, together with a literature review.CASE SUMMARY We report two cases of patients affected by PSC of the foot in stage III, according to the Milgram classification: the former PSC localized in the ankle that underwent open surgery consisted of loose bodies removal; the latter in the subtalar joint, and the choice of treatment was the arthrotomy and debridement from loose bodies, in addition to the subtalar arthrodesis. Both patients returned to complete daily and working life after surgery.CONCLUSION Synovial chondromatosis is a rare benign pathology, even rarer in the ankle joint and especially in the foot. Surgery should be minimal in patients with ankle PSC,choosing the correct timing, waiting if possible until stage III. More aggressive and early surgery should be performed in patients with PSC of the foot,particularly the subtalar joint, due to the high risk of arthritic evolution.     

Midline longitudinal fracture of the sacrum: case report and review of the literature

Abstract Midline longitudinal fracture of the sacrum rarely occurs, and the mechanism of the injury is still unclear. We report a 68-year-old man with midline longitudinal fracture of the sacrum. At the first consultation, he showed no neurological findings. Neither longitudinal nor rotational instability was observed. Therefore, 4 weeks of bed rest was prescribed as conservative treatment. Standing training using a tilt table was initiated 5 weeks after injury and gait training after 6 weeks. However, since radiographic examination in the standing position 7 weeks after injury showed instability, surgery was performed. This instability was due to conic separation of the sacrum (conical instability) during weight bearing and cannot be classified according to the conventional classification of instability which is vertical instability as a parameter of ring fracture of the pelvis or rotational instability. Eleven patients with this fracture have been reported. This report discusses the characteristics of the pathological condition of this fracture and its treatment with a brief review of the literature.     

胆管囊腺瘤6例诊疗分析并文献复习

【摘要】〓目的〓分析6例胆管囊腺瘤的临床特点,提高对胆管囊腺瘤的认识。方法〓回顾性分析中山大学孙逸仙纪念医院自2009年9月到2014年9月收治的6例胆管囊腺瘤患者的临床表现、影像特点及手术治疗结局情况。结果〓6例患者均为女性,年龄28~46岁。就诊主诉为:上腹痛占50%(3/6),无症状体检发现33.3%(2/6),黄疸、发热占13.7%(1/6)。发病至就诊时间3天~16年。除黄疸、发热患者肝功能异常外,其余患者术前肝功能无异常。肿瘤指标均无异常。术前B超、CT均未能作出准确定性诊断,仅2例术前经MR检查准确诊断。全部患者均行外科手术完整切除病灶,术后无明显手术并发症。术后随访3月~46月无复发。结论〓胆管囊腺瘤发病稀少,病因未明,好发于中年女性,临床症状轻,实验室及影像学检查诊断本病有一定困难,目前仍然依赖于病理。本病手术效果良好,完整切除病灶对本病预后极为重要。     

Monitoring of diabetic foot syndrome treatment: some new perspectives

Diabetic foot syndrome (DFS) is one of the major complications of diabetes, and it can lead to foot amputations. It is very important to assure good medical care for diabetic patients not only during their stay at hospital but also at home. Telecare can be one good solution for extending medical care to patients' homes. There are some reports regarding the application of new technologies in this field. The standard current model of telecare of DFS includes experts at hospital who conduct clinical examinations and decision making at a distance, in close cooperation with a visiting nurse and the patient. In the present paper a new paradigm of the DFS's telecare is introduced, which eliminates the visiting nurse. The designed and developed TeleDiaFoS system consists of a traditional database and mobile patient's module (PM) allowing for documentation of the foot images as well as the results of blood glucose and blood pressure measurements taken by the patient himself at home. A 2-year validation of the TeleDiaFoS system on 10 DFS patients (3 months each) proved its usefulness and led to acceptance of this type of technical support by patients and physicians. The designed and developed system and proposed sterilization procedure of the PM have been found to be easy to use by the patient at home.     

真两性畸形诊断治疗的探讨

目的探讨真两性畸形的早期正确诊断与合理治疗。方法介绍3例真两性畸形早期不适当的诊断治疗给患者遗留了精神创伤和生活问题及后期的准确诊断与合理治疗。结果 3例患者按社会性别成为男性1名、女性2名,解除了他(她)们长期的精神负担,且效果良好。结论真两性畸形是一种较少见的性分化异常,根据病理及临床表现早期作出正确诊断,并进行合理的性别选择及手术治疗,对患者形成正常的性心理和社会生活至关重要。     

手足口病206例临床分析

目的：探讨小儿手足口病（HFMD）的临床特点及治疗措施。方法回顾性分析本院2012年5月～8月收治的206例手足口病患儿的相关信息。结果 HFMD多发生在3岁以下儿童，重症倾向患儿主要发生在1～2岁男性患儿，伴持续高热及易惊、肢体抖动，且皮疹较少或无典型皮疹。结论若能及早识别HFMD重症患儿并及时处理，能够防止患儿向危重症发展，降低病死率及致残率。     

Surgical outcome of a post-traumatic dystonic foot: Case report and literature review

Post-traumatic dystonia is an underrecognized condition that can present with bizarre symptoms after trauma, usually out of proportion to the trigger event. We describe the case of a 31-year-old man with a severe lower extremity deformity, gradually developed after minor trauma. An interdisciplinary treatment was tried without any improvement and surgery was performed as a rescue approach. Tibialis anterior tendon transfer and hindfoot triple arthrodesis were carried out, successfully achieving a plantigrade foot and a functional gait. Despite the scarce literature available about functional results of surgery in dystonic feet, we present a step-by-step comprehensive approach to this disorder.Level of Clinical Evidence4.     

