|
|
|
|
Search
03/13/2017
RESPONSES/COMMENTS (PM ARTICLE OF THE DAY)
From: Brian Kiel, DPM
I realize that I am of an older generation of podiatrists having graduated in 1972, so maybe my take on the recent article by Dr. Grambart is very old school, and maybe I will embarrass myself but here goes. The first question I would want to know is what was the age or average age of the patient(s) undergoing these procedures? If this was a 25 year old with excellent blood supply, I would accept the procedures as described. However, in my experience, the great majority, if not all the the patients with severe HAV deformity and crossover second toe, are 65 or older. The amount of extensive surgery, the long and arduous recovery time, and the rate of complications would seem to preclude what Dr. Grambart recommends.
In the numerous cases like this that I have seen in the past 42 years, the chief complaint is that the second toe is painful. It seems to me that this is a lot of surgery to perform for a painful toe. So, here goes. Amputate the toe. It is a simple disarticulation. It takes about 20-30 minutes, there is mild, short-term post-op pain, and it heals quickly. The patient is never non-ambulatory, and due to the pre-op non-weight-bearing position of the toe, ambulation is not affected. Maybe I am just too old to want to do such extensive surgery for what I see as a simple problem. I am open to correction.
Brian Kiel, DPM, Memphis, TN
Other messages in this thread:
03/24/2017
RESPONSES/COMMENTS (PM ARTICLE OF THE DAY)
From: David Zuckerman, DPM
I have read with interest Dr. Pearl's article on Amnion injections for degenerative conditions. featured by PM News. There appears to be a false statement that quantifiable long-term outcomes have not been reported with ESWT treatments. I have included an abstract by Professor Wang which was done with long-term conclusions outlined.
Below is the portion from Dr. Pearl's article indicating that ESWT doesn't have long-term outcome. This is absolutely incorrect. Again see just one abstract by...
Editor's note: Dr. Zuckerman's extended-length letter can be read here.
03/16/2017
RESPONSES/COMMENTS (PM ARTICLE OF THE DAY)
From: Jeff Kittay, DPM
In 1980, I took over a palliative care practice from an older retiring DPM in Boston and began to introduce surgery into the services offered. Patients were at first resistant, but gradually some were convinced that they did not have to suffer any longer with their painful deformities and permitted me to make repairs.
One problem that I remember vividly involved a crossover 2nd toe with severe hallux valgus. The bunion was asymptomatic and the patient's chief complaint was the chronic painful keratoma at the dorsum of the 2nd toe PIPJ. The hallux was deviated so far laterally that...
Editor's note: Dr. Kittay's extended-length letter can be read here.
03/15/2017
RESPONSES/COMMENTS (PM ARTICLE OF THE DAY) - PART 1B
From: Name Withheld 2
A large percentage of the patients who have a painful overlapping second toe are over 65. Amputating the second toe would leave a space between the first and third toes which would cause more lateral deviation of the big toe and probably increase the bunion deformity. In most cases, straightening the second is hard to achieve without correcting the HAV deformity. Most second toe deformities can be corrected with MIS surgery with minimal pain and disability.
 |
MIS Correction of Overlapping 2nd Toe |
The majority of the cases can be corrected with a second metatarsal osteotomy and a second proximal phalangeal osteotomy. The severe second toe deformities where the joint is subluxed may also need a Haspal procedure. Most of the HAV deformities can be corrected with a Reverdin Isham bunionectomy, which has minimal pain and disability.
Name Withheld 2
03/15/2017
RESPONSES/COMMENTS (PM ARTICLE OF THE DAY) - PART 1A
From: Name Withheld 1
This is what happens when you amputate the overlapping 2nd toe. This patient was not asymptomatic and required surgery. She is only 60; however, we are living longer, and so a 65 year old woman with a 2nd toe amputation may look like this in 5 or so years and live another 20 with pain and discomfort.
 |
Sequellae of 2nd toe crossover amputation |
I guess the moral of the story is each person should be assessed individually instead of placing age requirements or limits.
Name Withheld 1
03/14/2017
RESPONSES/COMMENTS (PM ARTICLE OF THE DAY)
From: Gene Sherwood, DPM
I agree fully with Brian Kiel, DPM suggesting the amputation of the second toe with a painful toe as the chief complaint in older patients. I used this procedure in my practice days. It is straight forward surgery with limited complications. An explanation to the patient is the key. I am 65 with a cross-over second toe after failed hammertoe correction years ago. If it becomes painful, I would have the toe amputated before any more extensive and debilitating surgery.
Gene Sherwood, DPM (Retired), Fairfield, OH
12/07/2016
RESPONSES/COMMENTS (PM ARTICLE OF THE DAY)
From: Brian Lee, DPM
It's refreshing to finally see MIS get some positive press. It is a technique that I have used for 30 years with great success and numerous referrals from it. It most definitely has an important place in our profession. Many thanks to Dr. Peacock for writing the article.
I would like to add a few of my personal applications of the Akin and some observations I've seen over the years. There is obviously more than one way to skin a cat. I routinely use a Silver/Akin bunionectomy (all MIS) to correct bunions with IMs even in the 18-20 degree range. I know what many of you are thinking, but let me present an often encountered...
Editor's Note: Dr. Lee's extended-length letter can be read here.
|
| |
|
|
