10/22/2019    

RESPONSES/COMMENTS (CLINICAL) - PART 1B

RE: Re-evaluation of Traditional Angular Parameters for Austin Bunionectomies

From: Stephen Kominsky, DPM

 

I have been following this discussion for years now, in fact for more than 30. Several different iterations of discussion have evolved over the years based on the instrumentation including burs and motors, as well as intra-operative radiography. I have reached the point where I truly believe that there is a place for minimally invasive surgery, BUT, I also believe that it is not the panacea for every bunion patient that walks in the door. There must be a point where the surgeon decides that perhaps a different procedure may give the patient a better outcome.

 

This example is one of those cases; given the pre-operative appearance of this foot, I believe that a better course of action would have been a more proximal procedure like a tarso-metatarsal arthrodesis. Critically evaluating these post-operative x-rays, there is quite a bit of shortening of the first metatarsal which is likely to lead to either a second metatarsal stress fracture or metatarsalgia.  

 

Stephen Kominsky, DPM, Washington, DC

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02/09/2018    

RESPONSES/COMMENTS (CLINICAL) - PART 1B

RE: Treatment for Metastatic Cancer Spread to Feet (Roody Samimi, DPM)

From: Bryan C. Markinson, DPM

 

It is a little bit unsettling to ponder the original query by Name Withheld and the response by Dr. Samimi. It is true that metastatic cancer to the foot (generally considered rare) usually indicates a poorer prognosis, but so does all metastatic disease. MORE IMPORTANTLY, in metastatic disease to the foot, and specifically the nail unit, it is the first knowledge that any cancer exists in the patient anywhere in a way more than casual percentage of cases. In nail units, it approaches 50%. This puts us in a position to get the patient diagnosed and a chance at treatment for the original tumor, even though prognosis is naturally poorer. 

 

When a patient with a known history of cancer (as stated in original post) presents with a foot complaint or lesion, a ...

 

Editor's note: Dr. Markinson's extended-length letter can be read here.