Category: R

The Ruedi & Allgower classification system for tibial plafond fractures

Posted on August 12, 2023 by - Ankle, Classification systems, Fractures, R

The Ruedi and Allgower Classification is a renowned system utilized for categorizing fractures of the tibial plafond, which is the distal articular surface of the tibia forming the upper part of the ankle joint. Developed by Swiss orthopedic surgeons Maurice E. Müller, Martin Allgöwer, and Robert Schneider, this classification framework is instrumental in assessing and describing various types of tibial plafond fractures. These fractures typically result from high-energy trauma such as falls, sports injuries, or motor vehicle accidents.

The Ruedi and Allgower Classification for tibial plafond fractures is grouped into three major types, each with specific subtypes that provide insights into the severity and characteristics of the fracture:

Type A: Type A fractures involve a simple split in the tibial plafond without displacement of the fracture fragments. This type is further divided into three subtypes: Type A1 indicates a simple split pattern, Type A2 involves a split with marginal impaction of the fragments, and Type A3 signifies a split with compression of the articular surface.

Type B: Type B fractures are characterized by a depression of the tibial plafond. Like Type A, this category is divided into three subtypes: Type B1 involves a single central depression, Type B2 includes a central depression with marginal impaction, and Type B3 features a central depression with fragmentation of the articular surface.

Type C: Type C fractures are more complex, involving a combination of split and depression patterns. This category is further divided into three subtypes: Type C1 indicates a split with central depression, Type C2 involves a split with central and posterior depression, and Type C3 signifies a split with central depression and fragmentation of the articular surface.

Surgery considerations for patients with renal disease

Posted on April 17, 2023 by - R, S

Surgery considerations for patients with renal disease, specifically chronic kidney disease (CKD) or end-stage renal disease (ESRD), require careful evaluation and management to ensure optimal outcomes. Patients with renal disease often have unique medical and surgical considerations due to their impaired kidney function and potential complications related to their condition. Here are some important surgery considerations for patients with renal disease:

  1. Assessment of renal function: Patients with renal disease should undergo a thorough assessment of their renal function prior to surgery. This may include measurement of serum creatinine levels, estimated glomerular filtration rate (eGFR), and assessment of urine output. This information can help guide decision-making regarding the timing of surgery, choice of anesthesia, and management of perioperative fluid balance.
  2. Optimization of renal function: It is important to optimize the patient’s renal function prior to surgery to minimize the risk of postoperative complications. This may involve managing underlying medical conditions, such as hypertension or diabetes, that can affect renal function. Additionally, medications that are potentially nephrotoxic should be carefully reviewed and discontinued, if possible, to protect the kidneys during the perioperative period.
  3. Fluid management: Fluid management is critical in patients with renal disease undergoing surgery. Careful attention should be paid to the patient’s fluid status, electrolyte balance, and urine output during the perioperative period. Avoidance of excessive fluid administration can help prevent volume overload, congestive heart failure, and exacerbation of renal dysfunction. However, dehydration should also be avoided as it can lead to hypotension, decreased renal perfusion, and acute kidney injury.
  4. Anesthesia considerations: The choice of anesthesia should be carefully considered in patients with renal disease. Certain medications used in anesthesia, such as contrast agents or nonsteroidal anti-inflammatory drugs (NSAIDs), can be potentially harmful to the kidneys and should be used with caution or avoided. Close communication between the anesthesiologist and the surgical team is essential to ensure appropriate anesthesia management tailored to the patient’s renal function and medical condition.
  5. Medication management: Medication management in patients with renal disease should be carefully reviewed and adjusted as needed. Dosing of medications that are renally excreted may need to be modified based on the patient’s level of renal function to prevent drug accumulation or toxicity. Additionally, medications that can further compromise renal function, such as nephrotoxic antibiotics or contrast agents, should be used judiciously or avoided, if possible.
  6. Infection control: Patients with renal disease, particularly those on dialysis, may have increased susceptibility to infections. Infection control measures, including preoperative screening and appropriate use of prophylactic antibiotics, should be implemented to reduce the risk of surgical site infections or systemic infections.
  7. Close monitoring: Patients with renal disease should be closely monitored during the perioperative period for any changes in renal function, fluid balance, electrolyte abnormalities, or other complications. Frequent assessments of vital signs, urine output, laboratory values, and clinical status are important to detect and manage any potential issues promptly.
  8. Collaborative care: Collaboration among the surgical team, nephrologist, anesthesiologist, and other relevant healthcare professionals is crucial in the perioperative care of patients with renal disease. Close communication and coordination of care can help optimize outcomes and manage any potential complications effectively.

