Abstract:
:CVA comprises a large number of clinical entities, depending on the site of infarction in the brain. Accurate evaluation of deficits in the patient's sensory and/or motor systems and the patient's intellectual status are paramount in establishing realistic rehabilitation goals. With respect to the motor system, two types of voluntary movement may occur. These include synergistic or pattern movement and selective movement. Spasticity in the affected lower extremity may result in a variety of lower-extremity deformities and contractures. Those most commonly encountered include hip flexion and adduction contracture, inadequate knee flexion and knee flexion contracture, and ankle equinus, varus, and equinovarus. Correct evaluation of deformities may be aided by the use of poly-EMG analysis and evaluation after nerve block or motor point blocks. In hemiplegic gait dysfunction, the basic requirements for functional ambulation include (1) ability to maintain standing balance; (2) voluntary hip flexion; (3) leg stability; and (4) ability to follow instructions and adequate motivation. Often a hemiplegic patient can be trained to ambulate if an adequate extensor synergy pattern develops, since mass extension can provide stability of the leg for weight bearing. Medical rehabilitative management of the CVA patient includes early mobilization, restorative exercises (including neuromuscular facilitation techniques), measures to prevent or correct contractures, the use of AFOs, and occasionally functional electrical stimulation. Orthopedic management of deformities in CVA is indicated where conservative measures fail. Surgical procedures seek to alter the forces causing shortening of the muscles and tendons. Hence, the most commonly performed surgical procedures include (1) tendon lengthening or release; (2) soft-tissue release; and (3) tendon transfer. Surgery for hip contractures is not common; however, occasional release of hip flexors is indicated when hip flexion contracture impedes ambulation or prone lying. Inadequate knee flexion, caused by dysphasic quadriceps contraction, can be corrected by release of the vastus medialis and rectus femoris muscles. Distal hamstring tendon release with or without knee joint capsule release is the surgical procedure of choice for severe knee flexion contractures. Surgical correction of an equinus deformity is by TAL, with or without neurectomy of tibial nerve branches to the gastrocsoleus muscles. Severe ankle varus may require a SPLATT procedure. Surgery for equinovarus includes the combined surgery for both equinus and varus (that is, TAL and SPLATT procedures). Toe curling is corrected by toe flexor releases.(ABSTRACT TRUNCATED AT 400 WORDS)
journal_name
Clin Podiatr Med Surgjournal_title
Clinics in podiatric medicine and surgeryauthors
Izzo KL,Aravabhumi Ssubject
Has Abstractpub_date
1989-10-01 00:00:00pages
745-59issue
4eissn
0891-8422issn
1558-2302journal_volume
6pub_type
杂志文章,评审abstract::Ankle arthrodiastasis provides an alternative surgical treatment of the mild to moderate posttraumatic ankle arthritis. Ankle arthrodesis or ankle implant arthroplasty is usually reserved for the end-stage ankle arthritis and after conservative treatment options have been implicated for a long period of time. Ankle jo...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章,评审
doi:10.1016/j.cpm.2017.05.001
更新日期:2017-10-01 00:00:00
abstract::Chronic ankle and subtalar joint (STJ) instability is a common clinical entity and the physician must be able to determine the exact pathologic condition for proper treatment. There are many diagnostic techniques that can be used to evaluate the ankle joint and STJ. These diagnostic techniques do not take the place of...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章,评审
doi:10.1016/j.cpm.2010.10.001
更新日期:2011-01-01 00:00:00
abstract::Optimal healing for fractures requires anatomic reduction and stable fixation. This optimizes not only bone healing, but optimal function within the limb including joint functioning. Proper ligamentous healing is also crucial for optimal functioning. In patients with injuries around the ankle involving distal tibiofib...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章,评审
doi:10.1016/j.cpm.2020.03.011
更新日期:2020-07-01 00:00:00
abstract::Although the pediatric foot and ankle examination is essentially similar to that of the adult patient, there are subtle differences unique to a child's examination. The unique findings are discussed in this article based on the following: weight-bearing examination, gait evaluation, non-weight-bearing examination, vas...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章,评审
doi:10.1016/j.cpm.2013.07.008
更新日期:2013-10-01 00:00:00
abstract::The author provides a description of the deformity congenital vertical talus, including characteristics and contributing factors. Also outlined are the incidence, cause, and pathogenesis; radiographic features; anatomy; and treatment of the condition. The author includes results and discussion of surgical treatment. ...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章,评审
doi:
更新日期:2000-07-01 00:00:00
