The recent development of small bone suture anchors has created several potential applications in reconstructive surgery of the foot. Mitek bone anchors are simple to insert, require less aggressive dissection and surgical time than reefing of the redundant posterior tibial tendon, and are a reliable method of tendon-to-bone fixation. Mitek bone anchors are an excellent technique for the treatment of redundant tibialis posterior tendon following a modified Kidner procedure. In modified Kidner procedures involving an excessively large os tibiale externum, Mitek anchoring of the redundant tibialis posterior tendon to the navicular bone is an excellent means for secure plication of the posterior tibial tendon in cases involving intraoperative tendon laxity. A description of the Mitek Anchor System and technique of application in a modified Kinder procedure is presented. The purpose of this study was to describe patient satisfaction and long-term clinical outcomes of the modified Kinder procedure with and without the Mitek bone anchoring system. A retrospective study of the modified Kinder procedure was performed with 13 patients being evaluated, seven with Mitek anchoring and six without. The University of Maryland 100-point Painful Foot Center Scoring System was modified to be more specific to the modified Kinder procedure for assessment of subjective long-term results. Patient overall satisfaction was rated good to excellent by 85.6% of patients in the Mitek group and by 100% of patients in the non-Mitek group. Use of the Mitek anchor allowed for quicker postoperative recovery to resumption of ambulation without assistive devices (average of 3 weeks vs. 4.42 weeks) and a quicker return to pain-free ambulation in normal shoegear (average of 4 weeks vs. 6 weeks). Mitek anchoring of the tibialis posterior tendon, theoretically, increases medial arch support as evidenced by 14% of the Mitek group and 67% of the non-Mitek group requiring postoperative orthotics.

Osteonecrosis of the sesamoids is a fairly uncommon clinical entity. The development of this condition involving both sesamoids has never been presented in the American literature. After extirpation of the sesamoids and interdigital fusion, the patient returned to her regular activities, including dance.

Foot pain is a most unusual presentation of metastatic malignancy. Metastases to the hands or feet (acrometastases) have been recognized in only a few cases. A 68-year-old male, with a history of chronic gout, presented with left foot pain for 3 months duration. After conservative treatment failed to relieve his pain, radiographic and eventual bone biopsy of a cystic lesion involving the first metatarsal head revealed a Grade IV adenocarcinoma.

An unusual cause of tarsal tunnel syndrome is discussed, along with many of the other etiologies of this painful condition. The diagnosis was difficult because the patient's symptoms only occurred during activity. Because of burning paresthesias, it was felt that reflex sympathetic dystrophy was the etiology. Only through persistence of the treating podiatrists and the patient's agreeing to an exploration was this entity discovered.