In conclusion, surgery considerations for patients with renal disease require careful evaluation, optimization of renal function, fluid management, anesthesia considerations, medication management, infection control, close monitoring, and collaborative care. Individualized care plans and close coordination among the surgical team and other healthcare professionals are essential to ensure safe and effective perioperative care for patients with renal disease.

Root theory

Posted on March 10, 2023 by - Biomechanics, R

The root theory of podiatric biomechanics is a framework that helps podiatrists understand and diagnose problems with foot and ankle mechanics. The theory was first introduced by Dr. Merton Root in the 1960s and is still widely used today.

According to the root theory, the foot can be divided into three sections: the rearfoot, midfoot, and forefoot. Each section has a specific role in foot function and contributes to overall biomechanics.

The rearfoot is responsible for providing stability and shock absorption. It includes the heel bone (calcaneus) and ankle joint. The midfoot is responsible for providing a flexible arch that can adapt to uneven surfaces. It includes the bones of the arch (navicular, cuboid, and cuneiforms). The forefoot is responsible for propulsion and balance during gait. It includes the metatarsal bones and toes.

The root theory also describes three planes of motion that can affect foot function: sagittal (front-to-back), transverse (side-to-side), and frontal (up-and-down). Problems in any of these planes can lead to biomechanical issues and pain.

Based on the root theory, podiatrists use a variety of assessment tools, including gait analysis and biomechanical examination, to identify abnormalities in foot and ankle mechanics. They may then recommend treatments such as orthotics, physical therapy, or surgery to improve function and reduce pain.

Running injuries of the foot & ankle

Posted on March 9, 2023 by - R, Sports

Running can put a lot of stress on the feet, which can lead to a variety of injuries. Here are some common foot running injuries and how to prevent them:

  1. Plantar Fasciitis: This is a common injury that occurs when the tissue that connects the heel to the toes becomes inflamed. To prevent plantar fasciitis, make sure you wear shoes that provide good arch support, stretch your calves and feet before and after runs, and avoid overtraining.
  2. Achilles Tendinitis: This injury occurs when the Achilles tendon, which connects the calf muscles to the heel bone, becomes inflamed. To prevent Achilles tendinitis, make sure you stretch your calf muscles before and after runs, wear shoes that provide good heel support, and gradually increase your mileage to avoid overuse.
  3. Stress Fractures: These are small cracks in the bones of the feet that can occur due to overuse or repetitive stress. To prevent stress fractures, make sure you wear shoes that provide good cushioning and support, gradually increase your mileage to avoid overuse, and cross-train with low-impact exercises.
  4. Blisters: Blisters are caused by friction between the skin and the shoe or sock. To prevent blisters, make sure you wear moisture-wicking socks and shoes that fit well, apply anti-chafing products to areas of the feet that are prone to rubbing, and replace old or worn-out shoes.
  5. Shin Splints: This injury is characterized by pain in the shin bone and can be caused by overuse or improper footwear. To prevent shin splints, make sure you wear shoes that provide good support and cushioning, gradually increase your mileage to avoid overuse, and cross-train with low-impact exercises.

By taking these precautions, you can help prevent foot running injuries and keep your feet healthy and pain-free. If you do experience foot pain or discomfort, it is important to seek medical attention to prevent further injury.

RICE protocol

Posted on March 9, 2023 by - Other, R

The RICE protocol is a first-aid treatment for acute injuries, such as sprains, strains, and bruises. RICE stands for Rest, Ice, Compression, and Elevation, and the protocol is designed to reduce pain, swelling, and inflammation in the affected area.

  1. Rest: The first step in the RICE protocol is to rest the injured area. This may involve immobilising the area with a splint or brace, or simply avoiding any activities that cause pain or discomfort.
  2. Ice: Applying ice to the injured area can help reduce pain and swelling. Ice should be applied for 15-20 minutes at a time, several times a day. A cold pack or bag of ice can be used, but it should be wrapped in a towel or cloth to avoid direct contact with the skin.
  3. Compression: Using compression bandages or wraps can help reduce swelling and inflammation in the injured area. The bandage should be snug but not too tight, and it should be removed and re-applied every few hours to avoid cutting off circulation.
  4. Elevation: Elevating the injured area above heart level can help reduce swelling and improve circulation. This is particularly important for injuries to the lower extremities, such as the ankle or knee.

The RICE protocol should be followed for the first 48-72 hours after an injury, or until swelling and pain have subsided. If pain or swelling persists, or if there is significant loss of function, it is important to seek medical attention. A healthcare professional can help determine the severity of the injury and develop an appropriate treatment plan.

