John J Stapleton’s research while affiliated with Penn State Hershey Medical Center and Penn State College of Medicine and other places

The entire world is witnessing a steady increase in the prevalence of diabetes mellitus, with foot complications encompassing a large burden of the disease. The impact of diabetic foot complications is felt not only personally by the patient but also by their families, healthcare systems, and economies worldwide. Although the best treatment strategies often start with prevention, many physicians and surgeons are directly faced with the challenge of diabetic foot complications long after they have already been present in the patient for some time. Prompt identification of patients at high risk for diabetic foot complications and quick referral to the appropriate specialists are keys to successful clinical outcomes. As uncontrolled hyperglycemia takes its toll on the patient’s body, causing compromise to the circulation and often leading to peripheral sensory neuropathy, a cascade of events may be set in motion leading to foot ulcerations, soft tissue infections, osteomyelitis, amputations, and/or Charcot neuroarthropathy (CN). A strong focus on the appropriate medical and surgical treatment of these clinical entities through a multidisciplinary team may help reduce the overall morbidity and mortality rates associated within this population.KeywordsDiabetic foot infectionsPeripheral arterial diseasePeripheral sensory neuropathyCharcot neuroarthropathyAnkle-brachial indexesDiabetes mellitusOsteomyelitis

Triple (talonavicular, subtalar, and calcaneocuboid) joint arthrodesis and most recently double (talonavicular and subtalar) joint arthrodesis have been well proposed in the literature for surgical repair of the elective, posttraumatic, and/or neuropathic hindfoot deformities. The articulation of the hindfoot with the ankle and midfoot is multiaxial, and arthrodesis of these joints can significantly alter the lower extremity biomechanical manifestations by providing anatomic correction and alignment. This article reviews the indications and preoperative planning for some of the most common procedures to address the hindfoot deformity.

Ankle arthrodesis remains one of the most definitive treatment options for end-stage arthritis, paralysis, posttraumatic and postinfectious conditions, failed total ankle arthroplasty, and severe deformities. The general aims of ankle arthrodesis are to decrease pain and instability, correct the accompanying deformity, and create a stable plantigrade foot. Several surgical approaches have been reported for ankle arthrodesis with internal fixation options. External fixation has also evolved for ankle arthrodesis in certain clinical scenarios. This review article provides a comprehensive analysis of midterm to long-term outcomes for ankle arthrodesis using internal and/or external fixation each for elective and diabetic conditions.

The Cobb procedure is useful for addressing stage 2 posterior tibial tendon dysfunction and is often accompanied by a medial displacement calcaneal osteotomy and/or lateral column lengthening. The Cobb procedure can also be combined with selected medial column arthrodesis and realignment osteotomies along with equinus correction when indicated.

With the rising prevalence of diabetes mellitus, the impact of foot complications has been recognized worldwide. The potentially devastating effects of this disease have led to substantial personal, social, medical, and economic costs, therefore fueling the search for effective preventative measures and definitive treatment strategies. The main diabetic foot complications include neuropathic ulcerations, infections, amputations, and Charcot deformities. Understanding the pathways to these clinical manifestations provides a foundation for appropriate medical management and surgical intervention when indicated. Many complications are preventable with proper and frequent diabetic foot screenings, patient education in the overall management of diabetes mellitus and its related multi-organ manifestations, and directing high-risk patients into comprehensive treatment programs. Once a diabetic foot complication has ensued, early and aggressive treatment efforts under a multidisciplinary medical and surgical team approach should be targeted at maintaining the patient's function and preserving their quality of life. © 2014 Springer Science+Business Media New York. All rights are reserved.

Numerous techniques have been described for posttraumatic ankle arthritis with or without an associated lower extremity deformity in the adult population. These surgical procedures may include, but are not limited to, ankle exostectomy with joint resurfacing, ankle arthrodiastasis, ankle arthroplasty, and ankle arthrodesis. Associated deformities may also be addressed with supramalleolar osteotomies, tibia or fibular lengthening, and calcaneal osteotomies. In juvenile patients, surgical treatment options for posttraumatic ankle arthritis can be challenging, especially when an associated deformity is present. This article describes a combined supramalleolar osteotomy and ankle arthrodiastasis for a juvenile patient with posttraumatic ankle arthritis and valgus deformity.

Intra-articular fractures of the tibial plafond are typically the result of rotational or axial loading forces, and both mechanisms of injuries can result in an associated fibula fracture. Rotational distal tibial plafond fractures are typically of lower energy and are associated with less articular injury and chondral impaction, whereas axial load injuries of the distal tibial plafond are associated with a higher incidence of intra-articular and soft tissue injury. The goal of this article is to review the mechanisms of injury, fracture patterns, and potential complications associated with the most common presentations of tibial plafond fractures.

Most intra-articular calcaneal fractures are a result of high-energy trauma. The operative management of calcaneal fractures has been based on achieving anatomic reduction and minimizing complications of the compromised soft tissue envelope. The traditional extensile lateral approach offers advantages of achieving adequate fracture reduction with the risk of wound-healing complications and infection. Limited open reduction and internal fixation techniques with or without using external fixation focuses on achieving fracture reduction with less risk of wound complications but higher risk of malunion. This article discusses key points of operative management for various intra-articular calcaneal fracture patterns and clinical presentations.