Surgical Pictures – Podiatry, Orthopedics, & Physical Therapy

Ankle Fusion

Below is a picture of post-surgical ankle fusion using a cross screw technique. This type of procedure is typically necessary to relieve pain and disability from severe arthritis in the ankle as result of significant trauma or repetitive trauma. The goal of this procedure is to eliminate pain and continues to be the gold standard for severe joint arthritis.

Hallux Limitus

Abnormal anatomical position in addition to increased activity throughout a period of time or in some cases an injury will lead to the irregular shaping of the bones around the big toe joint from abnormal wear and tear. This will cause arthritis type pain with stiffness and swelling.

With abnormal wearing of the joint, spurring of the top of the joint occurs from jamming causing decreased motion of the big toe in an upwards direction.

Post-operative x-ray of a joint that was repaired with a Hemi (partial) joint replacement to alleviate limiting arthritis which also involves reshaping of the bones to eliminate spurring.

Open Fasciotomy for Acute Compartment Syndrome

Pictured below is an opening of the facial muscle compartments of the left leg. This procedure is performed to release pressure that has built up in the muscle from activity in which the pressure does not go down after a certain amount of time. This increased, sustained pressure within the compartments is very painful and puts at risk loss of blood supply to the muscles, and in severe cases can cause the death of the muscle tissue.

Below is a picture of retention sutures placed over the fasciitomy site in order to allow the muscle compartment to decompress but also does not allow the skin to retract and make the closure of the large incision difficult to perform at a later date.

This is the primary closure of the incision site once the compartment has been adequately decompressed, 

Juvenile Medial Malleolar Fracture in which the fracture runs from the ankle joint through the growth plate (pictured left) which is the jagged line running from side to side above the ankle joint. This growth plate will remain open until skeletal maturity to allow growth. The fracture running through the growth plate can jeopardize the growth and must be fixed to assure best results. Pictured on the right is the fracture after surgical repair with a screw that helps to compress the fracture without crossing the growth plate, but also aligning the growth plate as to not disrupt the growth of the bone. If possible crossing the growth plate with surgical hardware should be avoided in order to not affect the growth of the bone.

Medial Malleolar Fracture demonstrating displacement of the fracture fragment that could lead to abnormal healing and altering the mechanical function of the ankle joint necessitating the need for surgical repair. PostPPost 

Post-surgical repair of fracture with the realignment of fracture fragment held with two surgical screws to allow the appropriate position of the fragment and compression which is most ideal for the healing of the fracture. This also will allow a return to function of the ankle joint which will decrease the potential degenerative problems that can occur after this type of injury.

Salter-Harris IV Fracture (illustration), which is a classification for fracture in children involving the growth plate, of distal Tibia depicted on the left side with the fracture that extends above the growth plate and also disrupts the growth plate which can also stop the grown of the bone. It is important to repair this surgically to ensure that the bone heals and has the best change for the unaltered growth of the bone.in the juvenile patient. The picture on the right is after surgical repair demonstrating good approximation of the fracture fragment and re-establishment of the growth plate.

Jones Fracture Status Post Percutaneous Screw Fixation

Jones fractures are specific in that they occur at the base of the 5th metatarsal occurring away from the articular surface, and are a common injury in certain sports such as basketball. These fractures are precarious in their character in that the area of the bone in question where the fracture takes place which has less blood supply than the remainder of the bone, therefore compromising healing potential of this area.

This is a side view (lateral) of the foot after surgical repair of the Jones Fracture which is important to stabilize this fracture not only for adequate healing but also because of soft tissue structures such as ligament and tendon that attach to the base of the 5th metatarsal.

Chondrolysis of 2nd MPJ arthritis before and after microfracture

There is damage to the articular surface cartilage which can occur either from an acute injury or more commonly after repetitive injury and/or wears and tear. If the bones at the joint in questions are not aligned properly then this mechanically adds to the wear the joint receives with activity and increases the propensity of this occurring. Pictured below is linear damage to the articular surface of the 2nd metatarsal head.

The following pictures are debridement of damaged cartilage that is abnormal in appearance and/or loose. This is removed completely to expose the subchondral (underneath cartilage) bone plate.

Drills holes are then placed through the bone plate to allow bleeding in the area which will aid in the healing of the cartilage surface with fibrocartilage which is a kind of scarring of cartilage.

Bunion & Hammertoes

The following is depicting a bunion deformity of the great toe that has worsened a hammertoe contraction of the second toe. The outside deviation of the great to cause underriding of the second to which leads to increased dorsal (upward) dislocation of the toe.

Post-operative repair of the bunion and hammertoe deformities which straightens the great to utilizing a combination of bone cuts and soft tissue releases of the great toe and second toe to correct abnormal position of the toes and significantly improve pain with activities and use of shoes.

Below is a photograph a severe overlapping bunion and hammertoe deformity. At this point in the mechanical process, the digits especially the second digit is dislocated from its articulation with the long bone in the foot called the metatarsal. The severity of these deformities is multi-factorial involving genetics, altered mechanics with soft tissue contractures, and bad shoegear.

Below is a photograph of the top view of the same deformities that is pictured above.

Pictured below is the same foot after surgical correction of the bunion deformity of the great toe and hammertoe correction of the second, third and fifth toes. The plastic balls at the top of the second and third toe are covering wires that hold the position of the second and third toes into the long bones (metatarsals) of the foot so that the soft tissue contractures heal in the correct place. Depending on the deformity, the wires will stay in place for a period of 4-6 weeks and then are removed.

Compartment Syndrome

The following is the fascial covering over a muscle compartment. The condition occurs when the pressure within this compartment builds up after an injury or can also occur after exercise from the inability of the muscle to decompress naturally. This leads to pain that is unrelenting and could lead to decrease blood flow and oxygen to muscle tissue causing the death of that tissue.

The picture below demonstrates the fascia overlying the tissue being lifted by the forces at the top of the picture.

Below is demonstrates incision into the compartment exposing the muscle tissue that is a deeper red color where the retractor is to the left of the picture. The opening of this facial tissue is vital in releasing pressure in the compartment after injury or from exercise. It also important that this release is extensive as so the fascial tissue does not heal closed allowing build of pressure again.

Achilles Tendon Rupture

Most Achilles tendon tears occur from chronic degeneration of the tendon in conjunction with the improper conditioning of the tendon to perform certain activities such as jumping and sudden changes in direction. This is why this type of injury occurs in what is considered the “Weekend Warrior”. This person usually does not train and condition the tendon to handle intense physical activity then goes and plays a sport over the weekend and the tendon gives out. In the picture below one can see the frayed ends of the torn Achilles tendon.

The image below is the tendon after repair with a complex suture technique called the Krakow stitch. This is a very strong repair and prognosis after repair with physical therapy is very good.

 Picture of a large benign bone tumor at the front of the ankle

Benign Tumor after removal of the tumor

Pes Cavus (High arch foot)

Preoperative films of a Cavus foot with a high arch, which you can see the high pitch of the heel bone (calcaneus) relative to the ground (left). Post-surgical reconstruction of the cavus foot with a calcaneal sliding osteotomy fixated with two screws and a bone cut of the base of the first metatarsal to decrease the apex of the deformity near the joint fixated with a surgical staple (right).

This is Pre and Post-op xrays of surgical correction of a syndesmotic rupture that failed the first time by a different physician due to screw break. On the Postoperative films by our physicians, the space between the medial malleolus and talus is decreased and the joint is congruent and symmetrical. We bore a hole in the bone at the prior screw sites, added two syndesmotic screws that went across both bones for added stability as well as 2 Arthrex tightropes.

The following are pictures of a healed talar neck fracture status post ORIF. Due to the severity of the injury, the patient suffered from subtalar arthritis and pain. The patient’s heal also began to tilt in due to the injury. We performed a calcaneal osteotomy with subtalar fusion to correct the patient’s foot.

