Unstable acute and chronic Charcot’s deformity: staged skeletal and soft-tissue reconstruction

Acute and chronic Charcot's foot deformity is a progressive, disabling and disfiguring condition that is prone to ulceration and infection. If conservative treatment is ineffective, bone and soft-tissue reconstruction is a viable option.

Skin grafting techniques for soft-tissue coverage of diabetic foot and ankle wounds

Diabetic foot and ankle wounds frequently break down despite off-loading techniques. Skin grafting offers a simple, durable, minimally invasive and cost-effective means of wound closure, resulting in a functional and sensate limb.

The Doppler probe for planning septofasciocutaneous advancement flaps on the plantar aspect of the foot: anatomical study and clinical applications

A 5-MHz Doppler probe was utilized to identify the perforating septofasciocutaneous vessels on the plantar aspect of the right and left feet of 10 healthy subjects. Each audible perforator was marked, and each foot was photographed, scanned into a personal computer, and standardized to 8 inches high by 4 inches wide. All 20 feet were then stacked together to create a composite average of all markings. Loupe aided (2.5 x magnification) dissection of a latex cast of the perforating septofasciocutaneous vessels from a fresh frozen cadaveric foot revealed similar location and distribution as the composite average described above. The Doppler probe is capable of accurately identifying the septofasciocutaneous perforating vessels, thereby, creating a vascular map of the plantar aspect of the foot useful for precise planning of advancement flap coverage for full thickness defects. Two representative case examples are presented.

Torsion of the tendon of peroneus brevis

The authors present a previously undescribed torsion located within the tendon of peroneus brevis. The musculotendinous unit of peroneus brevis was isolated from 46 lower extremities of cadavers. A goniometer was constructed and utilized to quantify the degree of torsion located within each peroneus brevis tendon. Torsion was present in all 46 cadaver specimens, with a mean of 38.5 degrees and a range of 26 degrees to 56 degrees. The regional anatomy and biomechanical functions of peroneus brevis are discussed, and proposed bases for the embryologic origins and functional significance of the torsion are presented.

Position of the first ray and motion of the first metatarsophalangeal joint

The authors present a quantitative analysis of the effect that first ray position has on motion of the first metatarsophalangeal joint. A goniometer was constructed to measure the degrees of first metatarsophalangeal joint dorsiflexion with the first ray in three positions: weightbearing resting position, dorsiflexed 4 mm from the weightbearing resting position, and dorsiflexed 8 mm from the weightbearing resting position. First metatarsophalangeal joint dorsiflexion decreased 19% as the first ray was moved from the weightbearing resting position to 4 mm dorsiflexed, 19.3% as the first ray was moved from 4 mm dorsiflexed to 8 mm dorsiflexed, and 34.7% as the first ray was moved from the weightbearing resting position to 8 mm dorsiflexed. The biomechanical significance of decreased first metatarsophalangeal joint dorsiflexion that results from first ray dorsiflexion is discussed, and proposed bases for the pathomechanics of hallux abducto valgus and hallux rigidus deformities are presented.

The hallucal interphalangeal sesamoid

The hallucal interphalangeal sesamoid is considered by some to represent an anatomical rarity that possesses little clinical significance. However, the location of this seemingly innocuous sesamoid bone directly inferior to the hallucal interphalangeal joint of the hallux is associated with the development of several important anatomical, biomechanical, and clinical pathologies. The authors present a review of the literature regarding the location, shape, ontogeny, and surgical management of the hallucal interphalangeal sesamoid. Additionally, the authors discuss the detrimental effect the hallucal interphalangeal sesamoid has on the biomechanical functions of the first metatarsophalangeal and hallucal interphalangeal joints.

Functional significance of torsion of the tendon of tibialis posterior

The authors describe the anatomical necessity and functional significance of torsion of the tendon of tibialis posterior. A wooden model of the right lower extremity has been constructed which includes representations of the ankle, subtalar, and oblique midtarsal joints. The model is used to show that the presence of torsion within the tendon of tibialis posterior eliminates the need for any longitudinal slippage between individual tendon fibers during triplane movement of the joints of the lower extremity.

Torsion of the tendon of tibialis posterior

The authors present a previously undescribed torsion located within the tendon of tibialis posterior. The musculotendinous unit of tibialis posterior was isolated from 17 lower extremities of cadavers. A small goniometer was constructed and used to quantify the degree of torsion located within each tibialis posterior tendon. Torsion was present in all 17 cadaver specimens, with a mean of 47.5 degrees and a range from 21 degrees to 62 degrees. The regional anatomy and biomechanical functions of tibialis posterior are discussed, and proposed bases for the embryologic origins and functional significance of the torsion are presented.