Clinics in podiatric medicine and surgery
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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.
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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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Clin Podiatr Med Surg · Apr 2003
ReviewCurrent trends in preoperative patient evaluation and management for podiatric surgeons.
In preparation for elective foot and ankle surgery, the podiatric surgeon often will refer the patient for a preoperative evaluation. Surgeons rely on the input of that consultant to provide a determination as to the operative risk for the patient. This article reviews the fundamental parts of the preoperative evaluation, perioperative patient management, and recent changes and trends within this arena.
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Often overlooked in the differential diagnosis of heel pain is neuroma of the medial calcaneal branch of the posterior tibial nerve. Heel neuroma is an important disorder of the foot that has been misdiagnosed by physicians since the early 1900s as heel spur syndrome. The authors show how heel pain rarely has anything to do with calcaneal exostosis, but instead could be related to heel neuroma.
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Clin Podiatr Med Surg · Jul 2008
ReviewLower extremity regional anesthesia with the low sciatic nerve block.
Regional anesthesia with local anesthetics is an important component of the perioperative pain management algorithm in the context of lower extremity orthopedic surgery. These techniques have proved to be consistent and effective in minimizing postoperative pain and narcotic usage, and in reducing the morbidity associated with lower extremity surgery. The mechanisms of local anesthetic agents as they relate to acute surgical pain are reviewed in this article, with an emphasis on the low sciatic nerve block. Administration techniques and the clinical experience of the author with this blockade are discussed.