Ultrasound-guided Hydrodissection of Sural Nerve for Foot Pain

Background: Sural nerve entrapment is an impor­tant but infrequent cause of pain. The sural nerve provides sensation to the posterolateral aspect of the leg, lateral foot and fifth toe. Sural nerve entrapment can be challenging to treat and can cause significant limitation. We present a case of sural nerve entrapment resistant to conservative management that was effectively treated by percutaneous ultrasound guided hydrodissection of the sural nerve. Case Report: A 57 year old male came with complaints of pain and tingling sensation on both lower limbs with 50% decrease in sensation to touch (right > left) in lateral aspect of both foot. The patient had tried several conservative modalities with no success. We performed percutaneous ultrasound guided hydrodissection of the sural nerve and the patient reported complete improvement in his pain. Conclusion: Percutaneous ultrasound guided hydrodissection of the sural nerve, is a safe and effective treatment for patients with sural nerve entrapment that does not respond to conservative therapy. However, studies are needed to elucidate its effectiveness and safety profile.

Taxonomic Reassessment of the Izumo Lineage of Hynobius utsunomiyaorum: Description of a New Species from Chugoku, Japan

Here, we describe a new species of the genus Hynobius from Chugoku, Japan. In populations from central to eastern Shimane Prefecture, the Izumo Lineage of Hynobius utsunomiyaorum was clearly distinguished from the true Hynobius utsunomiyaorum based on morphological and molecular evidence. Thus, we describe the former lineage as a new species, Hynobius kunibiki sp. nov. Morphological comparisons revealed that H. utsunomiyaorum lacks a distinct yellow line on the ventral side of its tail, whereas the new species possesses this yellow line; most H. utsunomiyaorum individuals have distinct white spots on the lateral sides of their body and lack a fifth toe, whereas the new species largely lacks these spots, and all examined individuals had a fifth toe. The two species also differed significantly by several other morphological characteristics. The lentic species Hynobius setoi is morphologically similar to H. kunibiki sp. nov., but they differ significantly by various morphological characteristics. Despite their partial morphological similarity, these two species differed substantially in terms of their genetics. Finally, we show, in a phylogenetic tree including all Japanese Hynobius species, that the subgenus Hynobius can be divided into four genetic clades. Overall, this information will help develop conservation management strategies and policies for these species.

Analysis of Method of Axillary Crutch Measurement

The purpose of this study was to determine which of the 3 methods axillary measurement best predict ideal crutch length. Ideal crutch length is defined as the length of the crutch, including accessories, obtained during stance when the crutch tip is 15.2cm lateral and 15.2cm anterior to fifth toe and the axillary pad is 6.4cm below the axillary fold. Two hundred and twenty-four (224) volunteers were measured for crutches using each of the following methods: 77% of actual height; actual height minus 40.6cm and anterior axillary fold to heel in supine position with arm adducted. The result of the calculation were statistically significant (p<0.01). However, 77% of actual height and actual height minus 40.6cm had the strongest relationship to the ideal crutch length r (person Product Moment Correlation Coefficient) = 0.941; r2 (linear regression correlation coefficient) = 0.89; p<0.01. Axillary fold heel method had r =0.917: r2= 0.84; P<0.01.

Ultrasound-guided hydrodissection of sural nerve for foot pain- A case report

Sural nerve entrapment is an impor¬tant but infrequent cause of pain. The sural nerve provides sensation to the posterolateral aspect of the leg, lateral foot and fifth toe. We present a case of sural nerve entrapment that was effectively treated by percutaneous ultrasound guided hydrodissection.

Digital Transfer for Hand Reconstruction in Cleft Hand and Foot Differences

Background Digital transfer for hand reconstruction in children with cleft hand and foot differences present unique challenges with anomalous anatomy and rare opportunities to dramatically improve function of one- or two-digit hands. Methods Medical records were reviewed for patients with cleft hand and foot treated at two pediatric institutions between 1996 and 2018. Hospital records, clinical photographs, radiographs, and alginate molds were available on all patients. Patient characteristics, indications for transfer, associated syndromes, donor and recipient anatomy, and complications were examined. Results Twenty digital transfers were identified in 16 patients. The mean age at time of transfer was 6 years (range: 3–18 years). Associated syndromes in this study included ectrodactyly ectodermal dysplasia clefting (EEC) syndrome and Goltz's syndrome. Recipient sites included the thumb (n = 17) and index ray (n = 3) in 10 hands with monodactyly, 6 hands with a two-digit ulnar syndactyly, and 3 hands with central deficiency and associated polydactyly or other anomalies. Donor sites included the great toe (n = 7), fifth toe (n = 9), great toe polydactyly (n = 2), thumb polydactyly (n = 1), and second toe (n = 1). All transfers survived. Revisions included tenolysis (n = 2), repeat fixation for nonunion or malunion (n = 2), and fusion for instability (n = 3). Conclusion Digital transfer in cleft hand and foot patients is a functional endeavor. The transferred digits provide sensation, mobility, and stability for opposition. Technically challenging due to small structures and atypical anatomy, these rare cases represent unique opportunities to improve function and appearance in the pediatric hand. This is a therapeutic study and reflects level of evidence IV.