Pre-op

Post-op

These are pictures of a Pilon fracture that was performed by a different surgeon. The anterior tibial plate was placed too distal and invaded the patient’s joint. These injuries often cause post-traumatic arthritis regardless of the fixation. The plate was removed and the patient had some relief. Approximately 1 year later, the patient underwent a successful arthroscopic fusion.

S/P Pilon with an anterior plate too distal

After removal of the plate prior to arthroscopic fusion

After arthroscopic fusion

Intraoperative picture of an avulsion of the Achilles of the calcaneus

Below the Achilles is pulled through a trough in the heel bone to re-anchor it down)

Pic below of an avulsion of the Achilles off the heel bone prior to repair and re-anchor through the heel

Intraop pictures during hemi-implant for hallux limitus

Osteochondral Autograft Transfer System (O.A.T.S.)

Ankle fusion with fibular only graft after a severe post-traumatic arthritis post-Pilon fracture

Achilles rupture intraoperatively before and after repair

Intraoperative pics of a bunion correction with a bone cyst in the first metatarsal. The cyst is current and autogenous bone graft from the bunionectomy is morselized and packed into the bone cyst.

Surgical resection of the coalition allows removal of restriction of range of motion in the affected joint and elimination of pain associated with the attempted motion. Pictured is the coalition at the point of the metal instrument. Pictured right is the newly created space where that coalition once was located. The last picture is using the FDB muscle belly as an interpositional graft to occupy the dead space and decrease the chance of recurrence.

These are operative pictures of a child who had an enlarged fifth toe with a full extra set of bones that were removed to make the toe look more anatomic.

These are intraoperative pictures of removal of a painful spur in the back of the heel bone that failed conservative treatment. 

This is an intraoperative pic of a heel spur in the back of the heel prior to resection. It is next to the instrument on the bottom right. The spur causes pain as it irritates the Achilles tendon

This is the bone cut performed to remove the spur and bone that causes pain.

This is a picture of the bone that is removed. Underneath the bone is the void left after removal.

This is a picture of the size of the bone removed. The top portion should have glistening white cartilage. It is yellowish and devoid of cartilage due to constant irritation from the Achilles. The spur is at the bottom portion 30% of the bone.

This is a picture of the suture placement in the Achilles tendon to reattach the tendon to bone. There are anchors in the bone that have the suture already attached. The anchors are driven into the bone to allow the Achilles tendon to reattach to the heel. These sutures are then tightened down for an intimate bone to tendon apposition.

Intraoperative pics of anterior and lateral compartment release for Chronic Exertional Compartment Syndrome

Intraop Arthroscopic Pics of talar OCD Surgery

Series of Pics Biopsy for Subungal Melanoma

Bones, Tendons, Ligaments, and More

© 2014 WebMD, LLC. All rights reserved.

The feet are flexible structures of bones, joints, muscles, and soft tissues that let us stand upright and perform activities like walking, running, and jumping. The feet are divided into three sections:

• The forefoot contains the five toes (phalanges) and the five longer bones (metatarsals).
• The midfoot is a pyramid-like collection of bones that form the arches of the feet. These include the three cuneiform bones, the cuboid bone, and the navicular bone.
• The hindfoot forms the heel and ankle. The talus bone supports the leg bones (tibia and fibula), forming the ankle. The calcaneus (heel bone) is the largest bone in the foot.

Muscles, tendons, and ligaments run along the surfaces of the feet, allowing the complex movements needed for motion and balance. The Achilles tendon connects the heel to the calf muscle and is essential for running, jumping, and standing on the toes.

Feet Conditions

• Plantar fasciitis: Inflammation in the plantar fascia ligament along the bottom of the foot. Pain in the heel and arch, worst in the morning, are symptoms.
• Osteoarthritis of the feet: Age and wear and tear cause the cartilage in the feet to wear out. Pain, swelling, and deformity in the feet are symptoms of osteoarthritis.
• Gout: An inflammatory condition in which crystals periodically deposit in joints, causing severe pain and swelling. The big toe is often affected by gout.
• Athlete’s foot: A fungal infection of the feet, causing dry, flaking, red, and irritated skin. Daily washing and keeping the feet dry can prevent athlete’s foot.
• Rheumatoid arthritis: An autoimmune form of arthritis that causes inflammation and joint damage. Joints in the feet, ankle, and toes may be affected by rheumatoid arthritis.
• Bunions (hallux valgus): A bony prominence next to the base of the big toe that may cause the big toe to turn inward. Bunions may occur in anyone, but are often caused by heredity or ill-fitting footwear. 
• Achilles tendon injury: Pain in the back of the heel may suggest a problem with the Achilles tendon. The injury can be sudden or a nagging daily pain (tendinitis). 
• Diabetic foot infection: People with diabetes are vulnerable to infections of the feet, which can be more severe than they appear. People with diabetes should examine their feet daily for any injury or signs of developing infection such as redness, warmth, swelling, and pain.
• Swollen feet (edema): A small amount of swelling in the feet can be normal after prolonged standing and common in people with varicose veins. Feet edema can also be a sign of heart, kidney, or liver problems.
• Calluses: A buildup of tough skin over an area of frequent friction or pressure on the feet. Calluses usually develop on the balls of the feet or the heels and may be uncomfortable or painful.
• Corns: Like calluses, corns consist of excessive tough skin buildup at areas of excessive pressure on the feet. Corns typically have a cone shape with a point, and can be painful.
• Heel spurs: An abnormal growth of bone in the heel, which may cause severe pain during walking or standing. People with plantar fasciitis, flat feet, or high arches are more likely to develop heel spurs.
• Ingrown toenails: One or both sides of a toenail may grow into the skin. Ingrown toenails may be painful or lead to infections. 
• Fallen arches (flat feet): The arches of the feet flatten during standing or walking, potentially causing other feet problems. Flat feet can be corrected with shoe inserts (orthotics), if necessary.
• Nail fungal infection (onychomycosis): Fungus creates discoloration or a crumbling texture in the fingernails or toenails. Nail infections can be difficult to treat.
• Mallet toes: The joint in the middle of a toe may become unable to straighten, causing the toe to point down. Irritation and other feet problems may develop without special footwear to accommodate the mallet toe.
• Metatarsalgia: Pain and inflammation in the ball of the foot. Strenuous activity or ill-fitting shoes are the usual causes.
• Claw toes: Abnormal contraction of the toe joints, causing a claw-like appearance. Claw toe can be painful and usually requires a change in footwear.
• Fracture: The metatarsal bones are the most frequently broken bones in the feet, either from injury or repetitive use. Pain, swelling, redness, and bruising may be signs of a fracture.
• Plantar wart:  A viral infection in the sole of the foot that can form a callus with a central dark spot.  Plantar warts can be painful and difficult to treat.
• Morton’s neuroma: A growth consisting of nerve tissue often between the third and fourth toes. A neuroma may cause pain, numbness, and burning and often improves with a change in footwear.

Richa Chadha shares pic of her broken foot, thanks boyfriend Ali Fazal for caring for her ‘in sickness and in health’ | Bollywood

Actor Richa Chadha has written a thank you note for Ali Fazal, as she recuperates from a fracture on her foot, and he takes care of her. Taking to Instagram, she also shared a glimpse of the food that he served her.

She can be seen lying down on a couch, with her fractured foot well placed. She is dressed casually in a white t-shirt and black pants. Richa posted the picture and wrote, “In sickness and in health is basically a pinkie promise @alifazal9…Thank you my best for taking care of me through this stupid fracture. That’s avocado and tomatoes on gluten free toast, served right on the couch.”

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Richa had earlier posted a picture of her X-Ray and her injured foot to inform fans that she hurt herself. She captioned it as, “Fortitude.”

