Doctors are highly motivated to be effective in their professional life but maintaining a balance with their personal lives is a challenge for all of us. How you maintain this balance will ultimately determine not only your success but also your happiness. I have noted that occasionally I feel discouraged about various aspects of medical care such as the vast amount of paper work that I must complete in order to care for my patients or the continued decrease in reimbursements that we are all experiencing. When I meet with my colleagues, I know that many are experiencing the same feelings about their practices. I get very discouraged when I hear doctors talking about leaving practice when they should be at the most productive and enjoyable aspects of their career, or when they state that they wouldn’t recommend their children or family to enter the medical profession.
The time surrounding Boards Part 2 is one of the most important times of your podiatry school career. Everyone is aware that not only do you need to pass Boards to qualify for residency, you also need to remain functional to get through a grueling week of interviews and obtain that vaunted residency program. The best way to remain sane during this trying time is to know what is to come and tackle it head on.
We all work so hard during the four years of podiatry school. So many hours of our time are spent studying, making charts, and going to tutor sessions. We do this so that we can get into a residency program so that sensible surgical and practice options can be learned and honed for when it’s time to face the real world on your own.
Unfortunately, I wasn’t able to place into a residency. So then I had to ask myself, now what?
Recently, I had the pleasure of meeting with a group of second and third year students at KSUCPM. We discussed everything from difficult classes and preparing for residency, to fellowships, the places that they dreamed of living and working, and even the idea of taking the leap to open a practice of their own. For some students, these areas were only a matter of how, when and where (or in some cases, wherever the path would take them), but to others, with less room for a free spirit mentality, considering something like a post-residency fellowship, or deciding where to practice was much less “wait and see” and seemingly a lot more complicated.
As fourth year podiatric students embark on a new adventure of externships, many questions remain unanswered on the expectations and standards on how to be a good student and leave an impressive mark.
F. R. ZADIK, SHEFFIELD, ENGLAND
From the Wharncliffe Hospital, Sheffield
Ingrowing toe nail and onychogryphosis arising from deformity of the nail bed of the
great toe often give rise to much disability, and although many treatments have been used none is entirely satisfactory. Conservative measures such as thinning the nail and cutting a longitudinal groove may control the ingrowing, and repeated filing may suffice for onychogryphosis, but such treatment must be continued indefinitely. Repeated avulsion seldom gives permanent cure, and excision of a wedge from the lateral border causes persistent deformity of the nail. Removal of the whole nail bed together with excision of the distal half of the terminal phalanx is often satisfactory but the cosmetic result is poor; the wife of one of my friends who was so treated described her great toes as “two funny little dumplings.” Complete excision of the nail bed with mobilisation and suture of the proximal and distal flaps (Nuttall 1941) failed in three cases because tension caused necrosis of the flaps so that the wounds broke down. Moreover excision of the nail bed with skin grafting of the raw area is uncertain.
BY ISADORE G. YABLON, M.D.t, FREDERICK G. HELLER, M.D.t, AND LEROY SHOUSE, M.D.t, BOSTON, MASSACHUSETTS
From the Boston University Medical Center, Universiti Hospital, Boston
ABSTRACT: The reason why late degenerative arthritis developed in some patients who had sustained displaced bimalleolar fractures of the ankle was investigated. The roentgenograms indicated that incomplete reduction of the lateral malleolus and a residual talar tilt were present. When bimalleolar fractures were created in cadavera the talus could be anatomically repositioned only when the lateral malleolus was accurately reduced. Fifty-three patients with bimalleolar fractures were treated by anatomically fixing the lateral malleolus with a four-hole plate. There was an anatomical reduction of the talus and medial malleolus in each instance and there were no late cases of degenerative arthritis when these patients were followed for from six months to nine years. We concluded that the lateral malleolus is the key to the anatomical reduction of bimalleolar fractures, because the displacement of the talus faithfully followed that of the lateral malleolus.
FOOT & ANKLE INTERNATIONAL Copyright © 2001 by the American Orthopaedic Foot & Ankle Society, Inc.
David B. Thordarson, MD.; Ravinder Bains, MD.; Lane E. Shepherd, M.D. Los Angeles, CA
ABSTRACT Nineteen patients were prospectively randomized for operative treatment of their ankle fracture to be supplemented with or without ankle arthroscopy. All patients had an SER or PER fracture with an intact medial malleolus requiring operative treatment without evidence of intra-articular debris preoperatively. All patients underwent plate fixation of their fibula fracture and had a similar postoperative protocol. Ten patients were randomized to the control group with plate fixation only and nine patients randomized to the plate fixation plus operative arthroscopy. The average follow-up was 21 months. The arthroscopic examination of the study group revealed eight of the nine patients to have articular damage to the dome of the talus. Minimal arthroscopic treatment of these joints was required. All patients healed their fractures. No difference was noted between SF-36 scores or lower extremity scores between the two groups. At short term follow-up, it does not appear that the arthroscopic procedure will impact upon the patient's eventual outcome in this small group of patients.
