Foot and Ankle Surgery 1st Edition

Foot and Ankle Surgery 1st EditionThis book is a comprehensive guide to surgery of the ankle and foot. Beginning with an introduction and basic anatomy, the following chapters discuss numerous different conditions that may affect the ankle and foot, and the surgical procedures used to treat them.

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Topics include diabetic foot, foot arthritis, toenail disorders, soft tissue and skin disorders; and amputations. With contributions from renowned orthopaedic surgeons, most of whom are based in the USA, Foot and Ankle Surgery presents almost 700 images and illustrations, making it an invaluable reference for both orthopaedic surgeons and postgraduate students.

Foot and Ankle Surgery 1st Edition
by Selene Parekh (Editor)
ISBN-13: 978-9350909850
ISBN-10: 9350909855

Foot and Ankle Surgery 1st Edition Contents

1. Surgical Anatomy of the Foot and Ankle………………………………………………………………………….. 1
Shepard R Hurwitz
• The Ankle 1 • The Foot 3
2. The Basics of the Foot and Ankle ……………………………………………………………………………………. 9
Christopher Jones, Selene G Parekh
• Inspection 9 • Deformity╇╇10 • Palpation 11 • Ankle 11 • Hindfoot and Midfoot 11
• Range of Motion 12 • Gait Analysis and Biomechanics of the Foot and Ankle 14 • Component
Biomechanics 18 • Ankle Joint 19 • Subtalar Joint 19 • Transverse Tarsal Articulation 19
• Metatarsophalangeal Break 19 • Imaging of the Foot and Ankle 20 • Sesamoid Bones 21
• Ankle 23 • Ankle Stress Views 24 • Nuclear Medicine 24 • Computed Tomography 25
• Magnetic Resonance Imaging 26
3. General Surgical Considerations in Foot and Ankle Patients………………………………………….. 28
Randolph J Grierson, Sarang N Desai, Arthur Manoli II
• Detailed History 28 • Physical Exam 29 • Imaging 31 • Special Preoperative
Circumstances 32 • Surgery 33
4. Hallux Valgus ……………………………………………………………………………………………………………….. 41
David I Pedowitz, Andrew Steiner, Keith L Wapner
• Demographics 41 • Gender and Bilaterality 41 • Causes of Hallux Valgus 42
• Anatomic Considerations 43 • Pathoanatomy 44 • Clinical Evaluation 46
• Radiographic Evaluation 46 • Conservative Treatment 48 • Surgical Treatment 50
• Surgical Decision Making 51 • Chevron Osteotomy, Biplanar Chevron Osteotomy, and
Akin 52 • Procedures 52 • Chevron Osteotomy Technique 53 • DSTP with or
without Proximal First Metatarsal Osteotomy 58 • Mann HV Repair (Proximal Crescentic
Osteotomy with DSTP) 62 • Ludloff/Proximal Chevron/Opening Wedge with Bow Plate 65
• The SCARF Osteotomy 65 • Metatarsophalangeal Arthrodesis 67 • First Metatarsophalangeal
Joint Arthrodesis 68
5. Lesser Toe Deformities and Sesamoid Pathology ………………………………………………………….. 73
Aaron T Scott
• Basic Definitions 73 • History 73 • Physical Examination 74 • Radiographic
Examination 75 • Mallet Toe 76 • Hammer Toe 78 • Claw Toes 85 • MTP
Instability 87 • Freiberg’s Infraction 92 • Bunionette Deformity 94 • Sesamoids
and Accessory Bones 99 • Hallucal Sesamoids 100 • Specific Sesamoid Conditions 101
6. Nerve Disorders………………………………………………………………………………………………………….. 106
Richard M Marks
• Interdigital Neuroma 106 • Tarsal Tunnel Syndrome 112 • Entrapment of First Branch of
Lateral Plantar Nerve 119 • Superficial Peroneal Nerve Entrapment 120 • Deep Peroneal Nerve
Entrapment 122 • Acknowledgment 122
Contents
xviii Foot and Ankle Surgery
7. Plantar Heel Pain ………………………………………………………………………………………………………… 126
Mark Hamming, Rajiv Shah, Selene G Parekh
• Relevant Anatomy 127 • Etiology 128 • History 129 • Physical Examination 129
• Imaging and Further Diagnostic Studies 130 • Heel Spurs 132 • Treatment Options 132
• Plantar Fasciitis Nonoperative Therapy 133 • Operative Therapy 137 • Treatment of
Athletes with Plantar Fasciitis 139 • Criteria for Return to Sports 141 • Treatment of
Children 141 • Author’s Preferred Method of Treatment of Plantar Heel Pain 141
8. Tumors of the Foot and Ankle ……………………………………………………………………………………… 147
Ajay Puri, Manish G Agarwal, Ashish Gulia
• Bone Tumors 147 • Benign Bone Tumors 149 • Malignant Bone Tumors 154
• Soft Tissue Tumors 157
9. Toenail Disorders………………………………………………………………………………………………………… 161
Douglas W Schreyack, Michael S Kerzner
• Toenail Anatomy 161 • Systemic Disease 162 • Toenail Infections 163 • Tumors 165
• Toenail Trauma 168 • Toenail Surgery 169
10. Foot Arthritis………………………………………………………………………………………………………………. 175
Jeffrey D Seybold, Anish R Kadakia