abstract::Pain in the second metatarsophalangeal joint (MTPJ) is a complaint frequently encountered by foot and ankle specialists. The pathology associated with this joint is often painful and debilitating for the patient. In the past, typical treatment protocols for second MTPJ pathology were aimed at relief of patient symptom...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章,评审
doi:10.1016/j.cpm.2013.04.009
更新日期:2013-07-01 00:00:00
abstract::Complications associated with digital and lesser metatarsal surgical procedures have been well documented in the literature. These complications may stem from systemic medical, structural, biologic, biomechanical, or iatrogenic causes. The surgeon must be cognizant of all potential complications, including ways to pre...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章,评审
doi:10.1016/j.cpm.2010.06.001
更新日期:2010-10-01 00:00:00
abstract::Arthroscopic treatment of osteochondral lesions (OCLs) of the ankle is a popular first-line surgical option after conservative therapy has failed. MRI is the preferred imaging modality to evaluate OCLs and aid in surgical planning. Associated soft tissue pathology must be appreciated and addressed surgically, because ...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章,评审
doi:10.1016/j.cpm.2011.04.006
更新日期:2011-06-01 00:00:00
abstract::In reconstructive foot and ankle surgery, the use of bone graft is common. Whether for trauma, acquired or congenital deformities, arthrodeses, joint replacement, bone loss from infection, or bone tumor resection, the foot and ankle surgeon must be knowledgeable about current bone grafting options to make informed dec...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章,评审
doi:10.1016/j.cpm.2009.07.003
更新日期:2009-10-01 00:00:00
abstract::Achilles tendon pathologic conditions are implicated in contributing to the development of many diabetic foot complications including diabetic foot ulceration and Charcot neuroarthropathy. Surgical correction of the diabetic equinus deformity has been studied as an isolated or adjunctive treatment when dealing with di...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章,评审
doi:10.1016/j.cpm.2016.10.013
更新日期:2017-04-01 00:00:00
abstract::There has been extensive research and investigation into the subtalar joint (STJ), yet the biomechanics that relate to its anatomic function, especially instability after injury, are surrounded by controversy. With a mechanism of injury closely related to the classic inversion ankle sprain, chronic instability can res...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章,评审
doi:10.1016/j.cpm.2004.03.003
更新日期:2004-07-01 00:00:00
abstract::Management of the end-stage adult acquired flatfoot has historically been accomplished with a traditional two-incision triple arthrodesis. Although this procedure is well accepted, complications such as lateral wound dehiscence, nonunion, undercorrection, and residual deformity have been reported. The medial approach ...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章,评审
doi:10.1016/j.cpm.2007.06.003
更新日期:2007-10-01 00:00:00
abstract::The author presents an alternative approach to the pediatric flexible pes planovalgus patient. Hopefully, this algorithm can serve as a guide and not as a rule. It is meant to serve the foot and ankle surgeon as a means of eliminating the arbitrary assignment of a flatfoot to procedures. Instead, the algorithm assigns...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章,评审
doi:10.1016/j.cpm.2005.10.001
更新日期:2006-01-01 00:00:00
abstract::Arthroscopic lateral ankle stabilization procedures have been described for many years. New technological advances and a deeper understanding of the pathobiomechanics involved in chronic lateral ankle instability have allowed an expansion of arthroscopic approaches to this common pathology. As experience is gained and...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章,评审
doi:10.1016/j.cpm.2016.06.010
更新日期:2016-10-01 00:00:00
abstract::Knowledge of diabetic Charcot neuroarthropathy (DCN) has grown tremendously since this condition was first described in 1936 by William Riely Jordan. Despite advancements in diagnostic approaches and treatment options making DCN limb salvage a more viable option, ongoing and additional research is needed to determine ...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章,评审
doi:10.1016/j.cpm.2016.07.001
更新日期:2017-01-01 00:00:00
abstract::Cardiovascular complications are a major cause of postoperative morbidity and mortality. Proper assessment of risk and subsequent interventions can help diminish these complications. Assessing the patient's risk is based on the type of surgery performed and on individual patient characteristics. The latter can be esta...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章,评审
doi:10.1016/j.cpm.2006.12.005
更新日期:2007-04-01 00:00:00
abstract::The complete care of burns to the foot can be complex or straightforward, depending on the nature of the burn. Appropriate care requires experience and training. The keys to good management of burns to the feet are understanding the pathophysiology of burns, appropriate acute management of the burns, and appropriate i...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章,评审
doi:10.1016/S0891-8422(03)00083-1
更新日期:2002-01-01 00:00:00