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Earlier this year, Richa had shared long notes on how she found an equal partner in Ali. Sharing a quote by Audrey Kitching about a relationship with no gender roles, the actor wrote on her Instagram Stories, “Yes, Grateful for the extremely well-raised, progressive and equal partner I have found in @alifazal9. Great cook, workout buddy, reader, artist and homie. (Bass now, don’t let it get to your head).”

A screengrab of her post

Richa and Ali have been in a relationship for a few years and were all set to tie the knot in April 2020. The wedding had to be postponed in wake of the coronavirus-induced lockdown. The two have now moved in together in a sea-facing apartment in Mumbai and are yet to confirm a new wedding date.

Talking about living with Ali as a housemate, Richa had told Mumbai Mirror in an interview, “He is fun, and unlike most boys, likes to help around. He chose the curtains without fuss; luckily, our aesthetics match for the most part. It’s good to finally be able to take decisions together, right from what soap to buy to which maid to hire. Ali is a better cook, specially when it comes to continental cuisine. When we went grocery shopping, his bag was bigger than mine. I enjoy organic farming and here we have a space to grow a kitchen garden of our own, which he is helping me with.”

Also read: Anita Hassanandani celebrates 40th birthday with husband, watch

Ali and Richa will now be seen together on screen in Fukrey 3. They have worked in both the earlier films of the franchise. However, they were not cast opposite each other in those.

Ashley Judd Shares Photos, Video After Breaking Leg In 4 Places

• Ashley Judd broke her leg in four places while traveling in the Democratic Republic of Congo in February.
• She has posted new photos and videos revealing her recovery progress and rehabilitation following lengthy surgeries.
• Six months later, Ashley shared good news that she’s up and hiking again.

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Ashley Judd is walking again after breaking her leg in four places while hiking in the Democratic Republic of Congo.

A new video on Instagram shows just how far Ashley has come. In the clip, the actress is hiking across a field in Switzerland. She added a full update on her incredible progress in the post’s caption.

“Dear Friends, It is with reverence and quiet awe I offer this update. Today, five months and three weeks after the accident in the Congolese rainforest, I walked again, and in what fashion!” Ashley wrote.

“I hiked in the #SwissNationalPark. Stepping in, I felt in my ease, my natural garment of self, at home in my spirit. My leg and foot, worked beautifully. I walked up hill on uneven surfaces for an hour confidently and came down carefully and easily,” she continued.

“The next day, I walked again on a high Alp in #Ticino, working hard and feeling how much I stamina I have to rebuild. This is the road ahead. But I am up to the daily tasks, as I am even carrying firewood into our Alpine hut!” Ashley added.

“My leg will never be the same. She is a new leg. And I love her. We are buddies. We have a come a long way and we have a fabulous life ahead.”

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If you’re wondering what happened to Ashley Judd, she has been sharing updates and new details on her recovery throughout 2021.

Ashley shocked fans in February when she shared that she almost died after breaking her leg.



“Without my Congolese brothers and sisters, my internal bleeding would have likely killed me, and I would have lost my leg,” Ashley wrote in a post, alongside several photos of her ordeal. “I wake up weeping in gratitude, deeply moved by each person who contributed something life giving and spirit salving during my grueling 55 hour odyssey,” she continued.

Ashley then recounted how a number of people helped her after she broke her leg. A man named Dieumerci “stretched out his leg and put it under my grossly misshapen left leg to try to keep it still,” she wrote. He “remained seated, without fidgeting or flinching, for five hours on the rain forest floor. He was with me in my primal pain,” Ashley said.

A man she called Papa Jean found her “wretched and wild on the ground” and looked at her leg. “He told me what he had to do. I bit a stick. I held onto Maud. And Papa Jean, with certainty began to manipulate and adjust my broken bones back into something like a position I could be transported in, while I screamed and writhed,” Ashley said. ”How he did that so methodically while I was like an animal is beyond me. He saved me and he had to do this twice!”

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Six men Ashley called “heroes” then moved her into a hammock “with as little jostling as possible” and walked for three hours over “rough terrain” to carry her to safety.

Two men, Didier and Maradona, helped drive Ashley by motorcycle to get medical care. “Didier drove the motorbike. I sat facing backwards, his back my backrest. When I would begin to slump, to pass out, he would call to me to re-set my position to lean on him,” she wrote. “Maradona rode on the very back of the motorbike, I faced him. He held my broken leg under the heel and I held the shattered top part together with my two hands.”

That journey lasted for six hours on what Ashley called an “irregular, rutted and pocked” dirt road.

“Maradona was the only person to come forward to volunteer for this task,” Ashley wrote, before writing that the two have a “nice friendship.” Ashley also shared photos of women helping her, calling them, “my sisters who held me.”

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Ashley said in a previous Instagram post that she “struck something in the dark and fell,” leading to her broken leg.

Ashley also wrote on her Instagram Stories that fewer than 50 percent of “health zones” in the Democratic Republic of Congo are active and operable, urging people to donate.

Ashley has been keeping fans updated with intense details about her shattered leg and treatment.

Ashley said she and her father flew 22 hours over four flights back to America “thanks to unbelievably efficient disaster travel insurance on an Air Ambulance.”

Once she was at an American hospital, Ashley said she had to wait for the tissue damage and swelling to go down. “Eventually I was qualified to have the eight-hour surgery to repair the bones, decompress the hemorrhaging nerve and pick the shards of bones out of the nerve,” she wrote.

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Ashley shared another update on her health and ongoing rehabilitation from her serious injury on Instagram back in April. She was “getting back up” and mentioned that she had some big goals motivating her. “But look out, Patagonia, because when that nerve heals, you’ll be seeing me. My Partner gave me that book for my recent birthday. I believe. Just as that little endangered bonobo knows that she’ll be seeing me back in the Congolese rain forest soon.”

Slowly but surely, her physical therapy was working. “The knee is coming along, the four fractures healing,” she wrote. That progress is thanks to her hard work, she added: “With the kind of injury I (& many others) have, we speak of degrees. In the video, 109 degrees was an outrageous dream, & trying to reach it was agony. I did 60 of those heel slides a day. I sobbed through them. I made it because of the loving exhortation and validation of my many friends. Yesterday, I effortlessly reached the benchmark of 130 degrees.”

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Ashley didn’t expect to be able to hike so soon, either. “The peroneal nerve injury will take at least a year,” she wrote. “I concentrate hard at moving my very still foot (and appreciate my sister’s medical-grade massages which remind my brain that I do have a right foot). Come June, I will walk with a brace and a cane.”

Ashley has expressed her gratitude for everyone who helped her.

She shared her “deepest and most vulnerable thanks” to staff at Sunninghill Hospital in Johannesburg, South Africa, “for making split second decisions upon my arrival. ”

“I arrived to them from DRC in terrible shape and my leg had no pulse,” she wrote. “I desperately needed a blood transfusion.”

Ashley said the hospitals nurses—who she referred to as “sisters”—are “exemplary, technically top notch, and they cared for the trauma in my body as well as my soul with equal proficiency.”

Her doctor, Dr. Greef, was “super at stabilizing my leg with the external fixator until the massive soft tissue damage and swelling went down so that I could have the Big Operation,” she wrote, adding, “What he did was significant and I am forever in his debt.” Ashley also pointed out that she received top notch care while the country battles the COVID-19 variant B.1.351.

She then thanked her “beloved Dad, who had gotten the text no parent ever wants: ‘emergency, can’t answer questions, please come now,’ had indeed, because he is vaccinated, been able to come to South Africa.” Ashley said her dad “has been my rock, companion, resource, helped me listen to so many doctors, critical support system, and kind, loving presence as I have wept and wept. ”

Korin Miller
Korin Miller is a freelance writer specializing in general wellness, sexual health and relationships, and lifestyle trends, with work appearing in Men’s Health, Women’s Health, Self, Glamour, and more.

