A. rabbit model of Staphylococcus aureus osteomyelitis was used to compare 3 weeks of clindamycin-impregnated polymethylmethacralate (PMMA) bead treatment with 3 weeks of gentamicin-impregnated polymethylmethacralate bead treatment, 4 weeks of parenteral clindamycin treatment, and surgical debridement without any antibiotic treatment. The animals were weighed throughout the course of the experiment and cortical bone and marrow flush specimens were obtained for bacterial culture at the end of therapy. The cortical specimens were bacteria free in 100% (6/6) of the animals receiving parenteral clindamycin, 83% (5/6) of the animals in the clindamycin PMMA group and, none of the animals in the gentamicin PMMA group. The marrow flush specimens were bacteria free in 83% (5/6) of the animals in the parenteral clindamycin group, 67% (4/6) of the animals in the clindamycin PMMA group, and 40% (2/5) of the animals in the gentamicin PMMA group. While these findings are preliminary and further studies with larger numbers of animals are needed, the authors suggest that when PMMA bead therapy is being contemplated, serious consideration should be given to replacing gentamicin with clindamycin in treatment of gram-positive osteomyelitis. Furthermore, incorporation of clindamycin with gentamicin (or tobramycin) should be considered when treating mixed gram-positive and gram-negative osteomyelitis.

The clinical examination of acute soft tissue injuries of the ankle does not necessarily help to delineate the extent of injury. Ankle stress radiographs and arthrography have been applied for a more accurate assessment of the actual degree of ligamentous damage. However, these studies do not define the level of the ligament tear of the relationship of torn ligament ends to one another. This information would seem to be valuable in deciding whether a conservative or surgical approach would be advisable. The following study evaluated the possible role of magnetic resonance imaging in assessment of these injuries. The ability to assess ankle ligaments was first undertaken. Once this was successfully performed, magnetic resonance imaging was used to assess the degree of ligament damage in 15 patients. Magnetic resonance imaging proved to be comparable to arthrography. It also provided additional valuable information.

There are many changes on the horizon that will affect how we teach the future practitioners of podiatric medicine. The author describes the processes undertaken to date at the California College of Podiatric Medicine (CCPM), as well as the vision of tomorrow, for podiatric medical education. The educational system that will result from these changes will be more efficient; it will better meet the needs of students; and, it will broaden their base of knowledge, all to improve care given to the patient.

This manuscript examines the in vitro antibacterial activity of eight different antibiotics when mixed with polymethyl methacrylate. Two different parameters are presented as being important considerations in the choice of antibiotic. One parameter is the bacterial inhibition created by the direct contact of the antibiotic-impregnated bone cement. The second parameter is the bacterial inhibition produced by diffusion of antibiotic from the bone cement into the surrounding liquid medium. These two experimental models were created to establish the contiguous and remote antimicrobial effects of antibiotic-impregnated bone cement.

Arthroereisis procedures involving the subtalar joint in the pediatric flatfoot have had great success in limiting/preventing abnormal or destructive pronating forces transmitted into the foot. This report presents actual and potential complications of these procedures.

The authors describe their operative approach to metatarsus primus adductus deformity when present in conjunction with a congenitally short first metatarsal. Hallux abducto valgus correction in this clinical setting has traditionally advocated use of a crescentic or opening wedge osteotomy in order to prevent further shortening of the first metatarsal. Fixation of opening base wedge osteotomies has been fraught with problems in the past, with possibilities for displacement or eventual loss of initial correction. The authors have found the mini-Hoffmann external fixation device useful for this purpose.

This paper presents a review of nonsteroidal anti-inflammatory drugs (NSAIDs) in podiatric medicine and surgery. Although these agents possess a high degree of safety and efficacy, proper patient selection, monitoring, and early detection of side effects are emphasized. A discussion of prostaglandin biochemistry and physiology is included.

The authors investigated the statistical relationship and significance between the transverse and sagittal plane proximal articular set angles both radiographically and intraoperatively. The analysis revealed a highly significant difference between the means of the respective measurements. Although the radiographic and intraoperative findings were found to be related for the transverse plane proximal articular set angle, the transverse plane PASA was approximately 7 degrees greater when measured intraoperatively. The concept of a sagittal plane PASA was also introduced. The significance of accurate measurements in the surgical correction of hallux valgus was also examined.

A variety of cyst and cystlike lesions may present in the osseous structures of the foot. Such lesions are infrequent in their occurrence, and often cannot be diagnosed on the basis of radiographic appearance. In addition to the morphologic data that can be derived from evaluation of standard radiographs, other diagnostic radiographic studies such as tomography, CT scanning, radionuclide bone imaging, angiography, or other studies may be required to ascertain the nature and extent of cystlike lesions of the foot. This is dependent on histopathologic information derived from biopsy. A variety of cyst and cystlike lesions of the foot are presented with a review of their basic morphology and histopathologic, clinical, and prognostic characteristics.

Although most patients who seek relief are adults, the problem of hallux valgus frequently begins at an earlier age. In the juvenile patient, except for congenital anomalies or inflammatory juvenile rheumatic disease, hallux abducto valgus appears to be related to the biochemical malfunction. It requires not only surgical management, but also the use of orthotics or surgical stabilization.

In the past, many surgical procedures have been advocated for correction of painful flexible flatfoot deformity. More recent opinions advocate the concept that no one procedure is appropriate to all flatfoot deformities. Individual assessment is now necessary to determine the predominant component deformities. One such component deformity frequently encountered is forefoot supinatus. The authors review the more commonly performed procedures for this problem, as well as their preferred approach of the modified Hoke arthrodesis or Cotton osteotomy. The choice of procedure is dictated by whether the first metatarsal or longitudinal axis subluxation predominates.

A review of sickle cell anemia is presented, with attention to clinical manifestations, surgery, and lower extremity complications.

Rheumatoid nodulosis is a relatively benign variant of rheumatoid disease. This entity has been previously ignored in the medical literature. Confusion with other diseases that can produce nodules is not infrequent. A discussion of this entity, as well as a case report, will be presented.

Patients with arthritic complaints are seen frequently by podiatrists, who must establish a differential diagnosis. When combined with the patient's history, physical examination, joint aspiration, laboratory data, and radiographs, bone and joint scans provide a sensitive and objective means of arriving at an accurate diagnosis.

Fibrous histiocytomas are benign but aggressive tumors of histiocytic origin. The authors describe and discuss an example of an atypical fibrous histiocytoma that involved the soft tissue of the great toe. These tumors sometimes recur after local excision.

In many respects, tarsal tunnel syndrome is analogous to carpal tunnel syndrome. Despite this fact, tarsal tunnel syndrome has lagged far behind its counterpart in recognition and understanding. Thought of as a local compression phenomenon, reports of systemic associations are now being seen with increased frequency. This article reviews both local and systemic considerations for tarsal tunnel syndrome. Analysis of our own group of patients revealed 49 with electrodiagnostically confirmed tarsal tunnel syndrome, 24 of whom had bilateral involvement. The incidence of systemic disease was found to be 34.7%.

: In this paper, the authors discuss postoperative fever--the patterns, pathophysiology, thermoregulation, intraoperative and postoperative changes, and etiology of postoperative fevers. They stress the need for a thorough history and physical examination and the importance of determining the cause.

Inversion ankle injuries resulting in soft tissue injury or various types of fractures are seen frequently by podiatrists, and diagnosis and evaluation of treatment require a thorough knowledge and understanding of the anatomy of the area. In this paper, the authors approach the anatomy from the point of view of surgical dissection, with emphasis on the soft tissue structures. X