Curbside Consultation of the Foot and Ankle 49 Clinical Questions

Are you looking for concise, practical answers to those questions that are often left unanswered by traditional foot and ankle references? Are you seeking brief, evidence-based advice for complicated cases or controversial decisions? Curbside Consultation of the Foot and Ankle: 49 Clinical Questionsprovides quick answers to the tricky questions most commonly posed during a "curbside consultation" between orthopedic surgeons. Drs. George B. Holmes, Jr. and Simon Lee have designed this unique reference which offers expert advice, preferences, and opinions on tough clinical questions commonly associated with the foot and ankle. The unique Q&A format provides quick access to current information related to the foot and ankle with the simplicity of a conversation between two colleagues. Numerous images, diagrams, and references allow readers to browse large amounts of information in an expedited fashion. Curbside Consultation of the Foot and Ankle: 49 Clinical Questionsprovides information basic enough for residents while also incorporating expert advice that even high-volume clinicians will appreciate. Practicing orthopedic surgeons, orthopedic residents, foot and ankle specialists, and medical students will benefit from the user-friendly, casual format and the expert advice contained within. Some of the questions that are answered: When do you do an allograft or autograft talar transplantation graft for a failed osteochondral talar lesion? How do you treat an athlete with chronic lateral foot overload and peroneal tendonitis with a cavovarus foot? How do you fix your syndesmotic injuries? Can I use tight-ropes now? I have a 63 year old patient who had an ankle fracture 20 years ago. They are ready for a major procedure now. Should I perform an ankle arthrodesis or should I refer her out to someone for a total ankle arthroplasty? What are your criteria for a total ankle arthroplasty? Do I need to use bone graft in foot and ankle surgery, autologous or allograft? What graft should I use?

George B. Holmes, Jr, MD graduated from Yale College in New Haven, Connecticut and earned his medical degree from Yale University School of Medicine. He completed his orthopedic residency at the Harvard Combined Orthopaedic Residency. This was followed by a sports medicine fellowship with Lyle Micheli, MD at the Children’s Hospital Boston in Massachusetts and a foot and ankle fellowship with Roger A. Mann, MD in Oakland, California.   

Dr. Holmes is currently Director of the Section of Foot & Ankle Surgery at Rush University Medical Center, Chicago, Illinois. He is also an editor for Foot & Ankle International and has hosted visiting fellows from Brazil and Poland. Past nonacademic activities include serving as an orthopedic consultant for the Joffrey Ballet, the Philadelphia Dance Company, the Boston Marathon, the Chicago Bulls, and the Sacramento Kings. He has authored numerous peer-reviewed and nonpeer-reviewed articles; regional, national and international podium presentations; and book chapters.   

Simon Lee, MD is an assistant professor in Orthopaedic Surgery at Rush University Medical College. He is a graduate of Rush Medical College, completing his orthopedic surgery residency at the University of Illinois, Chicago. He completed his Foot and Ankle Surgery Fellowship in Charlotte, North Carolina at the Miller Clinic and Carolina’s Medical Center.   

Dr. Lee is active in the continued education of orthopedic residents at Rush Medical Center in foot and ankle surgery. He is active and serves as a committee member for the American Orthopedic Foot and Ankle Society (AOFAS). Dr. Lee has served on the faculty of numerous courses on surgery of the foot and ankle through the AAOS and AOFAS. Additionally, he is a reviewer for the Foot and Ankle International (FAI) journal. Locally, Dr. Lee serves as the foot and ankle consultant for numerous Chicago metro area high schools, colleges, semi-professional and professional dance companies, and the Chicago White Sox and Chicago Bulls.