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The Charcot Foot in Diabetes

Abstract

The diabetic Charcot foot syndrome is a serious and potentially limb-threatening lower-extremity complication of diabetes. First described in 1883, this enigmatic condition continues to challenge even the most experienced practitioners. Now considered an inflammatory syndrome, the diabetic Charcot foot is characterized by varying degrees of bone and joint disorganization secondary to underlying neuropathy, trauma, and perturbations of bone metabolism. An international task force of experts was convened by the American Diabetes Association and the American Podiatric Medical Association in January 2011 to summarize available evidence on the pathophysiology, natural history, presentations, and treatment recommendations for this entity.

The Charcot foot in diabetes poses many clinical challenges in its diagnosis and management. Despite the time that has passed since the first publication on pedal osteoarthropathy in 1883, we have much to learn about the pathophysiology, and little evidence exists on treatments of this disorder. The international task force was convened in January 2011 at the Salpêtrière Hospital in Paris, France, to review the literature and report on the definition, pathogenesis, diagnosis, and treatment of the diabetic Charcot foot. Recommendations in this report are solely the opinions of the authors and do not represent the official positions of the American Diabetes Association or the American Podiatric Medical Association.

DEFINITION

Charcot neuropathic osteoarthropathy (CN), commonly referred to as the Charcot foot, is a condition affecting the bones, joints, and soft tissues of the foot and ankle, characterized by inflammation in the earliest phase. The Charcot foot has been documented to occur as a consequence of various peripheral neuropathies; however, diabetic neuropathy has become the most common etiology. The interaction of several component factors (diabetes, sensory-motor neuropathy, autonomic neuropathy, trauma, and metabolic abnormalities of bone) results in an acute localized inflammatory condition that may lead to varying degrees and patterns of bone destruction, subluxation, dislocation, and deformity. The hallmark deformity associated with this condition is midfoot collapse, described as a “rocker-bottom” foot (Fig. 1), although the condition appears in other joints and with other presentations. Pain or discomfort may be a feature of this disorder at the active (acute) stage, but the level of pain may be significantly diminished when compared with individuals with normal sensation and equivalent degrees of injury.

Figure 1

The typical appearance of a later-stage Charcot foot with a rocker-bottom deformity.

The set of signs and symptoms that occur together with CN qualifies this condition as a syndrome, the “Charcot foot syndrome.”

Definition and classification recommendations

• Nomenclature should be standardized to CN or the Charcot foot.

• Existing classifications do not provide prognostic value or direct treatment. Active or inactive should be used to describe an inflamed or stable CN, respectively. Acute and chronic can also be used in this regard, but there is no accepted measure that defines the transition point.

PATHOGENESIS

There is no singular cause for the development of the Charcot foot, but there are factors that predispose to its development, as well as a number of likely precipitating events. The current belief is that once the disease is triggered in a susceptible individual, it is mediated through a process of uncontrolled inflammation in the foot. This inflammation leads to osteolysis and is indirectly responsible for the progressive fracture and dislocation that characterizes its presentation (1). The evidence to support this hypothesis is largely circumstantial. A neurally mediated vascular reflex leading to increased peripheral blood flow and active bone resorption has been proposed as an etiological factor in the development of bone and joint destruction in neuropathic patients. However, the relationship between increased blood flow to bone and active bone resorption has not been conclusively defined.

Uncontrolled inflammation

When a bone is fractured, the release of proinflammatory cytokines including tumor necrosis factor-α and interleukin-1β leads to increased expression of the polypeptide receptor activator of nuclear factor-κB ligand (RANKL) from any of a number of local cell types. RANKL triggers the synthesis of the nuclear transcription factor nuclear factor-κβ (NF-κβ), and this in turn stimulates the maturation of osteoclasts from osteoclast precursor cells. At the same time, NF-κβ stimulates the production of the glycopeptide osteoprotegerin (OPG) from osteoblasts. This “decoy receptor” acts as an effective antagonist of RANKL (2). The fracture will also be associated with pain, and this leads to splinting of the bone, and the rise in proinflammatory cytokines is usually relatively short-lived. In the person who develops an acute Charcot foot, however, the loss of pain sensation allows for uninterrupted ambulation, with repetitive trauma. It has been suggested that this results in continual production of proinflammatory cytokines, RANKL, NF-κβ, and osteoclasts, which in turn leads to continuing local osteolysis (1). This has subsequently been shown by an increase in proinflammatory phenotypes of monocytes in those with active Charcot foot when compared with diabetic control subjects (3).

Osteoclasts generated in vitro in the presence of macrophage colony-stimulating factor and RANKL from patients with active CN have been shown to be more aggressive and exhibit an increase in their resorptive activity compared with control subjects. However, these changes are only partially inhibited by OPG, indicating that other cytokines may also be important (4).

Predisposition

Neuropathy is a universal feature of the affected limb. Although it has been suggested that people with a Charcot foot may have particular patterns of sensory loss reflecting involvement of different fibers (5,6), this is not generally accepted. Nevertheless, three groups have shown that people who have had an acute Charcot foot exhibit retention of vasodilatory reflexes in contrast to diabetic individuals with distal symmetrical neuropathy without CN (7–9).

Despite these observations, it should be noted that the syndrome might also occur in patients with a spectrum of unrelated diseases complicated by nerve damage. These include distal neuropathies caused by toxins (ethanol, drug related) and infection (leprosy), as well as diseases of the spinal cord and nerve roots (tabes dorsalis, trauma, syringomyelia) and a number of other conditions (Parkinson’s disease, HIV, sarcoidosis, rheumatoid disease, and psoriasis). Although the neuroarthropathy is typically more proximal in those with disease of the spinal cord, the presentation may be otherwise indistinguishable.

Loss of protective sensation will increase the likelihood of trauma to the foot, while motor neuropathy could result in altered structure of the foot (with exaggeration of the plantar arch and clawing) and changed gait with resultant abnormal loading.

Finally, it is possible that peptides normally secreted from nerve terminals are also important in the underlying pathophysiology. Of these, calcitonin gene–related peptide (CGRP) is a likely candidate because it is known to antagonize the synthesis of RANKL. Hence, any reduction of CGRP through nerve damage will result in an increase in RANKL expression. It is of particular interest that CGRP has been reported to be necessary for the maintenance of the normal integrity of joint capsules, and it follows that any reduction in CGRP release by nerve terminals could facilitate joint dislocation (10).

Because it is not possible to identify those most likely to develop the Charcot syndrome, it is impossible to determine with any degree of confidence whether preexisting osteopenia is a significant predisposing factor. One group has, however, reported an apparent reduction in bone mineral density (BMD) of the femoral neck in the contralateral (unaffected) limb at the time of presentation. The researchers also reported an association between BMD and the relative prevalence of fracture and of dislocation in the affected foot (11).

Diabetes may be associated with osteopenia, but the available evidence suggests that reduction of BMD is a feature of type 1 diabetes more so than type 2 diabetes (12). Any reduction of BMD in type 1 diabetes may relate to loss of islet peptides such as insulin and amylin (IAPP), both of which act as growth factors for bone. Despite this, the fracture risk in type 2 diabetes may be no less than in type 1 diabetes (12), and this would explain the fact that the presentation does not appear to differ between the two types of the disease. Any associated deficiency of vitamin D—with or without renal failure and secondary hyperparathyroidism—would increase the possibility of reduced BMD in diabetes. The use of thiazolidinediones could theoretically increase the likelihood of an acute Charcot foot through an effect on bone density, but this has not yet been reported. The use of corticosteroids as immunosuppressants in people with diabetes who have had a renal and/or pancreatic transplant (13) may explain the apparent high incidence of the Charcot foot in this group.