Lipomeningioma: report of three cases and review of the literature

Lipomeningioma is a benign tumor of the meninges that contains mature adipose tissue. It demonstrates fat density on computed tomographic scan and mixed signal intensities on magnetic resonance imaging scan. Although the pluripotential nature of the mesenchymal cell has long been recognized, only a single case with this diagnosis has been documented in the literature to date. Three patients with this diagnosis seen at the Johns Hopkins Hospital during the last two years are presented, and the literature is reviewed.     

Pre-axial mirror polydactyly associated with tibial deficiency: a study of the patterns of skeletal anomalies of the foot and leg

Purpose The study was undertaken to identify the patterns and spectrum of aberrant development of the skeletal elements of the leg and foot in children with pre-axial mirror polydactyly of the foot. Methods Case records and radiographs of eight children (ten feet) with pre-axial mirror polydactyly were studied. Four feet were seen in association with fibular dimelia, three feet with dysplastic trapezoid shaped tibia, two with tibial aplasia and one with tibial hypoplasia. Results Distinct patterns of anomalies of the hindfoot, midfoot and forefoot were noted, with different patterns of leg malformation. Fibular dimelia was associated with duplication of the calcaneum, cuboid and the lateral cuneiform. Talar duplication occurred in children with a trapezoidal tibia. No duplication of tarsal bones was seen in association with tibial aplasia or hypoplasia. The first metatarsal was hypoplastic wherever the tibia failed to develop. Mere resection of the supernumerary rays resulted in a near normal looking foot in feet without calcaneal duplication. The cosmetic appearance of the foot was poorest in children with fibular dimelia. None of the authors received financial support for this study.     

Calcaneal nonunion: three cases and a review of the literature

The long-term follow-up of intra-articular calcaneal fractures is often accompanied by complications. Frequently occurring are arthrosis, arthrofibrosis of the subtalar joint, and malunion. Uncommon is the calcaneal nonunion. A total of three cases is presented in this report, including a review of the literature. The occurrence of a nonunion appears to be more common after conservative treatment, but the pathophysiology remains unclear, however smoking may play a role.     

真两性畸形诊断治疗的探讨

目的探讨真两性畸形的早期正确诊断与合理治疗。方法介绍３例真两性畸形早期不适当的诊断治疗给患者遗留了精神创伤和生活问题及后期的准确诊断与合理治疗。结果３例患者按社会性别成为男性１名、女性２名，解除了他（她）们长期的精神负担，且效果良好。结论真两性畸形是一种较少见的性分化异常，根据病理及临床表现早期作出正确诊断，并进行合理的性别选择及手术治疗，对患者形成正常的性心理和社会生活至关重要。     

13例肾上腺畸胎瘤临床诊疗分析并文献复习

目的 探讨肾上腺畸胎瘤(adrenal teratoma,AT)的临床特征及外科诊疗方法,以提高对该病的认识.方法 收集2012-10-2019-03间郑州大学第一附属医院收治的13例AT患者的临床及随访资料,对其进行回顾性分析并复习国内外相关文献.结果 13例患者中,男1例(7.7％),女12例(92.3％);中位年...     

Effectiveness of calcaneal osteotomy in surgical treatment of foot conditions: A Prisma statement guidelines compliant systematic review

Calcaneal osteotomy is a commonly established method used to correct various foot malalignment surgery problems that produce varus and valgus hindfoot abnormality as well as Haglund''s deformity, cavovarus foot reconstruction, flatfoot deformity, plantar fasciitis, posterior tibial tendon insufficiency and planovalgus foot. After decades, several procedures in orthopaedic foot surgery have been suggested for reducing the risk of wound and neurovascular complications. The goal of this Prisma statement guidelines compliant systematic review was to establish the effectiveness and safety of calcaneal osteotomy in foot surgery. We have performed a novel systematic review of the current published literature in order to evaluate the scientific evidence now available on this association, assigning predefined exclusion and inclusion criteria. Eight investigations were selected which had 191 cases. The adult flatfoot, tibialis posterior reconstruction and cavovarus foot deformity were treated with different procedures of calcaneal osteotomy techniques. The adequate level of effectiveness of calcaneal osteotomy is associated with the kind and location of the incision, with or without screw application, in each specific foot condition. There is a limited number of scientific investigations of the effectiveness and safety of the different kinds of calcaneal osteotomy in foot surgery, and there is the need to enhance outcome knowledge on this foot surgery technique.