• Hindfoot Arthritis 175 • Pathophysiology and Etiology 175 • Diagnosis 180
• Management 184 • Midfoot Arthritis 198 • Pathophysiology and Etiology 198
• Diagnosis 201 • Management 204 • Fore Foot 215 • Hallux Rigidus 215
• Pathophysiology and Etiology 216 • Diagnosis 217 • Management 219
11. Arthritis of the Ankle …………………………………………………………………………………………………… 238
Siddhant K Mehta, Eric A Breitbart, Nicholas A Abidi, Wayne S Berberian, Sheldon S Lin
• Etiology 238 • Clinical Evaluation 239 • Imaging 241 • Management Goals 242
• Arthroscopic Debridement 243 • Ankle Arthrodesis 245 • Ankle Arthroplasty 250
12. Pes Planus Deformity………………………………………………………………………………………………….. 261
Sudheer C Reddy
• Anatomy 261 • History 262 • Physical Examination 262 • Classification 263
• Imaging 264 • Surgical Treatment of Pes Planus Deformity 266
13. Pes Cavus Deformity…………………………………………………………………………………………………… 275
Benjamin Roller Williams, Jonathan Thorndike Deland
• Biomechanics 275 • Etiology 277 • Physical Examination 280 • Radiographs 282
• Conservative Treatment 283 • Surgical Treatment 283 • Plantar Fascia Release 284
• Dorsal Wedge Osteotomy 284 • Dwyer Osteotomy 285 • Samilson Osteotomy 285
14. Tendon Disorders ……………………………………………………………………………………………………….. 292
Samuel B Adams, Selene G Parekh
• Flexor Hallucis Longus Tendon 292 • Anterior Tibial Tendon 297 • Peroneal Tendon
Disorders 300 • Posterior Tibial Tendon Disorders 307 • Disorders of the Achilles Tendon 318
Contents xix
15. Diabetic Foot………………………………………………………………………………………………………………. 332
Tom Dowd, Eric M Bluman
• Epidemiology of Diabetes Mellitus in India 332 • Medical Considerations 332
• Ulceration 333 • Trauma 344 • Impaired Fracture Healing 344 • Treatment 345
• Operative Techniques 345 • Salvage 347
16. Neuropathic Foot………………………………………………………………………………………………………… 352
Artuvo Villarreal, Vinod Kumar Panchbhavi
• Pathophysiology of Charcot 352 • Neuroarthropathy 352 • Clinical Presentation 353
• Imaging of the Charcot Foot and Ankle 355 • Nonsurgical Treatment 356
• Surgical Treatment 357
17. Orthotics and Prosthetics for the Foot and Ankle…………………………………………………………. 367
Michael J Astilla
• Postoperative Edema Management 367 • Materials 368 • Postoperative Orthotic 369
• Management 369 • Postoperative Prosthetic Care 374
18. Amputations of the Foot and Ankle……………………………………………………………………………… 377
Vincent Y Ng, Gregory C Berlet
• General Considerations 377 • Surgical Considerations 380 • Surgical Technique 381
19. Athletic Injuries of the Foot and Ankle…………………………………………………………………………. 389
Phinit Phisitkul, Ned Amendola
• Ankle and Subtalar Joints 389 • Hindfoot 403 • Midfoot 418 • Forefoot 422
• Stress Fractures 425
20. Stress Fractures of the Foot and Ankle………………………………………………………………………… 436
Amar Patel, Greg Horton
• Epidemiology 436 • Approach to Stress Fractures 437 • Specific Stress Fractures 438
21. Arthroscopy of the Foot and Ankle………………………………………………………………………………. 444
Charles M Jobin, Joshua A Metzl, Justin K Greisberg
• Indications and Contraindications 444 • Anesthesia 444 • Equipment 445
• Positioning/Distraction 446 • Arthroscopic Anatomy and Portals 448
• Arthroscopic Diagnostic Examination 450 • Arthroscopic Technique for Treating Common
Disorders 451 • Osteochondral Lesions of the Talus (OLT) 454 • Arthroscopic Ankle
Arthrodesis 457 • Arthroscopic Subtalar 458 • Arthrodesis 458 • Complication 458
22. Pediatric Foot and Ankle……………………………………………………………………………………………… 460
Prerana Patel
• Diagnoses of the Newborn 460 • Calcaneovalgus foot 460 • Vertical Talus 460
• Calcaneovarus Foot 462 • Metatarsus Adductus 462 • Diagnoses of the Child Up
to Age 10 471 • Disorders in Children Over 10 Years 473
xx Foot and Ankle Surgery
23. Soft Tissue and Skin Disorders of the Foot and Ankle………………………………………………….. 491
David I Pedowitz, Walter J Pedowitz
• Complex Regional Pain Syndrome (Reflex Sympathetic Dystrophy) 491 • Treatment 495
24. Infections of the Foot and Ankle………………………………………………………………………………….. 500
Jeremy Smith, Richard J de Asla
• Classification 500 • Medically Important Bacteria 501 • Fungus 504 • Mycobacteria 506
• Antibiotics 506 • Soft Tissue Infections 510 • Osteomyelitis 513 • Septic Arthritis 515
25. Trauma of the Foot and Ankle ……………………………………………………………………………………… 519
Nirmal C Tejwani
• Introduction and Epidemiology 519 • Classifications 519 • Hindfoot Injuries 524
Index …………………………………………………………………………………………………………………………………………………..533

