Clinics in podiatric medicine and surgery
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Clin Podiatr Med Surg · Jan 2019
ReviewPerioperative Cardiac Considerations in the Surgical Patient.
The ability to identify and guide evaluation of the patient with cardiac disease represents a necessary skill for success in surgery of the foot and ankle. Common risk factors, such as diabetes and peripheral arterial disease, are encountered in podiatric practice. ⋯ Identification of risk factors, assessment of functional capacity, and appropriate work-up mitigate any untoward cardiac events surrounding surgery. This optimization results from appropriate medical and interventional treatment plans directed at minimizing or eliminating identified risks factors.
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Surgical treatment of the elderly can be a very difficult and complex endeavor. Appropriate and thorough evaluation of this group of patients is essential to identify surgical candidates who may be at increased risk for developing age-related problems, such as cognitive impairment or postoperative delirium. ⋯ In order to optimize surgical results, communication of goals of surgery and expectations of patients in order to achieve these goals is paramount. Physical therapy assessment of the elderly will give input on patients' capacity to perform needed changes in ambulatory status after surgery.
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Clin Podiatr Med Surg · Apr 2018
Review Case ReportsParadigm Shift for the Surgical Management of Calcaneal Fractures?
Calcaneal fractures account for up to 75% of all foot fractures and 1% to 2% of all fractures. Approximately 75% of calcaneal fractures are intraarticular, resulting in a prolonged recovery, more pain, and disability. ⋯ The literature continues to support surgical intervention; however, these injuries can still be managed nonoperatively in certain clinical scenarios. This article focuses on the surgical management of intraarticular calcaneal fractures and highlights the sinus tarsi approach.
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This article discusses tarsometatarsal arthrodesis for Lisfranc injuries. Although open reduction and internal fixation has traditionally been the treatment of choice for most Lisfranc fracture-dislocations, there is a trend toward primary fusion, especially for purely ligamentous injuries. Consideration should be made for primary fusion in select fracture-dislocation cases. Primary fusion offers a single-stage alternative with potentially more stable, predictable results overtime.
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Increased tissue pressure within a fascial compartment may be the result from any increase in volume within its contents, or any decrease in size of the fascial covering or its distensibility. This may lead to symptoms of leg tightness, pain or numbness brought about by exercise. There are multiple differential diagnoses of exercise induced leg pain and the proper diagnoses of chronic exertional compartment syndrome (CECS) is made by a careful history and by exclusion of other maladies and confirmed by compartment syndrome testing as detailed in this text. Surgical fasciotomies for the anterior, lateral, superficial and deep posterior compartments are described in detail along with ancillary procedures for chronic shin splints that should allow the athlete to return to competitive activity.