Although the Charcot syndrome may occur in a variety of conditions, diabetes is ostensibly the most common worldwide. Diabetes may predispose to its occurrence through a number of mechanisms. Apart from the presence of neuropathy and possible osteopenia, these include the effects of advanced glycation end products, reactive oxygen species, and oxidized lipids, which may all enhance the expression of RANKL in diabetes (10). The effect of local inflammation on this pathway would similarly compound the expression of RANKL. Furthermore, a single study has reported an apparent association between two OPG-related polymorphisms in people with a history of an acute Charcot foot in diabetes (14).

Many patients recall that the onset of the condition was precipitated by trauma that is often minor in nature (15). Other cases may be triggered by different causes of local inflammation, including previous ulceration, infection, or recent foot surgery. In this respect the occurrence of an acute Charcot foot as a complication of osteomyelitis is increasingly recognized in people with diabetes. Very occasionally, the onset of an acute Charcot foot may follow successful revascularization.

DIAGNOSIS

The initial manifestations of the Charcot foot are frequently mild in nature, but can become much more pronounced with unperceived repetitive trauma. Diagnostic clinical findings include components of neurological, vascular, musculoskeletal, and radiographic abnormalities. There have been no reported cases of CN developing in the absence of neuropathy. Accordingly, peripheral sensory neuropathy associated with reduced sensation of pain is the essential predisposing condition that permits the development of the arthropathy (16–19). Because of the very presence of insensitivity, a personal history concerning antecedent trauma is often unreliable (18,20,21). Typical clinical findings include a markedly swollen, warm, and often erythematous foot with only mild to modest pain or discomfort (16,18–20,22). Acute local inflammation is often the earliest sign of underlying bone and joint injury (23). This initial clinical picture resembles cellulitis, deep vein thrombosis, or acute gout and can be misdiagnosed as such. There is most often a temperature differential between the two feet of several degrees (20,24). The affected population typically has well preserved or even exaggerated arterial blood flow in the foot. Pedal pulses are characteristically bounding unless obscured by concurrent edema. Patients with chronic deformities, however, can develop subsequent limb-threatening ischemia. Musculoskeletal deformity can be very slight or grossly evident most often due to the chronicity of the problem and the anatomical site of involvement (16,17,19,25). The classic rocker-bottom foot, with or without plantar ulceration, represents a severe chronic deformity typical for this condition (16,26,27). Radiographic and other imaging modalities can detect subtle changes consistent with active CN.

Imaging of the Charcot foot

Radiographs are the primary initial imaging method for evaluation of the foot in diabetic patients. Easily available and inexpensive, they provide information on bone structure, alignment, and mineralization. X-rays may be normal or show subtle fractures and dislocations or later show more overt fractures and subluxations. In later stages, the calcaneal inclination angle is reduced and the talo-first metatarsal angle is broken (Fig. 2). Medial calcification of the arteries is present in most Charcot feet and is a frequent secondary finding on radiographs (25). However, radiographic changes of CN are typically delayed and have low sensitivity (28).

Figure 2

Lateral X-ray of a Charcot foot deformity showing a dislocation of the tarsometatarsal joint with break in the talo-first metatarsal line (dashed lines) and a reduced calcaneal inclination angle (solid lines).

Magnetic resonance imaging (MRI) allows detection of subtle changes in the early stages of active CN when X-rays could still be normal. MRI primarily images protons in fat and water and can depict anatomy and pathology in both soft tissue and bone in great detail. Because of its unique capability of differentiating tissues with high detail, MRI has a high sensitivity and specificity for osteomyelitis and has become the test of choice for evaluation of the complicated foot in diabetic patients (29). Although not required for diagnosis when X-rays are diagnostic for Charcot bone and joint changes, MRI is very useful in making the diagnosis at its earliest onset before such changes become evident on plain films.

Nuclear medicine includes a number of exams based on the use of radioisotopic tracers. Three-phase bone scans, based on technetium-99m (^99mTc), are highly sensitive for active bone pathology. However, diminished circulation can result in false-negative exams and, perhaps more importantly, uptake is not specific for osteoarthropathy. Labeled white blood cell scanning (using ¹¹¹In or ^99mTc) provides improved specificity for infection in the setting of neuropathic bone changes (30), but it can be difficult to differentiate soft tissue from bone. Therefore, this exam can be combined with a three-phase bone scan or sulfur colloid marrow exam when superimposed osteomyelitis is suspected (31). More recently, positron emission tomography scanning has been recognized as having potential for diagnosis of infection and differentiating the Charcot foot from osteomyelitis (32,33). However, this remains investigational at this time.

Evaluation of bone density may be useful in those with diabetes to assess onset of CN as well as fracture risk. BMD can be assessed using dual-energy X-ray absorptiometry or calcaneal ultrasound. BMD has been related to the pathological pattern of CN, whereby joint dislocation is more prevalent in those with normal mineralization versus fracture in those with diminished BMD (11).

Experts agree that radiographs are important as the first exam in virtually all settings (33,34). However, a negative result obviously should not offer any confidence regarding lack of disease. In a patient with low clinical suspicion of osteomyelitis and no sign of CN on radiographs, either three-phase bone scan or noncontrast MRI is very effective at excluding osseous disease. If the patient has an ulceration with a high likelihood of deep infection, MRI is the best diagnostic modality. Nonetheless, one test may not be adequate for full evaluation. In this setting where MRI diagnosis is indeterminate, a subsequent labeled white blood cell scan can provide more specificity and should be correlated with clinical findings. The decision of nuclear imaging versus MRI is largely based on personal preference, availability, and local experience. In general, if metal is present in the foot, nuclear medicine exams are preferred, whereas diffuse or regional ischemia makes MRI the preferred exam.

Diagnostic recommendations for active CN

• The diagnosis of active Charcot foot is primarily based on history and clinical findings but should be confirmed by imaging.

• Inflammation plays a key role in the pathophysiology of the Charcot foot and is the earliest clinical finding.

• The occurrence of acute foot/ankle fractures or dislocations in neuropathic individuals is considered active CN because of the inflammatory process of bone healing, even in the absence of deformity.

• X-rays should be the initial imaging performed, and one should look for subtle fractures or subluxations if no obvious pathology is visible.

• MRI or nuclear imaging can confirm clinical suspicions in the presence of normal-appearing radiographs.

MEDICAL TREATMENT

The medical treatment of CN is aimed at offloading the foot, treating bone disease, and preventing further foot fractures (34). Because of the various etiologies of increased local bone resorption and/or secondary osteoporosis in patients with CN and limited randomized placebo-controlled trials in this area, treatment guidelines are largely based on professional opinion rather than the highest level of clinical evidence.

Offloading

Offloading at the acute active stage of the Charcot foot is the most important management strategy and could arrest the progression to deformity. Ideally, the foot should be immobilized in an irremovable total contact cast (TCC), which is initially replaced at 3 days, then checked each week. Edema reduction is often remarkable in the first few weeks of treatment. The cast should be changed frequently to avoid “pistoning” as the edema subsides. If possible, the patient should use crutches or wheelchair and should be encouraged to avoid weight bearing on the affected side. The casting is continued until the swelling has resolved and the temperature of the affected foot is within 2°C of the contralateral foot (35). An alternative device for offloading the acute active stage of CN is a prefabricated removable walking cast or “instant TCC” technique, which transforms a removable cast walker to one that is less easily removed (36,37). It is important to take into consideration that TCC may actually have unfavorable consequences on the non-Charcot limb and induce unnatural stress patterns causing ulcerations and even fractures. Furthermore, patients with CN have increased instability and risk for falling and fracture as a result of multiple comorbidities including loss of proprioception and postural hypotension. Nonetheless, it should be noted that total immobility has disadvantages in itself with a loss of muscle tone, reduction in bone density, and loss of body fitness.

