Chronic decubitus ulceration of the heels is a common condition encountered by podiatric physicians, especially in diabetic patients. Very often these ulcerations can progress to osteomyelitis of the calcaneus. Many times, this in turn leads to a below-the-knee amputation. A partial calcanectomy is a viable alternative to below-the-knee amputation. A more functional limb both mechanically and cosmetically is achieved, and the morbidity and mortality associated with the calcanectomy is less than with a below-the-knee amputation. A brief overview of the history and outcomes associated with this procedure is outlined and a case utilizing a partial calcanectomy is presented.
The anatomy, mechanism, and two treatment approaches of an avulsion fracture at the plantar lateral base of the first metatarsal without any joint dislocation were discussed. The authors presented an injury that has not been reported in the literature but has only been seen as a part of Lisfranc's fracture dislocation types B and C.
The shortening Z-osteotomy of the proximal phalanx of the hallux has been presented as an alternative to the Regnauld enclavement procedure for patients with the appropriate indications. In addition to sharing the same positive characteristics as the Regnauld procedure, the Z-osteotomy has technical and physiologic advantages. The advantages of the Z-osteotomy over the Regnauld include maintenance of the intrinsic attachments at the base of the proximal phalanx, less risk of avascular necrosis, less technical difficulty, and absence of complications associated with an autogenous bone graft. Also, it does not affect the sesamoid apparatus. Research and extended follow-up studies will continue at Lakewood Regional Medical Center. In the last year, one author has completed approximately 13 of these procedures. The postoperative results have been encouraging and successful with one exception. In one case, the increase of the hallux interphalangeal angle was probably caused by excessive tightening of the distal screw compared with the proximal screw.
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