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Ankle Arthritis and Arthrodesis

The considerable morbidity imposed by degenerative joint disease of the ankle has driven new approaches to the treatment of ankle arthritis. Compared with the other major lower extremity joints, the ankle possesses unique anatomic, biomechanical, and biologic characteristics that make it resistant to primary arthritic degeneration and susceptible to posttraumatic arthritis after innocuous-appearing trauma, leading to a lower overall prevalence than in the hip or knee.…

Arthritis of the Foot

Arthritic Conditions of The Foot Overview Arthritis is the destruction of articular cartilage. Approximately one fourth of the human population will develop foot pain during their lifetime, and a significant percentage of this is due to arthritis. Several types of arthritis exist: osteoarthritis or degenerative joint disease, posttraumatic arthritis, inflammatory arthritis, crystal-induced arthritis, seronegative arthritis, septic arthritis, and others. Osteoarthritis is, by far, the most common…

Complex Regional Pain Syndrome

Complex regional pain syndrome (CRPS) is an exaggerated response to injury or immobilization, which, at times, leads to devastating chronic pain and disability. It involves an aberrant reaction of multiple aspects of the nervous system that persists long after the initial insult has resolved. Diagnosis is frequently delayed, prolonging morbidity and allowing entrenchment of peripheral and central neuroplastic changes, making treatment all the more difficult. Patients…

Congenital and Acquired Neurologic Disorders

This chapter describes and discusses disorders caused by neurologic disease that affect the adult and adolescent foot and ankle. It is divided into three sections: general considerations , congenital neurologic disorders , and acquired neurologic disorders . Both congenital and acquired neurologic conditions can profoundly impact the shape and function of the lower extremity. Accurate diagnosis is vital for determining prognosis, likelihood of progression of the…

Disorders of the Nerves

Anatomy and Definition of Injury The peripheral nerve is a complex structure with three layers surrounding the axons. The endoneurium is a connective tissue matrix that surrounds individual axons. The perineurium binds the axons into fascicles and it provides tensile strength and elasticity to the nerve. The epineurium is in the most peripheral layer, binds fascicles into a nerve, and provides protection to the nerve fibers.…

Soft Tissue and Bone Tumors

This chapter will serve as a review of the evaluation and management of tumors of the foot and ankle. We will highlight the diagnostic importance of the history and physical as well as the use of various imaging modalities to render a differential diagnosis. The principles of biopsy and staging are also covered. While malignant neoplasms of the foot and ankle are rare, the foot and…

Dermatology of the Foot and the Lower Extremity

Diagnosing Skin Disease on the Lower Extremity A patient presenting with a skin condition can prove to be a challenge to diagnose and manage. When faced with a patient with a skin condition in the office, the practitioner should have a systematic approach to arrive at a baseline differential diagnosis: observe and ask. After clinically visualizing the lesion, it may be helpful to perform a skin…

Soft Tissue Disorders of the Foot

Burns Burns of the foot pose unique and difficult problems in initial management, reconstruction, and attainment of long-term functional results. The primary reconstructive goals for this region are unimpeded ambulation and pain-free weight bearing. These objectives can be achieved by strict adherence to established principles of wound management, a clear delineation of the reconstructive requirements of the foot, and a team approach toward achieving these goals.…

Toenail Abnormalities

The nails are special cutaneous appendages that have the primary function of protecting the distal phalanx. Only primates have toenails, and whether the first primates with flat nails had an advantage over their peers by being able to remove parasites better from their bodies, thus promoting their evolutionary superiority, is a matter of fascinating speculation. In humans, diseases and deformities of the toenails are among the…

Keratotic Disorders of the Plantar Skin

Keratotic lesions of the plantar skin result from friction, pressure, shearing, or a combination of these mechanisms. They are often related to underlying bony prominences, muscle imbalance leading to atypical foot posture, or improper footwear. These must be distinguished from the intrinsic disorders of the skin, such as verrucae and dermatosis, especially tinea infestations (see Chapter 16 ). Keratotic lesions are related to both the pressure…

