Dextrose Prolotherapy Treatment for Unresolved “Morton’s Neuroma” Pain: A Prospective Study (In final editing)
by Ross A. Hauser, MD, Wayne A. Feister, DO, Debra K. Brinker, RN

Abstract: This study investigates the effectiveness of Dextrose Prolotherapy injections on a group of patients with “Morton’s neuroma.” These patients had failed previous conservative therapies, including surgical and non-surgical procedures as well as steroid injections. In this study, seventeen patients with neuroma pain were treated for six months. Every month, 10 to 20 injections containing 0.5 to 1 milliliter of Dextrose solution were given based on patient response. Pre- and post-treatment surveys utilized both objective data (i.e., solutions used, length and number of treatments, etc.) and subjective data (post-treatment visual analog scale or VAS ratings of pain relief/reduction). The results of this short-term study suggest that Prolotherapy, using injections of Dextrose into weakened ligaments, tendons, and joints, is a promising option among current treatment choices. Prolotherapy works by stimulating the body to repair these soft tissues. Future studies must confirm not only the efficacy but also the reduced risks of Dextrose Prolotherapy for one of the most common foot ailments.

WRING THEORY: Old Biomechanics with a New Twist (In review)
by Paul Clint Jones, DPM

Abstract: Through the years, repeated attempts have been made to describe the foot from either the view point as a large functional unit, or as individual joints. The purpose of this article is to combine the two fields of thought, with the introduction of a three dimensional structure that sews together both approaches, seamlessly. Simply stated, the foot is a “Conical Double Helix.” The conical helix is longitudinally oriented with its apex beginning at the medial tubercle of the calcaneus(heel bone). It progressively expands and enlarges into the talus(ankle bone), then into the toes. It internally rotates as it passes out the toes. As a helix is twisted, the helix shortens and tightens, end to end, and side to side. Conversely, as it is untwisted, it elongates and expands in width. This fits the complex motion commonly described as Supination and Pronation. The Conical Double Helix is at the root of how this “feet” of Nature is achieved.

Neurofibroma of the Anterior Leg: A Case Report (In editing)
By Brian Carpenter, DPM, FACFAS, Nathan Stickney, DPM

Abstract: A neurofibroma is a benign nerve sheath tumor usually involved with the peripheral nervous system. Neurofibromas are commonly associated with neurofibromatosis type 1, including being an inclusion criteria, but are not always associated with the disease. Neurofibromas are uncommon in the foot and ankle and account for less than 10% of all soft tissue tumors of the foot and ankle.1 Peripheral nerve tumors are most common in the face, neck, and flexor surfaces. Neurofibromas are characterized by a combination of cells of the nerve sheath including: schwann cells, peri-neurial cells, and fibroblasts.2 We report a rare case of a neurofibroma present in the anterior leg arising secondary to a traumatic event.

Arthrodiastasis in the Treatment of Ankle Arthritis: A Case Series (In editing)
By Edgardo Rodriguez, DPM, Byron Hutchinson, DPM, Craig Clifford, DPM, Kevin McCann, DPM

Abstract: Ankle arthritis that has failed conservative treatment warrants a more aggressive approach. Most treatments for ankle arthritis are primarily joint destructive, with a high probability for long term negative sequellae. The option to attempt surgical treatment with a less invasive procedure is appealing for both the surgeon and the patient. The purpose of this study is to demonstrate the efficacy of ankle arthrodiastasis with the use of external fixation as an alternative treatment for ankle arthritis. Eighty-two patients were evaluated preoperatively and postoperatively for pain, function, and complications with the Maryland foot score. Twenty patients (24%) experienced excellent results, forty-five (55%) good results, twelve patients (12%) had fair results, and five patients (6%) had poor results. Of the five poor results, four patients underwent an ankle replacement and one patient underwent ankle arthrodesis. The authors consider the use of ankle distraction with ankle arthroplasty as a viable alternative to previously accepted treatments for severe ankle arthritis. The hallmark benefit of this procedure is its joint sparing properties. Decreased soft tissue dissection associated with the use of external fixation makes this less invasive treatment available to a wide range of patients. Ankle arthrodiastasis is a viable treatment option for the treatment of advanced ankle arthritis.

