Between 1986 and 1990, we treated 68 patients with diabetes and neuroarthropathy of the midfoot, 21 of whom had bilateral involvement. Patients were managed according to a strict protocol defined by activity of the neuroarthropathy, instability, ulceration, infection, and ischemia. Initial management of acute neuroarthropathy (18 feet) was open reduction and arthrodesis (8), a total-contact cast or brace (9), and amputation (1). All patients with subacute neuroarthropathy (30 feet) were initially treated in a total contact cast. Four of these feet subsequently required amputation, two required arthrodesis, and one required exostectomy. For chronic neuroarthropathy (41 feet), a total-contact cast or a molded orthotic insert with or without bracing was used initially in all feet. Subsequent surgical salvage for this group included arthrodesis (9), plantar exostectomy (6), amputation (2), and abscess drainage (2). Four patients died during this treatment period and 64 patients (85 feet) were evaluated at a mean interval of 3 years (range 1-6 years) after initiation of treatment. This treatment program was found to be successful in 82 of 85 feet treated.
A prospective study was designed to evaluate the effect of a pneumatic intermittent impulse device in the treatment of postsurgical and posttraumatic swelling of the adult foot and ankle. Two groups of patients and their respective controls were studied. Group A consisted of 19 patients and 19 controls with acute swelling of the foot and ankle after major elective or posttraumatic surgery. Group B comprised 18 patients and 16 controls with chronic postsurgical or posttraumatic swelling. The pneumatic intermittent impulse device was used according to a predetermined daily regimen in both the control and experimental groups. The control patients were treated identically, except that their impulse device was modified to prevent effective compression. Reduction in swelling was measured by volumetric analysis with water displacement at selected intervals for each group. When compared with their respective controls, those patients who used an active impulse device had a statistically significant reduction in swelling. We conclude that this device is effective in the control of both acute and chronic swelling after trauma and surgery of the foot and ankle.
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