Section I          Forefoot/Midfoot             Question 1      How Do You Evaluate and Treat an 18-Year-Old Female With Plantar Hallux  Metatarsophalangeal Pain and a Radiolucent Line on Her Sesamoid?      Question 2      My Mother-in-Law is Developing Progressive Pain in the Ball of Her Foot and Clawing of Her Lesser Toes. What Do I Do?   Question 3      My Patient Has Failed Conservative Treatment of a Morton\u2019s Neuroma. Do I Perform a Plantar Were Digital Approach?        Question 4      A 43-Year-Old Recreational Marathon Runner Is Having Pain Over Her Bunion. Will This Eventually Need Surgery?       Question 5      How Would You Treat My 74-Year-Old Community Ambulator With a Severe Bunion Who Cannot Find Shoes for the Michigan Winters? Question 6      How Do You Treat an Ingrown Toenail? Should I Prescribe the Oral Antifungal Medication for Onychomycosis?         Question 7      How Do You Manage Hallux Rigidus? Which Patients With Hallux Rigidus Should Receive a Cheilectomy, Arthrodesis, or Arthroplasty?     Question 8      How Do I Perform a Midfoot Fusion?   Section II        Hindfoot            Question 9      How Do You Treat Plantar Fasciitis? How Do I Know if It Is the First Branch of the Lateral Plantar Nerve (Baxter\u2019s Nerve)?          Question 10    Do All Patients With Pes Planus Require Treatment?   Question 11    What Is Your Surgical Approach for Chronic Posterior Tibial Tendon Insufficiency?            Question 12    Which Patients With Cavovarus Feet Need Treatment?           Question 13    I Am Performing a Triple Arthrodesis But Cannot Seem to Reduce the Talonavicular Joint. What Am I Doing Wrong? Question 14    How Much Fixation Is Required for a Subtalar Fusion? What Is Your Postoperative Protocol?             Section III       Ankle    Question 15    How Do I Treat a Patient With Recurrent Medial Ankle Pain and a Magnetic Resonance Imaging Finding of Medial Malleolar Edema Consistent With a Medial Malleolar Stress Fracture?        Question 16    Which Osteochondral Talar Lesions Need Surgery?    Question 17    When Do You Perform an Allograft or Autograft Talar Transplantation Graft for a Failed Osteochondral Talar Lesion?   Question 18    How Do You Treat Chronic Achilles Tendinosis? When Do You Operate?    Question 19    How Do I Know if I Should Transfer the Flexor Hallucis Longus or Do a Turn-Down or V-Y Lengthening for My Achilles Tendon Gap?     Question 20    How Do You Treat a Haglund\u2019s Deformity That Does Not Have Any Changes Involving the Achilles Tendon?          Question 21    Magnetic Resonance Imaging Shows a Peroneus Tendon Tear. Should I Operate?      Question 22    How Do You Manage Ankle Arthritis With Minimal Arthritic Changes on Radiographs?        Question 23    Will an Ankle Arthroscopy and Removal of Bone Spurs Help Me?    Question 24    I Have a 63-Year-Old Patient Who Had an Ankle Fracture 20 Years Ago and Is Ready for a Major Procedure Now. Should I Perform an Ankle Arthrodesis or Should I Refer Her to Someone for a Total Ankle Arthroplasty? What Are Your Criteria for a Total Ankle Arthroplasty?   Section IV       Sports    Question 25    An 18-Year-Old Male Soccer Player Has Dislocating Peroneal Tendons. How Would You Treat This?    Question 26    How Would You Treat a 22-Year-Old Professional Ballet Dancer With an Os Trigonum and Fluid Around Her Flexor Hallucis Longus Tendon Sheath Seen on Magnetic Resonance Imaging?  Question 27    How Would You Treat a 32-Year-Old Triathelete With a Nondisplaced Navicular Stress Fracture?    Question 28    My 25-Year-Old Patient in Whom I Have Previously Placed a Jones Screw for a Fifth Metatarsal Stress Fracture Now Has New Pain With a Positive Triple Phase Bone Scan. Now How Do I Treat This Patient?            Question 29    How Do You Treat a 21-Year-Old Basketball Player Who Has Magnetic Resonance Imaging Evidence of Tibial Diaphyseal Edema Not Resolved After 3 Months of Protected Weight Bearing?   Question 30    How Do You Treat \u201cShin Splints\u201d in the High-Level Athlete Who Needs to Continue to Compete?   Question 31    What Is Your Technique for an Achilles Tendon Repair? What Is Your Cut-Off for a Primary Repair and How Do You Treat Them if Greater Than That?      Question 32    How Do You Treat an Athlete With Chronic Lateral Foot Overload and Peroneal Tendonitis With a Cavovarus Foot?          Question 33    How Do You Manage a Significant Turf Toe Injury?  Question 34    How Long Do High Ankle Sprains Really Take to Get Better? How Do You Evaluate Them Appropriately? Question 35    How Do You Treat Chronic Ankle Instability in Your Recreational Athletes?   Section V       Trauma             Question 36     How Do You Treat Proximal Fifth Metatarsal Fractures?         Question 37     How Do You Manage a 22-Year-Old College Lineman With a Minimally  Displaced  or Ligamentous Lisfranc Injury?           Question 38     Which Lateral Talar Process Fractures Should I Fix?   Question 39     Which Calcaneus Fractures Should I Operate On?       Question 40     How Should I Fix My Patient With Multiple Metatarsal Fractures?      Question 41     What Is Your Decision-Making Process for Pilon Fractures?   Question 42     Do I Rod or Plate My Distal Third Tibia Fractures? Should I Fix the Fibula, Too?      Question 43     How Do You Fix Your Syndesmotic Injuries? Can I Use a Tight Rope Now?   Section VI       Miscellaneous   Question 44    How Do You Treat Tarsal Tunnel Syndrome? What Are Your Indications for Surgical Decompression?            Question 45    How Do You Evaluate and Treat Exertional Compartment Syndrome of the Leg?           Question 46    Does Compartment Syndrome of the Foot Really Exist? How Should I Treat It?        Question 47    What Are Some Techniques You Use in Treating Foot and Ankle Injuries in Your Patients With Osteoporosis?  Question 48    What Are Some Techniques Used in Treating Foot and Ankle Injuries in Patients With Diabetes?            Question 49    Do I Need to Use Bone Graft for Foot or Ankle Surgery? Which Graft Should I Use—Autologous or Allograft?          Financial Disclosures  Index