abstract::Antibiotic-loaded bone cement is a useful adjunct in the management of chronic osteomyelitis and in the prevention of recurrent osteomyelitis after an initial attack. Additionally, antibiotic-loaded bone cement stimulated the formation of granulation tissue in excess of that which would normally be expected. Our exper...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章,评审
doi:
更新日期:1990-07-01 00:00:00
abstract::External fixation as a modality is a versatile and minimally invasive stabilization option that should not be forgotten even as new and specially designed implants for nearly each bone become more fashionable. As a temporary traction device, the external fixator can help condition the soft tissues and, if closed reduc...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章,评审
doi:10.1016/s0891-8422(02)00057-5
更新日期:2003-01-01 00:00:00
abstract::The supination of the forefoot that develops with adult acquired flatfoot is defined as forefoot supinatus. This deformity is an acquired soft tissue adaptation in which the forefoot is inverted on the rearfoot. Forefoot supinatus is a reducible deformity. Forefoot supinatus can mimic, and often be mistaken for, a for...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章,评审
doi:10.1016/j.cpm.2014.03.009
更新日期:2014-07-01 00:00:00
abstract::The congenital convex pes valgus deformity has been presented in reference to its etiology, pathologic anatomy, diagnosis, and treatment. It is imperative that this deformity be diagnosed immediately and treatment instituted rapidly to achieve a functional plantigrade and asymptomatic foot. ...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章,评审
doi:
更新日期:1987-01-01 00:00:00
abstract::Revision hammertoe surgery can be extremely challenging for the foot and ankle surgeon given the scar tissue and available osseous and soft tissue. Although not a common procedure, lesser metatarsophalangeal joint arthrodesis is an option for the patient especially in lieu of an amputation. This article describes the ...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章,评审
doi:10.1016/j.cpm.2020.03.006
更新日期:2020-07-01 00:00:00
abstract::Many patients with foot and ankle deformities have concurrent deformities (osseous and soft tissue), with or without limb length discrepancies. Lower extremity deformities and limb length discrepancies typically result from trauma, congenital abnormality, avascular necrosis, previous surgery, nonunion, and malunion. L...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章,评审
doi:10.1016/j.cpm.2004.04.004
更新日期:2004-07-01 00:00:00
abstract::The time has long since passed when gangrene followed by amputation was the anticipated outcome of peripheral vascular disease of the extremities. Nevertheless, today in the United States it is estimated that there are more than half a million amputees. With preventive measures, early diagnosis, and adequate treatment...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章
doi:
更新日期:1987-07-01 00:00:00
abstract::Arthritis-affected foot joints can create function-related changes with regard to foot stability, shock attenuation, and normal foot function in gait. ...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章,评审
doi:
更新日期:1999-04-01 00:00:00
abstract::Management of the medially deviated and overlapping second digit is often frustrating because of inconsistent surgical results. After a review of the pertinent anatomy and previous forms of treatment, both conservative and surgical, the author discusses the concept of a laterally closing metatarsal head osteotomy. Exp...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章,评审
doi:
更新日期:1996-04-01 00:00:00
abstract::Wounds of the lower extremity involving the distal third of the leg remain a significant challenge due to anatomic location and often poor host physiology. Perforator-based propeller flaps may provide rapid coverage of these wounds with a relatively low rate of major complications and often readily managed minor compl...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章,评审
doi:10.1016/j.cpm.2020.06.001
更新日期:2020-10-01 00:00:00
abstract::The standard approach for correction of severe painful rheumatoid forefoot deformities has involved resection of the metatarsal heads with realignment of the lesser toe deformities and first metatarsophalangeal joint (MTPJ) arthrodesis. Modifications of this procedure may include a pan-metatarsal head resection, inclu...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 历史文章,杂志文章,评审
doi:10.1016/j.cpm.2008.09.006
更新日期:2009-01-01 00:00:00
abstract::Pathology of the fifth ray has been reviewed with emphasis on the tailor's bunion. Based on a thorough radiographic analysis, the bunionette has been grouped into four types, and surgical criteria has been proposed. The goal of this study is to provide guidelines that may enable both podiatric and orthopedic surgeons ...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章,评审
doi:
更新日期:1990-10-01 00:00:00
abstract::Since wounds in patients with diabetes will heal slowly at best, and since they are so much more susceptible to infection and the infection will be more devastating, the old adage of "first do no harm" must be adhered to. Diabetics have poor circulation, poor resistance to infection, and poor local nutrition. Their wh...
journal_title:Clinics in podiatric medicine and surgery
pub_type: 杂志文章
doi:
更新日期:1987-04-01 00:00:00