Foot and Ankle Surgery 1st Edition CHAPTER 1

Surgical Anatomy of the Foot and Ankle

INTRODUCTION
Surgeons use anatomy in several ways—they plan surgery via an approach that minimizes the difficulty of exposure, avoids damage to structures, they borrow structures and they need to preserve nerve and vascular function. Knowledge of anatomy also helps with the interpretation of image studies, particularly with spatial relations seen on CT and MRI.

Anatomy forms the basis for physical diagnosis of musculoskeletal problems— the surgeon is a clinical anatomist who applies basic knowledge of the human structure in order to diagnose a problem and begin creating options for treatment. This use of anatomy of the foot and ankle is the basis for repairing fractures, restoring unstable ankles, correcting deformed toes and feet, fusing or replacing arthritic ankles or toes, releasing compressed nerves, fixing torn or damaged tendons and removing foreign bodies, loose bodies or osteophytes. Expert command of foot
and ankle anatomy are needed for ablative procedures such as amputation or debridement.

THE ANKLE
Bones The ankle is a diarthrodial joint that function very much as a hinge. There is a socket, called the mortise, created by the distal end of the tibia and the medial and lateral malleoli. Within the mortise lies the body of the talus,
referred sometimes as the trochlea. Since the talus is wider anteriorly, the joint is mechanically more stable
to torque and shear when the talus (and the foot) are in dorsiflexion (Fig. 1.1). The axis of rotation is a line connecting the distal tip of the lateral and medial malleoli.1 Since the lateral malleolus is posteriorly placed with reference to the medial malleolus there is 18-30 degrees of external rotation of the ankle joint with reference to the knee in the transverse plane. Similarly, the lateral malleolus extends distal to the medial malleolus so the axis is
inclined 70-88 degrees from the vertical axis of the limb in the direction of the lateral malleolus.

The net result of the ‘average’ axis is a line that is directed from anteromedial to posterolateral with the motion of the
foot tending toward external rotation and abduction with dorsiflexion of the ankle. Similarly, plantarflexion
of the ankle produces internal rotation and adduction of the foot via the axis of rotation. The ankle socket or mortise is created by the distal ends of the tibia and fibula with a highly congruous fit by the body of the talus, there is good deal of stability created by the bony architecture (Fig. 1.2). The distal ….

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