Curbside Consultation of the Foot and Ankle: 49 Clinical Questions, Curbside Consultation

Book Description

Are you looking for concise, practical answers to those questions that are often left unanswered by traditional foot and ankle references? Are you seeking brief, evidence-based advice for complicated cases or controversial decisions? Curbside Consultation of the Foot and Ankle: 49 Clinical Questions provides quick answers to the tricky questions most commonly posed during a “curbside consultation” between orthopedic surgeons.

Drs. George B. Holmes, Jr. and Simon Lee have designed this unique reference which offers expert advice, preferences, and opinions on tough clinical questions commonly associated with the foot and ankle. The unique Q&A format provides quick access to current information related to the foot and ankle with the simplicity of a conversation between two colleagues. Numerous images, diagrams, and references allow readers to browse large amounts of information in an expedited fashion.

Curbside Consultation of the Foot and Ankle: 49 Clinical Questions provides information basic enough for residents while also incorporating expert advice that even high-volume clinicians will appreciate. Practicing orthopedic surgeons, orthopedic residents, foot and ankle specialists, and medical students will benefit from the user-friendly, casual format and the expert advice contained within.

Some of the questions that are answered:
• When do you do an allograft or autograft talar transplantation graft for a failed osteochondral talar lesion?
• How do you treat an athlete with chronic lateral foot overload and peroneal tendonitis with a cavovarus foot?
• How do you fix your syndesmotic injuries? Can I use tight-ropes now?
• I have a 63 year old patient who had an ankle fracture 20 years ago. They are ready for a major procedure now. Should I perform an ankle arthrodesis or should I refer her out to someone for a total ankle arthroplasty? What are your criteria for a total ankle arthroplasty?
• Do I need to use bone graft in foot and ankle surgery, autologous or allograft? What graft should I use?

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Section I Forefoot/Midfoot

Question 1           How Do You Evaluate and Treat an 18-Year-Old Female With Plantar
                               Hallux Metatarsophalangeal Pain and a Radiolucent Line on Her
                               Sesamoid?

Daniel L. Ocel, MD

Question 2 My Mother-in-Law is Developing Progressive Pain in the Ball of Her Foot
and Clawing of Her Lesser Toes. What Do I Do?

David R. Richardson, MD

Question 3 My Patient Has Failed Conservative Treatment of a Morton’s Neuroma.
Do I Perform a Plantar or Dorsal Surgical Approach?

Daniel L. Ocel, MD

Question 4 A 43-Year-Old Recreational Marathon Runner Is Having Pain Over Her
Bunion. Will This Eventually Need Surgery?

Steven A. Kodros, MD

Question 5 How Would You Treat My 74-Year-Old Community Ambulator With a
Severe Bunion Who Cannot Find Shoes for the Michigan Winters?

Robert S. Marsh, DO and Donald R. Bohay, MD, FACS

Question 6 How Do You Treat an Ingrown Toenail? Should I Prescribe the Oral
Antifungal Medication for Onychomycosis?

Yong Chae, DPM, FACFAS

Question 7 How Do You Manage Hallux Rigidus? Which Patients With Hallux
Rigidus Should Receive a Cheilectomy, Arthrodesis, or Arthroplasty?

Jennifer Chu, MD and Judith Baumhauer, MD, MPH

Question 8 How Do I Perform a Midfoot Fusion?

Michael S. Pinzur, MD

Section II Hindfoot

Question 9 How Do You Treat Plantar Fasciitis? How Do I Know if It Is the First
Branch of the Lateral Plantar Nerve (Baxter’s Nerve)?

Bruce Cohen, MD

Question 10 Do All Patients With Pes Planus Require Treatment?

Eric Breitbart, MD; Wayne Berberian, MD; and Sheldon Lin, MD

Question 11 What Is Your Surgical Approach to Chronic Posterior Tibial Tendon
Insufficiency?

Scott Nemec, DO and John G. Anderson, MD

Question 12 Which Patients With Cavovarus Feet Need Treatment?

Armen S. Kelikian, MD

Question 13 I Am Performing a Triple Arthrodesis But Cannot Seem to Reduce the
Talonavicular Joint. What Am I Doing Wrong?

Scott Nemec, DO and John G. Anderson, MD

Question 14 How Much Fixation Is Required for a Subtalar Fusion? What Is Your
Postoperative Protocol?

