Biomedical subjects
Publications and source records attributed to N A Grumbine.
The authors present a modification of the Jones Suspension procedure for clawfoot deformity. The specific mechanisms of this deformity are analyzed. The procedure is a split transfer of the extension level with an aggressive clawfoot release and fixation. Recurrence and complications are reduced with the modification.
The results of the study indicate that tarsal tunnel syndrome is a pathologic condition in which there are multiple etiologies, which in some cases are poorly defined. In order to arrive at a definitive diagnosis, all available tests, including pathology reports, are important. Where proper diagnosis is made and followed with appropriate adjunctive care, the probability of recurrence will be minimized. Statistical information in itself is of some value, because it may help the podiatrist to more clearly diagnose and treat the patients in whom vague or general symptoms may exist.
In summary, it has been demonstrated by the statistical analysis of 48 subjects (96 feet) that as the foot moves from the neutral to the resting calcaneal stance position, the tendo Achillis alignment is displaced lateral to the center of gravity. Class I heels demonstrated a direct correlation with tendo Achillis deviation suggesting that their subtalar joint motion is in the transverse plane. Class II and III heels did not directly correlate with Achilles deviation, suggesting probable frontal plane variability. Class IV heels showed no correlation with rearfoot pathology and are considered to be a consequence of distal or proximal pronatory forces. We advocate the recognition of the Achilles tendon as it interacts with transverse and frontal plane subtalar joint motion and believe that it deserves ample attention when evaluating the patient biomechanically as well as surgically.
The authors introduce the peroneal tendon balance procedure and discuss normal and hypermobile function of the first ray. The procedure is based on the theory that the peroneus longus tendon is a primary retrograde stabilizer of the proximal portion of the first ray. The theory emphasizes that abnormal pronation results in a positional weakness of the peroneus longus tendon, which induces first ray hypermobility. This surgical procedure involves an anastomosis of the peroneus longus to the peroneus brevis tendon. It is designed to increase the force of the peroneus longus tendon in order to reduce first ray hypermobility.
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The authors present a modified method for treating painful cicatrix nerve entrapments. A series of three high-volume injections of local anesthetic, steroid, and hyaluronidase are used to perform percutaneous adhesiotomies and extraneural fibrosis decompression. If special attention is given to the tissue plane level in performing the sequential injections, circumferential neural trunk decompression or cicatrix adhesiotomy can be obtained. The procedure may decrease or eliminate pain sufficiently to circumvent surgical intervention.
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A new surgical procedure for the treatment of severe structural flatfoot with forefoot varus is presented. The talar osteotomy for flatfoot deformity and the pathology in the talus with medial column forefoot varus is described. The flatfoot considerations, adjunctive deformities, and the surgical reduction are presented. The talar osteotomy has been performed on 47 feet with a follow-up that is intermediate in length from 1 to 7 years. The results indicate that the procedure is specific and allows for good reduction when indicated in the majority of the cases.
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Presented is an alternative surgical anchoring technique which alleviates the need for button, bolster, and osseous fixation devices. This method can be applied to the fixation of tendon and ligamentous structures in the foot and ankle. The available fixation tension is increased, while the potential for complications from hardware is eliminated.
The lines of maximal tension are parallel to the skin creases, or lines of cleavage, as described by Langer. This study verifies that incisions in the foot produce the least amount of scarring when made parallel to the lines of minimal movement. Incisions made perpendicular to these cleavage lines produce maximal scarring, and oblique incisions produce an intermediate amount of scarring.
This article presents a technique for obtaining a split-thickness graft from the junctional skin of the arch. This anatomic area is easily accessed and readily utilized as a split-thickness skin donor site. Junctional skin is similar in durability to plantar skin and responds well to weight-bearing and ambulation stress. The results in a series of 21 patients are presented.
Presented is a retrospective study in plastic surgery comparing various donor sites for split-thickness grafting in the lower extremity. Split-thickness donor grafts obtained from the buttocks, thigh, leg, and medial arch of the foot were transferred to various sites on the foot and ankle. Results indicate that medial arch donor sites provide a more functional graft and a cosmetic result which is generally more acceptable to the patient.
Complications of adjacent tissue transfers tend to be lessened due to similarity in structure and function of adjacent skin. When complications are encountered, prompt and effective treatment is of tantamount importance.
Anterior cavus is a multiplane structural deformity that can originate from different areas within the foot. Differentiation of these areas is a necessary examination in order to determine the effect of proper treatment. A depressed fourth and fifth ray or lateral column is a major deformity in anterior cavus. The lateral column deformity is a pronatory force that causes a premature medial shift of weight. The premature shift can cause a breakdown of the medial column of the foot. We have developed an examination of the compensated anterior cavus deformity that enables the practitioner to isolate better the pronatory forces within the foot.
This examination is used in cava-adducto-varus feet to determine the primary areas producing the secondary forefoot pathology. Table I is a compilation of the data and shows by means of an asterisk those pathologies possible with an additional primary deformity. The fold face test parts, when indicated in the exact order, are diagnostic. Once the primary areas have been elucidated, the remaining components are secondary, and the prognosis of biochemical and specific surgical treatment can be made. The specific treatment procedures and their rational use will be discussed in a future presentation.
In this retrospective study of 36 patients and 58 feet, the "L" shaped osteotomy of the calcaneus body was investigated. The procedure, designed to add intrinsic stability to the shape of the osteotomy, was performed to correct triplane deformities of the heel in a variety of pathologic foot types. A retrospective analysis of clinical and radiographic data suggests that this procedure is a valuable alternative for surgical treatment of deformities of the calcaneus. Advantages appear to be predictability, stability, and versatility with respect to triplane reduction of deformities. A reliable method of evaluating calcaneal position both perioperatively and intraoperatively is also presented.
Retrospective preliminary report of 19 cases undergoing partial ankle joint arthroplasties with open surgical procedures were rehabilitated with continuous passive motion (CPM). Preoperative and post-operative ankle range of motion and subjective findings (pain, physical signs, activity, quality of motion) were evaluated. Results indicated significant increases to ankle joint range of motion with the use of continuous passive motion, decreased pain, increased activity, decreased edema, and improved quality of motion in the majority of patients undergoing ankle joint arthroplasty with continuous passive motion.