Foot & ankle specialist
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Regional anesthesia has increasingly expanded its role in the perioperative care of patients undergoing foot and ankle surgery. In addition to avoiding side effects associated with both general anesthesia and neuraxial anesthetic techniques, especially those related to cardiovascular and pulmonary systems, regional nerve blocks have been shown to improve postoperative pain and reduce hospital stay and associated expenses. The techniques utilized to achieve analgesia of the foot and ankle are diverse, multifaceted, and often incorporate ultrasound guidance. Given the aging of patient populations, and especially the growing incidence of cardiovascular-, pulmonary-, and obesity-related morbidity, the use of regional blocks is likely to expand in these surgical procedures. This review highlights some of the most current developments in the expanding role of regional anesthesia in foot and ankle surgery. ⋯ Therapeutic, Level II.
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Foot & ankle specialist · Jun 2015
Treatment of Stage II Adult Acquired Flatfoot Deformity With Subtalar Arthroereises.
The role of arthroereises in the treatment of adult acquired flatfoot deformity (AAFD) has been controversial. This study aims to evaluate the outcome of subtalar arthroereisis in treating stage II AAFD. A total of 24 feet with stage II AAFD were treated surgically between 2009 and 2011 using subtalar arthroereisis. The average follow-up was 29.7 months (range = 24 to 35 months). The average postoperative AOFAS (American Orthopaedic Foot and Ankle Society) Ankle-Hindfoot Scale score was 85.6 (compared with 51.7 preoperatively). Average preoperative talar-first metatarsal angle and talonavicular coverage angle were -13.9° and 38.3°, respectively. The average postoperative angles were 1.6° and 11.2°, respectively (P < .01). No deformity recurrences were found at the time of last follow-up, with the exception of 1 case. Subtalar arthroereisis appears to be a reasonable treatment option for stage IIA and IIC AAFD. It can be used alone to correct mild hindfoot valgus, and it can also be performed with a calcaneal osteotomy to gain more correction in severe stage II AAFD. ⋯ Therapeutic, Level IV: Retrospective Case Series.