Eric Breitbart MD; Wayne Berberian, MD; and Sheldon Lin, MD

Section III Ankle

Question 15         How Do I Treat a Patient With Recurrent Medial Ankle Pain and a
                               Magnetic Resonance Imaging Finding of Medial Malleolar Edema
                               Consistent With a Medial Malleolar Stress Fracture?

David R. Richardson, MD

Question 16 Which Osteochondral Talar Lesions Need Surgery?

Christopher Bibbo, DO, FACS, FAAOS

Question 17 When Do You Perform an Allograft or Autograft Talar Transplantation
Graft for a Failed Osteochondral Talar Lesion?

Gregory C. Berlet, MD and Jaymes D. Granata, MD

Question 18 How Do You Treat Chronic Achilles Tendinosis? When Do You
Operate?

Steven A. Kodros, MD

Question 19 How Do I Know if I Should Transfer the Flexor Hallucis Longus or
Do a Turn-Down or V-Y Lengthening for My Achilles Tendon Gap?

Donald R. Bohay, MD, FACS and Robert S. Marsh, DO

Question 20 How Do You Treat a Haglund’s Deformity That Does Not Have Any
Changes Involving the Achilles Tendon?

W. Hodges Davis, MD

Question 21 Magnetic Resonance Imaging Shows a Peroneus Tendon Tear. Should I
Operate?

Keith L. Wapner, MD

Question 22 How Do You Manage Ankle Arthritis With Minimal Arthritic Changes
on Radiographs?

Pradeep Kodali, MD and Anand Vora, MD

Question 23 Will an Ankle Arthroscopy and Removal of Bone Spurs Help Me?

Armen S. Kelikian, MD

Question 24         I Have a 63-Year-Old Patient Who Had an Ankle Fracture 20 Years
                               Ago and Is Ready for a Major Procedure Now. Should I Perform an
                               Ankle Arthrodesis or Should I Refer Her to Someone for a Total
                               Ankle Arthroplasty? What Are Your Criteria for a Total Ankle
                               Arthroplasty?

Gregory C. Berlet, MD and Jaymes D. Granata, MD

Section IV Sports

Question 25 An 18-Year-Old Male Soccer Player Has Dislocating Peroneal Tendons.
How Would You Treat This?

Simon Lee, MD and Robert R. L. Gray, MD

Question 26         How Would You Treat a 22-Year-Old Professional Ballet Dancer With an
                               Os Trigonum and Fluid Around Her Flexor Hallucis Longus Tendon
                               Sheath Seen on Magnetic Resonance Imaging?

W. Hodges Davis, MD

Question 27 How Would You Treat a 32-Year-Old Triathelete With a Nondisplaced
Navicular Stress Fracture?

Alex J. Kline, MD and Robert B. Anderson, MD

Question 28         My 25-Year-Old Patient in Whom I Have Previously Placed a Jones Screw
                               for a Fifth Metatarsal Stress Fracture Now Has New Pain With a
                               Positive Triple Phase Bone Scan. Now How Do I Treat This Patient?

Bruce Cohen, MD

Question 29         How Do You Treat a 21-Year-Old Basketball Player Who Has Magnetic
                               Resonance Imaging Evidence of Tibial Diaphyseal Edema Not Resolved
                               After 3 Months of Protected Weight Bearing?

Jeremy A. Alland, BA and Shane J. Nho, MD, MS

Question 30 How Do You Treat “Shin Splints” in the High-Level Athlete Who Needs
to Continue to Compete?

Jeremy A. Alland, BA and Shane J. Nho, MD, MS

Question 31         What Is Your Technique for an Achilles Tendon Repair? What Is Your
                               Cut-Off for a Primary Repair and How Do You Treat Them if Greater
                               Than That?

Christopher P. Chiodo, MD

Question 32 How Do You Treat an Athlete With Chronic Lateral Foot Overload and
Peroneal Tendonitis With a Cavovarus Foot?

Brian C. Toolan, MD

Question 33 How Do You Manage a Significant Turf Toe Injury?

Nicholas R. Seibert, MD and Robert B. Anderson, MD

Question 34 How Long Do High Ankle Sprains Really Take to Get Better? How Do
You Evaluate Them Appropriately?

Jennifer Chu, MD and Judith Baumhauer, MD, MPH

Question 35 How Do You Treat Chronic Ankle Instability in Your Recreational
Athletes?