Duration and aggressiveness of offloading (nonweight bearing vs. weight bearing, nonremovable vs. removable device) are guided by clinical assessment of healing of CN based on edema, erythema, and skin temperature changes (34,35). Evidence of healing on X-rays or MRI strengthens the clinical decision to transition the patient into footwear. To prevent recurrence or ulceration on subsequent deformities, various devices are recommended after an acute or active episode has resolved, including prescriptive shoes, boots, or other weight-bearing braces. Frequent monitoring is required.

Antiresorptive therapy

Treatment by antiresorptive drugs has been proposed because bone turnover in patients with active CN is excessive. However, there is little evidence to support their use, but both oral and intravenous bisphosphonates (38) have been studied in the treatment of CN in small randomized, double-blind, controlled trials (39,40) or in retrospective controlled studies (41). Some patients cannot tolerate oral bisphosphonates but may benefit from intravenous therapy using pamidronate or zoledronic acid (42). Intranasal calcitonin is another antiresorptive agent that has been studied in CN. This treatment was associated with a significantly greater reduction in cross-linked carboxy-terminal telopeptide of type I collagen and bone-specific alkaline phosphatase than standard treatment in the control group that received only calcium supplementation and offloading. Calcitonin has a safer profile in renal failure when compared with bisphosphonate therapy (43–46). However, a single dose of intravenous bisphosphonate generally does not require renal adjustment. There is no conclusive evidence for using bisphosphonates in active Charcot foot, and our understanding is evolving as more trials are currently underway.

Bone growth stimulation

There is limited evidence for the use of external bone stimulation in CN. Ultrasonic bone stimulation was reported for the treatment of CN of the ankle and for the healing of fresh fractures. Direct current electrical bone growth stimulators have been used specifically in CN patients undergoing arthrodesis and clinically tested to promote healing of fractures in the acute phase of CN in small case series. Although these findings are promising, there have been no subsequent studies to validate this method, and its use has been supported only as an adjunct therapy during the postsurgical period (45–49).

Recommendations for medical therapy

• Offloading the foot and immobilization are the most important treatment recommendations in active CN and can prevent further destruction.

• There is little evidence to guide the use of available pharmacological therapies to promote the healing of CN.

• Protective weight bearing is required after an active episode, involving weight-bearing devices such as prescription shoes, boots, or braces.

• Lifetime surveillance is advised to monitor for signs of recurrent or new CN episodes as well as other diabetic foot complications.

SURGICAL TREATMENT

Surgical treatment of Charcot arthropathy of the foot and ankle is based primarily on expert opinion. Surgery has generally been advised for resecting infected bone (osteomyelitis), removing bony prominences that could not be accommodated with therapeutic footwear or custom orthoses, or correcting deformities that could not be successfully accommodated with therapeutic footwear, custom ankle-foot orthoses, or a Charcot Restraint Orthotic Walker (50). This clinical approach is based on expert opinion and small, uncontrolled retrospective case series. There has been an increasing trend in the literature to advise earlier surgical correction of deformity and arthrodesis, based on the assumption that surgical stabilization would lead to an improved patient-perceived quality of life (51).

Several investigators have suggested that Achilles tendon lengthening combined with total contact casting has the potential to decrease the deforming forces at the midfoot and decrease the morbidity associated with CN (52–57). Exostectomy offers the potential to reduce pressure caused by bony prominences. This treatment is often combined with accommodative bracing and appears to obtain more favorable results in patients without associated ulcers (58–60).

Surgery has generally been avoided during the active inflammatory stage because of the perceived risk of wound infection or mechanical failure of fixation. Two recent case series would suggest potentially favorable outcomes with early correction of deformity combined with arthrodesis (61,62). Most case series have focused on reconstruction of the deformity by reduction and arthrodesis using standard methods of internal fixation. Because of the poor bone quality, expert opinion has advised an extended period of nonweight bearing after surgery to account for the poor bone healing and inherent weakness of the underlying osseous structures. Early surgical series showed improvement in restoring a plantigrade foot and preventing recurrence of ulceration, although nonunion, failure, and loss of initial correction were common (63–67). The concept of an internal fixation “superconstruct” that extends internal fixation beyond the zone of fusion has evolved to address these issues (68). The combination of poor bone quality and a tenuous soft tissue envelope in a relatively immune-impaired population has led many surgeons to use a modification of the external fixation method of Ilizarov to correct deformity with a limited risk for surgical-associated morbidity (69–74).

Charcot arthropathy of the ankle

Given the common failures of nonsurgical management of CN of the ankle, the task force members agree that surgical management could be considered a primary treatment. Surgical correction of deformity at the level of the ankle is likely more necessary due to the poor tolerance of deformity in the coronal plane (i.e., ankle varus or valgus) and the resultant prominence of the malleoli and their vulnerability to pressure-induced ulceration. Several small uncontrolled series have recommended augmented internal fixation followed by prolonged periods of immobilization and nonweight bearing in neuropathic patients who sustain acute ankle fractures (75–77). Acute ankle fractures in patients with complicated diabetes are associated with significantly higher rates of noninfectious complications and need for surgical revision when compared with diabetic patients without other organ system comorbidities (78). Numerous techniques have been reported without comparative effectiveness (79–82). All of the surgical studies are retrospective in nature without a control group and are based on a limited number of patients. While a strong, stable construct is required, inconclusive data exist to recommend one form of fixation over another (i. e., internal, external, or combined) in the surgical reconstruction of the foot and ankle in patients who are not infected.

Recommendations for surgical treatment

• Surgical treatment is beneficial in CN cases refractory to offloading and immobilization or in the case of recalcitrant ulcers.

• The initial management of acute neuropathic fractures and dislocations should not differ from other fractures.

• Exostectomy is useful to relieve bony pressure that cannot be accommodated with orthotic and prosthetic means.

• Lengthening of the Achilles tendon or gastrocnemius tendon reduces forefoot pressure and improves the alignment of the ankle and hindfoot to the midfoot and forefoot.

• Arthrodesis can be useful in patients with instability, pain, or recurrent ulcerations that fail nonoperative treatment, despite a high rate of incomplete bony union.

• For severe CN of the ankle, surgical management could be considered a primary treatment.

CONCLUSIONS

The Charcot foot syndrome is a complex complication of diabetes and neuropathy. Its destructive effects on the foot and ankle begin with a cycle of uncontrolled inflammation. The classic rocker-bottom foot deformity is a late stage of the syndrome and can be avoided by early recognition and management. Offloading is the most important initial treatment recommendation. Surgery can be helpful in early stages involving acute fractures of the foot or ankle or in later stages when offloading is ineffective. An algorithm summarizing the approach to the Charcot foot can be seen in Fig. 3.

Figure 3

An algorithm depicting the basic approach to the Charcot foot. *Osteomyelitis can be difficult to distinguish from the Charcot foot. The reader is referred to the “Imaging of the Charcot foot” section of the article for techniques to improve specificity of various imaging modalities.

Acknowledgments

The American Diabetes Association/American Podiatric Medical Association Task Force meeting was supported by unrestricted educational grants from Small Bone Innovations, sanofi-aventis, and Integra LifeSciences. No other potential conflicts of interest relevant to this article were reported.

The authors thank Cécile Swiatek, chief librarian, from the J.-M. Charcot library at the Hospital Pitié-Salpêtrière for her assistance with the site preparation for the task force and references in this article.

• © 2011 by the American Diabetes Association and the American Podiatric Medical Association.

Broken Bones (for Kids) – Nemours Kidshealth

What Is a Broken Bone?

A broken bone, also called a fracture (say: FRAK-shur), is when a break goes through part or all of a bone.

How Do Broken Bones Happen?

Most broken bones in kids happen from a fall. Kids also can break a bone in an accident or while playing sports.

What Are the Kinds of Broken Bones?

