By Nikolaus Wülker, Michael Stephens, Andrea C. Cracchiolo
The second one version of An Atlas of Foot and Ankle surgical procedure builds at the good fortune of the 1st, with a world choice of professional participants to symbolize the present perform of foot and ankle surgical procedure in the course of the global. the fabric during this atlas is gifted based on how foot and ankle pathology is encountered by way of such a lot orthopaedic surgeons of their perform. a few chapters take care of person universal strategies, comparable to the tender tissue method for hallux valgus: in those, technical info and diversifications of strategy are provided. different chapters take care of diagnoses, reminiscent of metatarsalgia or cavus foot, and a couple of diverse surgical operation recommendations are defined. The scope of every bankruptcy exceeds surgical directions by myself: the respective pathology is unique, as are diagnostic concepts and substitute equipment of remedy. The Atlas of Foot and Ankle surgical procedure might be of curiosity not just to green professional surgeons, but additionally to the overall orthopaedists and physician in education with an curiosity in problems of the foot and ankle
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Extra info for Atlas Foot and Ankle Surgery, Second Edition
The foot is immobilized in a cast, and weightbearing is limited to a minimal amount needed for balance during ambulation. 5 weeks, and the foot is placed into a cast or a cast boot. If radiographs taken at 8 weeks show bony union, weightbearing is increased as tolerated, and the foot is gently phased into a normal shoe. Walking in a pool is an excellent form of early rehabilitation. Occasionally, the intermetatarsal screw is prominent and symptomatic. This screw may be removed in the office after 3–6 months using a local anesthetic.
Shear strain-relieved bone graft must be added to encourage union. A dorsal skin incision is made over the first ray to expose the tarsometatarsal joint without jeopardizing the anterior tibial tendon. The long extensor is held medial and the extensor brevis is kept lateral during dorsal exposure of the proximal first metatarsal. The incision can be extended proximally for fusion of the medial intercuneiform joint (needed in approximately 10% of cases) and is routinely extended distally for soft-tissue procedures at the lateral first MTP joint.
A full-thickness dorsal and plantar flap is created along the capsular plane. Care is taken to avoid the dorsal and plantar cutaneous nerves. A vertical incision is made 2–3 mm proximal to the base of the proximal phalanx, using a no. 11 blade. A second incision is then made parallel to the first, anywhere from 3 mm to 8 mm more proximal, depending upon the size of the deformity (Figure 5). These two parallel cuts are connected by an inverted V on the dorsomedial aspect of the metatarsophalangeal joint and plantarward by a V-shaped incision through the abductor hallucis tendon [DuVries 1959].