In order to determine the incidence of avascular necrosis after osteotomy of the talar neck, we re-evaluated 11 patients (16 feet) with idiopathic club foot who had undergone this procedure at a mean age of eight years (5 to 13) to correct a residual adduction deformity. All had been initially treated conservatively and operatively. The mean follow-up was 39 years (36 to 41). Surgery consisted of a closing-wedge osteotomy of the talar neck combined, in 14 feet, with lengthening of the first cuneiform and a Steindler procedure. At follow-up eight feet were free from pain, three had occasional mild pain and five were regularly painful after routine activities. Two patients were unlimited in their activity, six occasionally limited after strenuous and three regularly limited after strenuous activity. Using the Ponseti score, the feet were rated as good in four, fair in three and poor in nine. In seven feet avascular necrosis with collapse and flattening of the talar dome had occurred. In all of these feet the children were younger than ten years of age at the time of surgery. In three feet, avascular necrosis of the talar head was also observed. We conclude that osteotomy of the talar neck in children under the age of ten years can cause avascular necrosis and should be abandoned.
Until recently creeping eruption was seen rarely in Switzerland. With the increase in tourism, in particular to East Africa, isolated cases have been seen in this country in recent years. This study describes an outbreak of epidemic proportions in a group of 24 young men after an organized group travel to Kenya. Hands and feet only were affected by characteristic lesions but the larva migrans could not be found in any of those affected, a commonly encountered difficulty. It appeared most likely that the larvae had entered the feet via sea sand and the hands during the riding of two horses shared by the group. There was no evidence of direct skin to skin transmission. There was a good therapeutic response to topical to γ-hexachlorcyclohexan 1% in an ointment base.
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