Types of bone fractures include:

• A greenstick fracture: a break on one side of the bone only
• A buckle or torus fracture: an outward bend on one side of the bone without breaking the other side
• An avulsion fracture: when a tendon or ligament pulls off of a tiny piece of bone
• A growth plate fracture: a break in the area of a child or teen’s growing bone
• A stress fracture: a tiny crack in the bone
• A comminuted fracture: a bone breaks into more than two pieces
• A compression fracture: a collapsing of the bone

What Are the Signs of a Broken Bone?

It always hurts to break a bone. There also might be swelling and bruising. The injured area may be hard to move and use.

Sometimes the body part looks crooked or different than it did before the injury.

What Do Doctors Do?

Doctors order X-rays if they think a bone is broken.

How Are Broken Bones Treated?

Most broken bones are treated with a cast, splint, or brace. This keeps the broken bone from moving while it heals. Even broken bones that don’t line up (called displaced) often will heal straight over time.

Sometimes the displaced bones need to be put back in place before the cast, splint, or brace is put on. This is done through a procedure called a reduction. This is also called “setting the bone.”

How Do Bones Heal?

In the first few days after a fracture, the body forms a blood clot around the broken bone to protect it and deliver the cells needed for healing.

Then, an area of healing tissue forms around the broken bone. This is called a callus (say: KAL-uss). It joins the broken bones together. It’s soft at first, then gets harder and stronger over the following weeks.

New bone forms in the weeks to months after a break, but full healing can take longer.

How Can I Help My Bone Heal?

To help your bone heal well:

• eat a healthy diet that includes plenty of calcium and vitamin D
• take care of the cast or splint
• rest and/or do any exercises that your doctor recommended

With the right treatment, a broken bone usually heals well. After a few months, you will be back to doing all the things you did before the injury.

Pic: Rafael dos Anjos shares picture of broken foot and it looks pretty nasty

There were plenty of conspiracy theories yesterday when it emerged that Rafael dos Anjos had pulled out of his scheduled world lightweight title fight against Conor McGregor in Las Vegas.

he Brazilian was running scared – just like Jose Aldo – was one theory while a PR stunt to generate even more money was another.

But Dos Anjos has taken to Twitter to post up a picture of the extent of the damage done to his foot and it looks quite clear that it is serious.

“Sorry to all my real fans and @ufc,I never cancel any fight due to injury but accidents happen #Jesus #truechampion,” tweeted Dos Anjos with a picture of a rather crooked looked foot attached.

Sorry to all my real fans and @ufc,I never cancel any fight due to injury but accidents happen #Jesus #truechampion pic. twitter.com/wrV58w9KaS

— Rafael dos Anjos (@RdosAnjosMMA) February 24, 2016

UFC president Dana White has confirmed that McGregor will face Nate Diaz at the MGM Grand in Las Vegas on March 5 following dos Anjos’ withdrawal.

“We figured this would be the most exciting fight,” White said. “It’s the fight that Conor really wanted. A lot of people wanted to fight Conor McGregor, but Diaz wanted the fight and we figured this was the fight to make and the fight that the fans wanted to see.”

White revealed that a number of fighters turned down the chance to step into the breach while others were keen to enter the Octagon with ‘The Notorious’.

“We called Jose Aldo, Jose Aldo turned the fight down,” White said.

“We called Frankie Edgar, Frankie Edgar turned the fight down. We called ‘Cowboy’ Cerrone, (and he) absolutely accepted the fight – would love to take the fight. B.J. Penn said he wanted the fight. A lot of guys wanted this fight, but we ended up with Nate Diaz. We felt this was the fight to make and the fight the fans wanted to see.”

Read more here:

90,000 McGregor published a photo after breaking his leg in a duel with Poirier :: Single combats :: RBC Sport

The fight ended after the first round by the doctor’s decision, since McGregor could not continue the fight

Read us at

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Photo: Global Look Press

Former UFC champion Irishman Connor McGregor made his first Instagram post after breaking his leg against American Dustin Poirier.

The Irlade man published a photo in which he is carried out on a stretcher, accompanied by the caption: “you need people like me.”

The third fight between McGregor and Poirier took place as part of the UFC 264 tournament and ended with the American’s victory by TKO. The fight was interrupted after the first round at the request of the doctor due to a leg injury from the Irishman. As it became known later, he received a broken leg.

Poirier accuses McGregor of cheating at UFC 264

The first fight took place in 2014, the Irishman knocked out Poirier in the first round.However, in the second, in January of this year, Poirier took revenge by winning by TKO.

Author

Nikita Armand

90,000 Mayweather trolled McGregor after breaking his leg at UFC 264: photo

https: // rsport.ria.ru/20210713/makgergor-1741064000.html

Mayweather trolled McGregor after breaking his leg at UFC 264: photo

Mayweather trolled McGregor after breaking his leg at UFC 264: photo – RIA Novosti Sports, 13.07.2021 McGregor

Mayweather after breaking his leg at UFC 264: photo

Former world boxing champion in five weight divisions Floyd Mayweather Jr. laughed at former UFC belt holder in two divisions Conor McGregor, … RIA Novosti Sport, 13.07.2021

2021-07-13T12: 45

2021-07-13T12: 45

2021-07-13T12: 45

Floyd Mayweather Jr.

ufc

Conor McGregor

martial arts

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MOSCOW, July 13 – RIA Novosti.Former five-weight boxing world champion Floyd Mayweather Jr. laughed at former UFC two-division belt winner Conor McGregor, who broke his leg last weekend in a fight with Dustin Poirier. UFC tournament. The meeting ended after the first round with Poirier’s victory by TKO: McGregor broke his leg and was unable to continue the fight.

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floyd mayweather Jr., ufc, conor mcgregor, mixed martial arts (mma)

to fight with Poirier I went out with a broken leg

The famous Irish mixed martial arts fighter Conor McGregor told reporters that his defeat in a fight with American Dustin Poirier provoked a broken leg, which happened before the fight.

In a video posted to Instagram, McGregor claims to have fought Poirier with multiple stress fractures of his left leg, the leg he allegedly broke in the first round.

“I was injured when I went into battle,” McGregor quoted the New York Post as saying. “They ask me,“ When was my leg broken? ”Ask Dinah White. Ask the UFC. Ask Dr. [Jeff] Davidson, the League’s chief physician. They knew that I had fractures of my leg when I entered the cage. “

It should be noted that the cause of Conor’s leg injury is still unknown. It was believed that he suffered a fracture at the end of the first round after taking an awkward step back. But the video of the battle revealed that the injury could have occurred earlier. Poirier can be seen signaling a fracture shortly after being kicked by McGregor. At the same time, after this episode, Conor lasted 4 minutes before collapsing to the floor.

According to McGregor’s claim, Poirier’s blow simply exacerbated existing fractures.The 33-year-old Irishman has already undergone surgery to recover from fractures of the tibia and fibula.

“Now I’m getting what I needed on the eve of the fight,” McGregor admits. that it cannot be broken. ”

McGregor lost to Poirier for the second time this year. In January, the American knocked out Conor in the second round.Their first fight took place in 2014, then the Irishman celebrated the victory by knockout in the opening round. Many experts believe the fighters will meet for the fourth time.

Hip arthroplasty

Hip arthroplasty is an extremely important area of ​​modern traumatology and orthopedics. The essence of endoprosthetics is to replace the damaged articular surfaces (due to illness or injury) with artificial ones .Endoprosthetics or, as patients sometimes say, “replacement” of the joint can effectively help patients with diseases of the hip joint, such as idiopathic (age-related) arthrosis, aseptic necrosis of the femoral head, dysplastic coxarthrosis, rheumatoid arthritis, etc., and patients with injuries of the hip joint (fracture of the femoral neck, fracture of the acetabulum) and the consequences of trauma (pseudarthrosis, post-traumatic arthrosis).