Plantar Heel Pain

History Plantar heel pain is a common disease process that continues to challenge orthopaedic surgeons. Because of the complex anatomy around the heel and the plantar surface of the foot, the function and etiology of pain have been difficult to understand. Early examiners suggested an infectious origin for heel pain. In the 1930s, they proposed that tuberculosis, streptococcal, gonorrhea, and syphilis infections caused heel pain. Dedicated…

Sesamoids and Accessory Bones of the Foot

Galen is reported to have first coined the term sesamoid because of the resemblance of these small rounded bones to the sesame seed. The anatomic location of several of the sesamoids is constant, but the frequency of occurrence of other sesamoids is quite variable. The sesamoids function to alter the direction of muscle pull, diminish friction, and modify pressure. Sesamoids occur in the substance of their…

Bunionettes

A bunionette deformity is characterized by a painful prominence of the lateral eminence of the fifth metatarsal head. The position of a tailor sitting in a cross-legged position has given rise to the term tailor ' s bunion to describe this prominence. Davies observed that pressure over the lateral condyle of the fifth metatarsal head leads to chronic irritation of the overlying bursa ( Fig. 10-1…

Lesser Toe Deformities

Lesser Toe Deformities Overview Lesser toe deformities can be static or dynamic. They can occur as isolated entities or be associated with deformities of the hallux, midfoot, or hindfoot. Poor footwear is the most commonly attributed cause of lesser toe deformities, but they also can be due to heritable causes or can result from congenital and neuromuscular conditions. The terms hammer toe, mallet toe , and…

Hallux Varus and Complications of Bunion Repair

This chapter will focus on managing complications and unplanned outcomes following hallux valgus corrective surgical procedures. The chapter is divided into three sections: (1) Soft tissue complications, (2) hallux varus, and (3) managing failed bunion procedures. Unplanned results can occur, even among the best of surgeons, surgical technique, and patient compliance. A thorough and transparent informed discussion and consent process is critical to create expectations on…

Hallux Valgus

The term bunion is derived from the Latin word bunio , meaning turnip. Use of this term has led to some confusing misapplications regarding the various disorders of the first metatarsophalangeal (MTP) joint. The word bunion has been used to denote any enlargement or deformity of the MTP joint, including such diverse diagnoses as an enlarged bursa, overlying ganglion, gouty arthropathy, hallux valgus, hallux rigidus, and…

Regional Anesthesia for the Foot and Ankle

Overview This chapter aims to provide a concise but comprehensive overview of the pharmacologic and interventional therapies available for perioperative pain management for foot and ankle surgery. The focus is on providing updates on topics discussed previously, as well as an introduction to newer methods not included in the previous edition. Although seemingly out of place in this voluminous surgical manual, the importance of this chapter…

Nonsurgical Treatment of Foot and Ankle Conditions

General Considerations Many foot and ankle disorders may be treated conservatively. Nonoperative regimens are often inexpensive, easily accomplished, and successful. It is important that the treating physician has thorough knowledge and understanding of the interaction of the foot and the shoe or device applied. The biomechanics of normal foot function and the effect of the disease entity being treated must be analyzed. The anatomy of the…

Scientific Evidence-Based Foot and Ankle Care

In this chapter a description of evidence-based foot and ankle care will be described that is no different than evidence-based medicine (EBM) care other than being focused on orthopedic foot and ankle care. First and foremost, it is important for health care providers to have a comprehensive understanding of what scientific evidence-based (SEB) care is. Next, a detailed description of how to practice SEB care using…

Imaging of the Foot and Ankle

Imaging is an essential component in the diagnostic workup of many conditions of the foot and ankle. This chapter reviews the basic principles of imaging, with the aim of providing a solid foundation for routine clinical practice. In the limited space available, the authors' approach will be clinically pragmatic and focused on general concepts, rather than individual conditions. Role of Imaging For the foot and ankle…