BY DAVID B. THORDARSON, M.D.f, SOHEL MOTAMED, B.S4, THOMAS HEDMAN, PH.D.t, EDWARD EBRAMZADEH, PH.D.8, AND SAM BAKSHIAN, M.DJ, LOS ANGELES, CALIFORNIA
Investigation performed at the Department of Orthopaedic Surgery, University of Southern California, Los Angeles
ABSTRACT: Nine fresh-frozen cadaveric specimens were disarticulated through the knee, and the soft tissues, except for the interosseous ligaments and interosseous membrane, were removed to the level of the ankle. The subtalar joint was secured with screws in neutral position (approximately 5 degrees of valgus). Contact pressures in the tibiotalar joint were measured with use of low-grade pressure-sensitive film, which was placed through an anterior capsulotomy. For each measurement, 700 newtons of load was applied to the specimen for one minute. The film imprints were scanned, and the contact pressures were quantitated in nine equal quadrants over the talar dome. A fracturedisplacement device was secured to the distal end of the fibula; the device allowed for individual or combined displacements consisting of shortening, lateral shift, and external rotation of the fibula. The ankle was maintained in neutral flexion. The ligamentous injury associated with a pronation-lateral rotation fracture of the ankle was simulated by dividing the deep fibers of the deltoid ligament, the anterior-inferior tibiofibular ligament, and the interosseous membrane to a point that was an average of fifty-three millimeters proximal to the ankle joint. Baseline contact area and contact pressure in the joint were determined, followed by measurements after two, four, and six millimeters of shortening of the fibula; after two, four, and six millimeters of lateral shift of the fibula; and after 5,10, and 15 degrees of external rotation of the fibula. The three types of displacement were tested individually as well as in combination.
BY PAUL L. RAMSEY, M.D.*, AND WILLIAM HAMILTON, M.D.t, WILMINGTON, DELAWARE
Iro,,i t/U Alfred I. duPont Institute, Wilmington
ABSTRACT: A carbon black transference technique was used to determine the contact area in twenty-three dissected tibiotalar articulations, with the talus in neutral position and displaced one, two, four, and six millimeters laterally. The greatest reduction in contact area occurred during the initial one millimeter of lateral displacement, the average reduction being 42 per cent. With further lateral displacement of the talus the contact area was progressively reduced but the rate of change for each increment of shift was less marked.
BY DUNCAN C. MCKEEVER, M.D., HOUSTON, TEXAS
The multiplicity of procedures devised for the radlical cure of hallux valgus, metatarsus
primus varus, and hallux rigidus, and the failure of any one of them to become generally accepted as the best. procedure for these conditions, would indicate that none of them yields a high percentage of good results. Some of the fascial and tendinous sling procedures
for the correction of metatarsus primus varus are undoubtedly applicable in young pa
tient.s and will produce satisfactory results; however, only the test. of time will determine
whether they ‘ill prevent the ultimate development or recurrence of the hallux valgus
and its accompanying disability. Correction of varus of the first metatarsal must continue
to be essential in any operation for hallux valgus which hopes to yield a permanent cor
rection. The principle inherent in the McBridlc operation would seem to be the only
anatomically reasonable contribution so far to functional correction of this deformity.
P. H. HARDCASTLE, R. RESCHAUER, E. KUTSCHA-LISSBERG, W. SCHOFFMANN
From the Department ofAccident Surgery, Landeskrankenhaus, Graz, Austria
Injuries to the tarsometatarsal (Lisfranc) joint are not common, and the results of treatment are often unsatisfactory. Since no individual is likely to see many such injuries, we decided to make a retrospective study of patients from five different centres. In this way 119 patients with injuries of the Lisfranc joint have been collected. This paper classifies these injuries and describes their incidence, mechanism of production, methods of treatment, results and complications. Sixty-nine of the patients attended for review: 35 of these had been treated by closed methods, 27 had had an open reduction and seven patients had had no treatment. On the basis ofour study we suggest that these injuries should be classified according to the type of injury rather than the nature of the deforming force and that their treatment be based upon this classification. It seems that, whatever the severity of the initial injury, prognosis depends on accurate reduction and its maintenance.
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A Horizontally Directed "V" Displacement Osteotomy of the Metatarsal
Head for Hallux Valgus and Primus Varus
DALE W. AUSTIN, D.P.M., M .D., AND EDWARD O. LEVENTEN, M.D., F .A.C.S.*
Our Program provides a great deal of resident autonomy in the O.R. , clinic, and with inpatient hospital management. We single scrub all of our cases which allows us to experience a more hands-on approach to surgery. We also see our own patients in clinic under the supervision of our attendings. We typically see around 20 patients per resident in our weekly resident run clinic. During our clinic time, we see our own post-op patients and develop our own surgical/treatment plans for new consults. We also admit many of our own patients and therefore must be able to manage them from a medical standpoint.