Clinical examples: a female patient of 89 years old with a fracture of the femoral neck with displacement of fragments.

Due to the peculiarities of the blood supply to the head and neck of the femur, such fractures do not heal even if there is good contact between the bone fragments. Endoprosthetics is the only chance for elderly patients to stand on their feet after a hip fracture and will not turn into a bedridden patient who will require long-term laborious care from relatives.

The patient underwent unipolar bipolar hip arthroplasty (replacement of only the broken neck and head of the femur).

5 days after the operation, the patient began to walk with a walker on her own.

For younger patients with a fracture of the femoral neck, it is advisable to perform total arthroplasty (replacement of the head, femoral neck and acetabulum).

A 65-year-old female patient with a fracture of the femoral neck with displacement of fragments.

Performed total cementless hip arthroplasty.

The patient started walking with crutches on the 3rd day after the operation.

PHOTOS

Result in 2.5 months. after operation. Walking with a cane is allowed for 2 months.

A 78-year-old female patient with a fracture of the femoral neck with displacement of fragments.

Total cement hip arthroplasty was performed.

She was put on her feet with a walker on the 3rd day after the operation.

Walking confidently with a walker on the 5th day after surgery.

A 76-year-old female patient with a fracture of the femoral neck with displacement of fragments.

Total cement hip arthroplasty was performed.

She was put on her feet with a walker on the 4th day after the operation.

With arthrosis, patients suffer from persistent pain syndrome due to damage to the articular surfaces of the joint. Replacement of all joint components (femoral head and acetabulum) is required. Total cementless endoprosthetics of the right hip joint was performed, allowing to restore the function of the joint, relieve pain, restore normal gait without crutches and canes as soon as possible after the operation.

A 56-year-old female patient with a diagnosis of Right-sided coxarthrosis, stage III.

Performed total cementless endoprosthetics of the right hip joint.

Result 3 months after surgery. The gait has recovered, the patient is not limping, she can squat down.

A 45-year-old patient with a diagnosis of Dysplastic (joint developmental disorder) bilateral coxarthrosis, stage III.

Result after the operation.

Patient 54 years old with a diagnosis of Right-sided coxarthrosis, stage III.

Performed total cementless endoprosthetics of the right hip joint.

Result 3 months after surgery. The gait has recovered, the patient is not limping, she can sit down.

A 72-year-old female patient with a diagnosis of Right-sided coxarthrosis, stage III.

Total cementless hip arthroplasty was performed.

Result after the operation.

A 64-year-old patient with a diagnosis of Left-sided coxarthrosis, stage III.

Total cementless hip arthroplasty was performed.

Result after the operation.

A 63-year-old female patient with a diagnosis of Right-sided coxarthrosis, stage III.

Total cementless hip arthroplasty was performed.

Result after the operation.

The presented clinical examples constitute an insignificant part of the personal results of the specialists of our Orthocenter.

All hip arthroplasty operations are performed by Orthocenter specialists using the most modern techniques using modern implants, with minimal blood loss during the operation, minimal pain syndrome, which, together with the experience of our specialists, ensures excellent results in our patients.

Results of bilateral hip arthroplasty operations performed by Orthocenter staff can be viewed here

You can sign up for a consultation with the specialists of our center here.

90,000 how to determine at home

27 November 2019

The vigilance of the victim and his environment is necessary in case of an injury that has already occurred, since the outcome of treatment, subsequent rehabilitation and return to normal life depend on the timely diagnosis of the type of traumatic injury. This article focuses on the signs of fractures that require urgent medical attention. Consider the general and specific signs of fractures of the bones of the lower extremities.

Types and symptoms of fractures

Common symptoms include constant aching or dull pain at the fracture site, intensifying and taking on a sharp, pulsating character when trying to step on the leg; limitation of limb mobility; swelling; blue discoloration of the skin; crepitus of rubbing bone fragments and pathological mobility at the site of the fracture, unnatural position of the limb and shortening of its length in comparison with a healthy one; increased body temperature.At the moment of receiving a fracture, a sharp sound similar to a crunch is characteristic.

How to find out at home if you have broken your hip? Specific signs of a fracture of the lesser trochanter of the thigh include the inability to raise a straightened leg while sitting. Diaphyseal hip fractures are accompanied by significant damage to soft tissues, neurovascular bundle, blood loss, severe pain syndrome and are dangerous by the development of traumatic shock, fatty embolism. At the same time, shortening and violation of the limb axis, hemodynamic disturbance, possible absence of pulse in the peripheral arteries of the limb, impaired sensitivity are characteristic.With a fracture of the femoral condyles, pain in the knee joint and in the lower third of the thigh is disturbing. The contours of the knee joint are smoothed, the patella is balancing. The displacement of the external condyle upwards leads to the valgus deviation of the lower leg, the internal one – to the varus. Movement in the knee joint is limited.

An extra-articular fracture of the femoral neck occurs when a fall on the trochanteric region. This fracture is more common in older people. Due to the abundant vascularization of the proximal metaphysis, such fractures are accompanied by significant hemorrhages, extending to the upper third of the thigh, the perineum.In this case, the thigh is rotated outward, the limb is shortened, the apex of the greater trochanter is displaced above the Roser-Nelaton line, active movements are impossible.

With intra-articular fractures of the femoral neck (capital, subcapital, transcervical, basal), the pain is not intense, especially with impacted fractures. There is external rotation and shortening of the limb up to 2-4 cm (with abduction fractures – slight lengthening). It is usually not possible to lift the injured limb.There is a positive symptom of Girgolava – increased pulsation of the femoral artery under the pupar ligament due to periarticular hematoma. The absence of the periosteum, the penetration of synovial fluid between the fragments, insufficient blood supply in old age makes it difficult for fusion.

An avulsion fracture of the tibial tuberosity occurs with excessive contraction of the quadriceps femoris muscle. In this case, the extensor function of the lower leg is not impaired due to the safety of the lateral portions of the tendon of the aforementioned muscle.

What are the risks of fractures of the knee, lower leg, or ankle?

With diaphyseal fractures of the lower leg bones, the support function is impaired. In addition to general features, an isolated fibular fracture is characterized by damage to the peroneal nerve.

Pronation-abduction fractures of the ankles (Dupuytren) occur with excessive external rotation and abduction of the foot. In this case, the deltoid ligament breaks or the medial ankle breaks.Ongoing forceful force causes a fracture of the outer ankle or fibula 5 cm above the joint line.

Malgene supination-adduction fractures occur with forced internal rotation and adduction of the foot. First, the talofibular ligaments (anterior and posterior) and the calcaneofibular ligaments of the ankle are damaged. With further forceful action, the talus is displaced inward and leads to a fracture of the medial malleolus and epimetaphysis of the tibia.

For ruptures of the menisci of the knee joint in the acute period, it is characterized by an increase in its volume, smooth contours, the impossibility of active extension of the limb, forced flexion, blockade due to infringement of the torn meniscus. After the blockade is eliminated, the function of the limb is restored, pain increases when walking down the stairs (symptom of Perelman’s stairs), a sensation in the joint of an interfering object (symptom of Krasnov’s hold). Intermittent joint blockages and increased pain during passive extension of the lower leg (Baykov’s symptom) are characteristic.Increased pain during rotation of the leg bent at an acute angle outward or inward indicates damage to the corresponding meniscus (McMurray symptom). Incomplete extension of the lower leg is also noted (symptom of Land’s “palm”). One of the most common types of injury is the Turner triad (“unfortunate triad”): rupture of the collateral tibial ligament, the anterior cruciate ligament and the medial meniscus. Rupture of the collateral peroneal ligament is combined with damage to the anterior cruciate and lateral meniscus.Severe damage is considered to be a rupture of both cruciate and both collateral ligaments, which leads to joint laxity and makes the limb unsupported.