The purpose of this study was to assess the impact of Ilizarov frame fixation and total contact casting on the complications of Charcot arthropathy. The diabetic charcot foot or ankle is a potentially limb threatening disorder. This progressive disorder is characterised by osteopenia, bone fragmentation and joint subluxation. The risk of significant deformity and osteomyelitis lead to high rates of amputation in these patients. We analysed patients with acute charcot arthropathy attending the Rowley Bristow Unit between 2008 and 2012. We assessed 48 patients with a mean age of 59 years. Mean follow up was 24 months. 12 patients were managed with Ilizarov frame fixation and 36 using total contact casting. The duration of management was determined using serial infrared temperature monitoring to ensure the temperature of the limb normalised before patients were deemed safe to remove their immobilisation. The mean duration of Iliazarov frame fixation was 6.2 months and 5.3 months duration for total contact casting. In the Ilizarov group pin site infections were common and treated with a short course of antibiotics. In total one patient required below knee amputation following Ilizarov frame fixation. No patients suffered with osteomyelitis. We feel that prompt management of acute charcot arthropathy with either total contact casting where appropriate or Ilizarov frame fixation can reduce serious complications of this disorder.
Morton's neuroma (MN) is a common cause of metatarsalgia. Whilst there are a many treatment modalities available, studies looking at the long term effectiveness of most forms of treatment are scarce. The injection of MN with alcohol has gained popularity over the past ten years with widespread media coverage. Many surgeons have anecdotally questioned the long-term effectiveness. Sixty patients underwent alcohol injection for the treatment of MN by Radiologists at our institution. These results were originally published showing 92% (92/100) success rates and only 3% (3/100) requiring surgical excision at a mean follow up of 10.5 mths. The authors concluded that alcohol injection was comparable to results for surgical excision. We were able to review forty five of this original cohort with an average follow up of 61 (range, 33 to 73) months. The modified Johnson score and visual analogue scales were used to assess the patients and compare these results to five year results available in the literature for surgical management.Background
Methods
Most patients with Achilles tendinopathy (AT) are treated successfully with physiotherapy ie eccentric calf training. In some patients gastrocnemius contracture persists. Three other publications have reported improvement in AT following gastrocnemius release, but this is the first series of patients to have proximal medial gastrocnemius release (PMGR) for AT. The purpose of this study was to review patients with refractory non-insertional and insertional AT treated by PMGR with a minimum followup of 18 months. Sixteen PMGRs were performed over a two year period. Nine patients (10 PMGRs) were available for followup. The mean age of patients was 45 (Range, 25 to 63) years, with five female and four male subjects. The average followup period was 2.5 (range, 1.7 to 3.3) years. The sample was divided into non-insertional and insertional tendinopathy, with five PMGRs per group. Outcome measures were VAS scores, VISA-A scores, AOFAS ankle-hindfoot score and overall satisfaction. Complications and further procedures were also recorded.Background
Method
