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Biomedical subjects

D E Baxter

Publications and source records attributed to D E Baxter.

30 records · Page 2Linked to original sources
PubMed1990

Neuropathies of the foot and ankle in athletes.

Although neuropathies in the athlete's foot and ankle are uncommon, they are often underdiagnosed. This is primarily due to the complex interplay of factors that are required for their presentation. The most frequently encountered entrapment syndromes (in decreasing order) involve the interdigital nerves, first branch of the lateral plantar nerve, isolated medial or lateral plantar nerves, posterior tibial nerve, deep peroneal nerve, superficial peroneal nerve, sural nerve, and saphenous nerve. A thorough knowledge of peripheral nerve anatomy is essential in establishing the diagnosis. Roentgenograms may reveal bony abnormalities that are the diagnosis. Roentgenograms may reveal bony abnormalities that are commonly contributory. Electrodiagnostic tests may be normal because these dynamic syndromes often resolve at rest. In most cases, correction of underlying etiologies combined with rest, NSAIDs, and occasionally injections will allow resolution of the syndrome. Recalcitrant cases may require surgical decompression, which frequently provides satisfactory results.

Adult↗
PubMed1989

Chronic heel pain. Treatment rationale.

Chronic heel pain needs a treatment rationale. Most heel pain responds to conservative treatment. When surgery is done, the surgeon must be aware of the anatomy and especially the nerves about the heel that can cause pain. The author's experience is presented.

Chronic Disease↗
PubMed1988

Recurrent pain following interdigital neurectomy--a plantar approach.

Thirty patients with 39 recurrent interdigital neuromas were evaluated to determine the success of subsequent surgery. Two surgical techniques were used to resect the nerve over a 2.5-year period and their results were compared. One consisted of exposure through the previous dorsal incision and the other of exposure through a transverse plantar incision proximal to the metatarsal heads. Overall results revealed significant improvement for greater than 80% of patients after their final operation. Less than 50% gained complete relief, however, and 58% experienced persistent discomfort in certain types of shoes. The plantar approach offers a simplified, less traumatic exposure of the nerve in a more proximal location. No healing problems were encountered with the proximal plantar incision.

Adolescent↗
PubMed1987

Regional anesthesia for ambulatory foot and ankle surgery.

Regional anesthesia provides significant advantages for the patient and practitioner involved in ambulatory foot and ankle surgery. Reliable techniques for administering regional ankle blocks emphasizing their importance in the practice of ambulatory surgery are presented.

Ambulatory Surgical Procedures↗
PubMed1986

Common forefoot problems in runners.

Forefoot injuries constitute a significant portion of the problems that affect runners. With the increasing popularity of recreational running, more emphasis on the treatment of specific running injuries has surfaced. For the orthopaedic surgeon interested in treating runners, a thorough understanding of foot anatomy, biomechanics, shoes, orthotics, running surfaces, and conservative and surgical treatment options is mandatory. Runners place high demands on their feet and therefore require careful evaluation prior to embarking on a specific treatment course. This article represents a current overview of common problems affecting the forefoot of recreational and world-class runners. Treatment plans are based on the senior author's experience in the care of runners over the past 14 years.

Athletic Injuries↗
PubMed1985

Nerve entrapment of the foot and ankle in runners.

In the 10 years 1972 through 1982, the senior author performed 21 operations on 15 runners with persistent foot and ankle pain. The operative procedures involved decompression of peripheral nerves in the foot and ankle, consisting of release of soft tissues in the tarsal tunnel and foot or removal of abnormal bony excrescences that were irritating these nerves. All 15 runners had good to excellent results and all returned to their preinjury running status, including the competitive athletes. Foot and ankle pain is best treated conservatively, but when signs and symptoms culled from a careful history and physical examination reflect a nerve entrapment syndrome, surgical intervention has its place in the armamentarium of the surgeon.

Adult↗
PubMed1981

Running symposium.

The running symposium has been designed to demonstrate to the reader the basic mechanics of the running gait, as compared to normal walking. It is imperative in order to understand the nature of the problems seen in runners to understand the forces and motions which are occurring in the various joints of the lower extremity, so that as much as possible, treatment can be based upon accurate anatomical diagnoses, rather than empiric treatment. The second part of this symposium discusses the nature of the injuries seen in the lower extremity in runners. Suggestions are made as to how to manage the problems as well as their prevention. Finally, a comment is included on the nature of the running shoe and on shoe selection.