Haemangioma Successfully Treated in a Bitch with Mercurius solubilis: A Case Report

Conventional medical therapy for haemangioma usually consists of corticosteroids through oral administration, intralesional injection or topical application. Recently, propranolol has demonstrated to offer advantages because its therapeutic efficacy is comparable and fewer adverse effects are observed. This benign vascular tumour is not always so complicated to have to be removed surgically and many others remit without treatment. However, sometimes the unexpected can happen and evolve unfavourably. For these situations, homeopathy can also be evaluated. Here is a case report of an elderly bitch that developed a haemangioma on the pad of the left fifth toe. The lesion increased in size after applying a corticosteroid ointment and became an infected wound with suppuration when the bitch bit it (self-mutilation). A homeopathic approach to the treatment was proposed. Complete remission of the vascular tumour and improvement of behavioural and physical complaints was achieved with a high dilution of Mercurius solubilis. The homeopathic remedy Phosphorus, a phytotherapic ointment of Calendula officinalis, and the application of topical antibiotics did not have the efficacy of the previous one. Although homeopathy does not yet have a specific mechanism of action for each remedy, the pathogenesis of M. solubilis is compatible with a negative regulation of glutamine synthetase. Given that it has been shown that ultra-dilutions can stimulate gene expression, it is theoretically hypothesised here that Mercurius could stimulate glutamate-ammonia ligase gene, which expresses the aforementioned enzyme, and solve or improve diseases whose symptoms are due to their underexpression or inhibition (at gene and protein level). Hence, the aim of this article is to show the results of homeopathy in the clinical practice and to propose a line of research on the mechanism of action of the remedies.

Case-control study of the treatment of postaxial polysyndactyly of the foot: Comparison of surgical results after removal of the fifth or sixth toe

Background In postaxial polysyndactyly of the foot, the choice of which toe to excise is controversial. It is often treated by resection of the fifth toe to save the lateral neurovascular bundles of the sixth toe. However, the sixth toe is often short and laterally deviated, which may require wedge osteotomy, potentially shortening the phalanx and compromising circulation. This study outlines an individualized method to spare the length and axis of the fifth toe in polysyndactyly with a short and deviated sixth toe.Methods We retrospectively analyzed 38 patients who underwent surgery between 2006 and 2019. The fifth toe was spared in 18 cases, and the sixth toe in 20 cases. The ratios of the forefoot width, angle difference, and toe length were compared between the affected and unaffected sides postoperatively. Complications and subjective judgments on cosmetic results were recorded and compared.Results No significant between-group differences were observed for sex, age at surgery, or the follow-up period. The forefoot width ratio did not significantly differ between the groups. However, the angle difference and toe length ratios showed significantly better results in the fifth toe-spared group than in the sixth toe-spared group (P<0.05 and P<0.01, respectively). There were no cases of impaired circulation, and subjective evaluations revealed satisfactory results in the fifth toe-spared group.Conclusions In cases with short and deviated sixth toes, sparing the fifth toe is an effective method of cosmetic treatment. The surgical results were satisfactory, with an improved appearance and no residual deformities.

Congenital Unilateral Hypertrophy of the Plantar Musculature with Multiple Toe Deformities: A Case Report and Literature Review

Congenital unilateral hypertrophy of the plantar musculature is a rare condition, and to our knowledge, reports of only 14 cases have been previously published. As only one describes a concomitant orthopedic toe deformity, we report our case of abductor hallucis, flexor digitorum brevis, and abductor digiti minimi muscle hypertrophy in combination with hallux valgus and claw toe deformity as well as a laterally abducted fifth toe. Thus, this report presents the rare case of congenital hypertrophy of the plantar musculature associated with complex toe deformities. Moreover, the present article contains a detailed description of our surgical technique as well as a review of the current literature.