Calcaneal Intraosseous Lipoma treated with External Fixation: Case Report and Review of the Literature (received)
by James Losito, DPM, Victor L. Herrera, DPM, Riquel Gonzalez, DPM, Thomas Merrill, DPM

Abstract: Intraosseous lipomas are rare benign bone tumors. This benign neoplasm has been reported to occur in the calcaneus as well as the proximal femur (1); (6); (7). In the past, the relative absence of symptoms and radiographic similarity to a bone cyst has accounted for under diagnosis of Intraosseous Lipoma (IOL) (2); (3). The case presented in this article was diagnosed with the help of Magnetic Resonance Imaging and Histopathologic analysis, after which the patient was treated by means of curettage and packing with bone graft substitute (Trinity). The purpose of this article is to increase awareness among clinicians of the existence of this unusual lesion and the benefits of the use of external fixation on patient with high risk of calcaneal fracture. Also we want to point out the benefit of the application of external fixation for the early weight bearing and early recovery without confronting the risk of calcaneal pathologic fracture.
Although calcaneal intraosseous lipoma accounts for a small portion of cases in the huge differential diagnosis chart for foot pain, it should be kept in mind as a possible diagnosis in unresolved cases. Most of the patients would benefit from non-surgical treatments. But if this is not the case, surgical treatment is indicated. In conclusion, curettage and bone grafting is an easy and effective method for the surgical treatment of calcaneal intraosseous lipomas.
The list of differential diagnoses for heel pain is long and varied, and includes such common culprits as plantar fasciitis, retrocalcaneal bursitis, gout, and stress fracture.

15 Diagnoses, 9 Surgical Procedures, 1 Device – Multiple Applications of the MiniRail (received) 
by Thomas Merrill, DPM, Mario Cala, DPM, Victor Herrera, DPM, Alan E. Sotelo DPM

Abstract: The last decade has seen an increase in the successful application and use of external fixators. More complex procedures involving the ankle and leg require Illizarov circular or ring fixators for stability and strength. Procedures involving the forefoot and rearfoot (excluding the ankle) do very well with the application of MiniRail fixators. The use of Unilateral MiniRail External Fixation System has grown in popularity over the last decade and has seen a high degree of success. From 2009 to 2011 and application of 29 MiniRail External Fixators were placed on 26 patients ranging in age from 23 to 79. A total of 9 different procedures were performed on the population with 15 different diagnoses. Mini-Rail External Fixators have also been found to be successful in the presence of comorbidities such as in patients with diabetes mellitus, smokers, osteomyelitis and avascular necrosis and have been shown to be definitive in cases where internal fixation has failed. All patients went on to full recovery with no complications or recurrences.

Neuropathic Ankle Arthrodesis with Intramedullary Nail Fixation (received)
by Brent Bernstein, DPM FACFAS, Zachary Ritter, DPM, Robert Diamond, DPM FACFAS

Abstract: Tibiotalocalcaneal/Tibiocalcaneal arthrodesis with intramedullary nail fixation is a useful and stable means through which to address complex rearfoot deformities. In this manuscript, we have critically analyzed the modalities and surgical outcomes within existing literature—comparing each to our institutional results—and have found a critical void in information. In tracking and addressing variables such as smoking cessation, glucose control, weight management, vascular stability, extremity ulcerations and postoperative pedorthics we have observed improved operative outcomes and fusion rates. In reviewing literature, we have found boney union rates of 79.6%, non-union rates of 7.6%, fracture rates of 1.4% and amputation rates of 4.7%. Those results were then compared to our rates of 88.88%, 0%, 0% and 0% respectively. Yet, while our institution noted improved results, a meaningful meta-analysis was difficult to achieve considering that most literature failed to make not of the aforementioned variables. Accordingly, we offer that a strict preoperative regimen of glycemic control, vascular patency, weight management and smoking cessation, in conjunction with strict postoperative non-weight bearing and aggressive wound management will improve overall results. Furthermore, it is our suggestion that future research address these topics.