Athletic Injuries↗
PubMed1980

Leptinotarsin: a presynaptic neurotoxin that stimulates release of acetylcholine.

Leptinotarsin, a toxin found in the hemolymph of the beetle Leptinotarsa haldemani, can stimulate release of acetylcholine from synaptic termini. Leptinotarsin causes an increase in the frequency of miniature end plate potentials (mepps) of the rat phrenic nerve-diaphragm preparation. The increase in the frequency of mepps induced by leptinotarsin is biphasic: about 10% of the total mepps are released in an initial burst that lasts about 90 sec, after which the remaining mepps are released over a period of 10-20 min. Tetrodotoxin has no effect upon the release induced by leptinotarsin, but low-Ca(2+) conditions abolish the first phase. The two phases of release may represent two presynaptic pools of acetylcholine, both of which can be released in quantized form. In a second study, rat brain synaptosomes were incubated with [(3)H]choline and were immobilized on Millipore filters. Leptinotarsin induced release of [(3)H]acetylcholine from this preparation, confirming the release seen by using neurophysiological methods. The ability of leptinotarsin to induce release from either intact nerve terminals or synaptosomes was abolished when the toxin was heated. The releasing activity of leptinotarsin from synaptosomes was also partially dependent upon the presence of Ca(2+) in the perfusing solution. Release from synaptosomes followed first-order kinetics, and was not inhibited by commercial antibodies to black widow spider antigens. The data suggest that leptinotarsin acts as a presynaptic neurotoxin and may be of value as a mechanistic probe in understanding the storage and release of neurotransmitters.

Acetylcholine↗
PubMedDate not supplied

Bunionectomies and related surgery in the elite female middle-distance and marathon runner.

When contemplating bunion surgery in the elite athlete, serious consideration should be given to its effects on the overall function and biomechanics of the forefoot. Many surgical treatment options are available, but their use in the high performance athlete has not previously been reported in the literature. In this paper we report on the successful use of the chevron bunionectomy procedure and related surgery in two world class female middle-distance and marathon runners.

Adult↗
PubMedDate not supplied

Heel pain--operative results.

In 6 years through 1982, the authors performed 34 operative cases in 26 patients with recalcitrant heel pain. The operative procedure involves an isolated neurolysis of the mixed nerve supplying the abductor digiti quinti muscle as it passes beneath the abductor hallucis muscle and beneath the medial ridge of the calcaneus. The deep fascia of the abductor hallucis muscle is released routinely, and an impinging heel spur or tight plantar fascia is partially removed or released if it is causing entrapment of the nerve. The biomechanical pathogenesis of heel pain in relation to pes planus and pes cavus predisposing to an entrapment neuropathy is described, and the anatomy of the heel in relation to the nerve distribution is clarified and well illustrated. Of the 34 operated heels, 32 had good results and two had poor results. Heel pain can cause total disability in the working population and may jeopardize one's employment or professional athletic career. The authors believe operative treatment has a place in the care of recalcitrant heel pain and that an entrapment neuropathy is an etiological factor in heel pain.

Adult↗
PubMedDate not supplied

Heel pain syndrome: electrodiagnostic support for nerve entrapment.

A local entrapment neuropathy has been proposed as one of the etiologies of heel pain, but it has never been documented by electrodiagnostic studies. Primary symptoms in patients suspected of having a neurologic basis for their heel pain include neuritic medial heel pain and radiation either proximally or distally. On physical examination, all patients in our series had reproduction of their symptomatology with palpation over the proximal aspect of the abductor hallucis and/or the origin of the plantar fascia from the medial tubercle of the calcaneus. Twenty-seven patients (20 women and seven men; average age 49) with these clinical characteristics were examined by electromyography and motor/sensory/mixed nerve conduction studies. Bilateral heel signs and symptoms were present in 11 patients. Ten of the patients had a significant history of back pain with referral to the legs. In 23 of the 38 symptomatic heels, abnormalities were identified in the lateral and/or the medial plantar nerves. The number of abnormal values per heel ranged from one to four, with a mean of 2.1. The most common finding was involvement of the medial nerve (57%). Thirty percent of the heels had isolated findings in the lateral plantar nerve and 13% had abnormalities in both plantar nerves. Two patients had electrophysiologic evidence of active S1 radiculopathy, with ipsilateral evidence of plantar nerve entrapment suggesting a "double crush" syndrome. The results of this study support the presence of abnormalities of plantar nerve function in a selected group of patients with neuritic heel pain.

Adult↗