Johnny Lin, MD and Nickolas G. Garbis, MD

Section V Trauma

Question 36 How Do You Treat Proximal Fifth Metatarsal Fractures?

Carroll P. Jones, MD

Question 37 How Do You Manage a 22-Year-Old College Lineman With a Minimally
Displaced or Ligamentous Lisfranc Injury?

Terrence M. Philbin, DO and Jaymes D. Granata, MD

Question 38 Which Lateral Talar Process Fractures Should I Fix?

Brian C. Toolan, MD

Question 39 Which Calcaneus Fractures Should I Operate On?

Pradeep Kodali, MD and Anand Vora, MD

Question 40 How Should I Fix My Patient With Multiple Metatarsal Fractures?

Simon Lee, MD and Samuel McArthur, MD

Question 41 What Is Your Decision-Making Process for Pilon Fractures?

Sameer J. Lodha, MD and Walter W. Virkus, MD

Question 42 Do I Rod or Plate My Distal Third Tibia Fractures? Should I Fix the
Fibula, Too?

Cara A. Cipriano, MD and Walter W. Virkus, MD

Question 43 How Do You Fix Your Syndesmotic Injuries? Can I Use a TightRope
Now?

Jaymes D. Granata, MD and Terrence M. Philbin, DO

Section VI Miscellaneous

Question 44 How Do You Treat Tarsal Tunnel Syndrome? What Are Your Indications
for Surgical Decompression?

Christopher P. Chiodo, MD

Question 45 How Do You Evaluate and Treat Exertional Compartment Syndrome of
the Leg?

Johnny Lin, MD and Samuel McArthur, MD

Question 46 Does Compartment Syndrome of the Foot Really Exist? How Should
I Treat It?

Michael S. Pinzur, MD

Question 47 What Are Some Techniques You Use in Treating Foot and Ankle Injuries
in Your Patients With Osteoporosis?

Carroll P. Jones, MD

Question 48 What Are Some Techniques Used in Treating Foot and Ankle Injuries in
Patients With Diabetes?

Keith L. Wapner, MD

Question 49 Do I Need to Use Bone Graft for Foot or Ankle Surgery? Which Graft
Should I Use—Autologous or Allograft?

Christopher Bibbo, DO, FACS, FAAOS

Financial Disclosures

Index

About the Editors

George B. Holmes, Jr, MD graduated from Yale College in New Haven, Connecticut and earned his medical degree from Yale University School of Medicine. He completed his orthopedic residency at the Harvard Combined Orthopaedic Residency. This was followed by a sports medicine fellowship with Lyle Micheli, MD at the Children’s Hospital Boston in Massachusetts and a foot and ankle fellowship with Roger A. Mann, MD in Oakland, California.

Dr. Holmes is currently Director of the Section of Foot & Ankle Surgery at Rush University Medical Center, Chicago, Illinois. He is also an editor for Foot & Ankle International and has hosted visiting fellows from Brazil and Poland. Past nonacademic activities include serving as an orthopedic consultant for the Joffrey Ballet, the Philadelphia Dance Company, the Boston Marathon, the Chicago Bulls, and the Sacramento Kings. He has authored numerous peer-reviewed and nonpeer-reviewed articles; regional, national and international podium presentations; and book chapters.

Simon Lee, MD is an assistant professor in Orthopaedic Surgery at Rush University Medical College. He is a graduate of Rush Medical College, completing his orthopedic surgery residency at the University of Illinois, Chicago. He completed his Foot and Ankle Surgery Fellowship in Charlotte, North Carolina at the Miller Clinic and Carolina’s Medical Center.

Dr. Lee is active in the continued education of orthopedic residents at Rush Medical Center in foot and ankle surgery. He is active and serves as a committee member for the American Orthopedic Foot and Ankle Society (AOFAS). Dr. Lee has served on the faculty of numerous courses on surgery of the foot and ankle through the AAOS and AOFAS. Additionally, he is a reviewer for the Foot and Ankle International (FAI) journal. Locally, Dr. Lee serves as the foot and ankle consultant for numerous Chicago metro area high schools, colleges, semi-professional and professional dance companies, and the Chicago White Sox and Chicago Bulls.

Curbside Consultation of the Foot and Ankle: 49 Clinical Questions, Curbside Consultation

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Contents

About the Editors

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