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N Gould

Publications and source records attributed to N Gould.

47 records · Page 3Linked to original sources
PubMedDate not supplied

Bilateral tarsal tunnel syndrome caused by varicosities.

The authors present a case report of bilateral tarsal tunnel syndrome occurring in a 39-year-old, slightly overweight female with a long history of varicose veins of her legs. Symptomatology suggestive of tarsal tunnel syndrome was present over the left heel. Vein stripping was done on both legs. When the burning discomfort at the inner aspect of the left heel continued in spite of the strippings, she presented at our Foot Clinic. Surgery on the left heel revealed varicosities overlying the medial and lateral plantar nerves near their origin, and removal of these resulted in prompt relief of her complaints. Nine months later and 10 months following the venous stripping of her right leg, medial right heel pain, burning, paresthesias, and a positive Tinel sign appeared over the inner aspect of her right heel. There was prompt subsidence of these complaints when again varicosities were found and removed.

Adult↗
PubMedDate not supplied

The simple bunion: anatomy at the metatarsophalangeal joint of the great toe.

The pathomechanics for the development of the hallux valgus deformity takes place at the first metatarsophalangeal joint--the sesamoid complex. The sesamoid complex consists of seven muscles, eight ligaments, and two sesamoid bones. When the first metatarsal escapes the complex and drifts medially, the sesamoids remain twisted in situ, several of the ligaments "fail," and others contract. The authors propose reduction of the metatarsus primus varus by first metatarsal osteotomy and appropriate ligament releases and plications to restore alignment. A detailed understanding of the pathomechanics is essential for proper interpretation of the problems and anticipated lasting surgeries.

Hallux Valgus↗
PubMedDate not supplied

Surgery in advanced Charcot-Marie-Tooth disease.

Crippling equinocavovarus position of the foot in advanced Charcot-Marie-Tooth disease with its attendant metatarsalgia tender calluses and rigidity creates painful, limited, hobbling ambulation with lowered work and general activity tolerance. The object of the surgeries is to convert this foot into a plantigrade , more flexible, painless unit. Surgery consists of plantar fasciotomies off the tubercle of the os calcis and also transversely through the middle of the longitudinal arch. Dorsally angulated green-stick osteotomies are performed at the bases of all the metatarsals. A Jones operation with transfer of the long extensor great toe tendon through the neck and head of the first metatarsal and arthrodesis of the IP joint of the great toe complete the surgery. Often it is necessary to do Bunnell repair lengthening of the flexor hallucis longus tendon. Occasionally, the first metatarsophalangeal joint needs dorsal capsulotomy and lengthening of the short extensor tendon. Variations in and simplicity of techniques are demonstrated with a case report. Ten patients (eight men and two women: 18 feet), ranging in age from 18 to 46 years (average age, 29 years), with a 3- to 6-year follow-up are herein reported. Correction has been maintained in the oldest case.

Adolescent↗
PubMedDate not supplied

Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions.

A retrospective study of 22 ankles in 22 patients with osteochondral talar dome lesions between 1975 and 1983 has indicated that surgical treatment yields superior results to conservative therapy. Thirteen male and 9 female patients, ages 9 to 72 years, average age 28 years, showed 10 medical lesions (Berndt and Harty classification (stage I (one); stage II/III (nine)) and 12 lateral lesions (stage II/III (5), stage IV (7)). Examination follow-up on 19 patients (86%) has averaged 24 months. The initial diagnosis seen retrospectively on x-rays was missed 43% of the time by emergency room physicians. A history of trauma was verified in 100% of the lateral lesions and 80% of the medial talar dome lesions. Of the 22 ankles, 14 lesions were isolated injuries, while 8 had concomitant fractures, lateral ligament, or peroneal tendon damage. Surgical treatment consisted of removal of the osteochondral fragment, curettage, and drilling of its bed. Two distinct surgical approaches were utilized. Lateral dome lesions were approached through the standard anterolateral incision, while medial dome lesions were approached through the anterior tibial tendon sheath with grooving of the anteromedial distal tibia articular surface. The medial approach allowed the somewhat posteriorly placed medial lesions to be reached, negating the need for a medial malleolar osteotomy and postoperative immobilization. On follow-up, no untoward ankle arthrosis was noted as a result of the grooving of the anteromedial distal tibia. Nineteen of the 22 patients had surgical therapy with 79% excellent or good, 21% fair, and no poor results. Five of the eight patients who elected prolonged conservative therapy finally had surgery. Of the three remaining patients conservatively treated, there were two fair results and one poor result.

Adolescent↗
PubMedDate not supplied

Public prejudice.

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Community Mental Health Services↗