Rheumatoid arthritis and the foot

Posted on March 9, 2023 by - R, Rheumatology

Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes inflammation in the joints, which can lead to pain, swelling, stiffness, and deformity. RA can affect any joint in the body, including those in the foot and ankle. When RA affects the foot and ankle, it can cause significant pain and difficulty walking.

Treatment for RA in the foot and ankle may include a combination of medication, physical therapy, and surgery. Medications used to treat RA may include non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs), and biologic drugs. Physical therapy can help improve range of motion, strength, and balance, as well as reduce pain and swelling.

Surgery may be necessary in cases where non-surgical treatments have failed or when there is significant joint damage. Surgical options may include joint fusion or joint replacement.

It is important to work with a healthcare professional, such as a rheumatologist or podiatrist, to develop a personalised treatment plan based on the individual’s specific needs. Early treatment can help slow the progression of RA and reduce the risk of joint damage and deformity.

Restless leg syndrome

Posted on March 9, 2023 by - Neurology, R

Restless leg syndrome (RLS) is a neurological condition that causes an uncontrollable urge to move the legs, usually due to an uncomfortable sensation in the legs. This sensation is often described as aching, tingling, or burning, and is usually worse when a person is at rest, such as when sitting or lying down. Movement, such as walking or stretching, can provide temporary relief.

The exact cause of RLS is unknown, but it is believed to be related to a problem with the dopamine signalling system in the brain. RLS can also be associated with other conditions such as iron deficiency, kidney disease, and pregnancy.

Treatment options for RLS include lifestyle changes and medication. Lifestyle changes may include avoiding caffeine and alcohol, regular exercise, and stretching before bedtime. Medications used to treat RLS include dopaminergic drugs, iron supplements, and anticonvulsants. Some cases of RLS may also benefit from cognitive behavioural therapy (CBT).

If you suspect you have RLS, it is important to consult with a healthcare professional, as there are other conditions that can cause similar symptoms. A healthcare professional can help determine the best course of treatment based on the individual’s specific needs.

Rehabilitation for foot injuries

Posted on March 9, 2023 by - Other, R

The rehabilitation of foot injuries is important to help reduce pain, swelling, and improve mobility and function. The specific rehabilitation plan will depend on the type and severity of the injury, but some general principles include:

  1. Rest: Resting the affected foot is crucial to allow for healing. Depending on the severity of the injury, the foot may need to be immobilised in a cast, brace or special shoe for a period of time.
  2. Ice: Applying ice to the injured foot can help reduce swelling and pain. Ice should be applied for 15-20 minutes at a time, several times a day.
  3. Compression: Using compression bandages or socks can help reduce swelling and improve circulation.
  4. Elevation: Elevating the injured foot above heart level can help reduce swelling and improve circulation.
  5. Range of motion exercises: Once swelling and pain have subsided, range of motion exercises can help improve flexibility and mobility in the foot. This may include stretching exercises and range of motion exercises.
  6. Strengthening exercises: Strengthening exercises can help improve the strength and stability of the foot and ankle. This may include exercises using resistance bands or weights.
  7. Gait training: In cases where walking has been affected, gait training may be necessary to help retrain the proper mechanics of walking.

It is important to work with a healthcare professional, such as a physical therapist or athletic trainer, to develop a personalised rehabilitation plan based on the specific injury and individual needs.

Raynaud’s phenomenon

Posted on March 9, 2023 by - R, Vascular

Raynaud’s phenomenon is a condition that affects the blood vessels, usually in the fingers and toes, causing them to narrow and reduce blood flow in response to cold temperatures or emotional stress. This can result in pain, numbness, and tingling sensations in the affected areas, and the skin may turn white, blue, or red in response.

There are two types of Raynaud’s phenomenon: primary and secondary. Primary Raynaud’s phenomenon is the most common and occurs in people with no underlying medical conditions. Secondary Raynaud’s phenomenon is less common and occurs as a result of an underlying medical condition, such as autoimmune diseases like scleroderma or lupus, or occupational exposure to certain chemicals.

Treatment for Raynaud’s phenomenon may involve lifestyle changes such as avoiding triggers like cold temperatures and stress, wearing warm clothing, and quitting smoking. In some cases, medication may also be prescribed to improve blood flow and reduce symptoms.

Radiofrequency ablation

Posted on March 9, 2023 by - Other, R

Radiofrequency ablation (RFA) is a minimally invasive procedure used to relieve chronic pain caused by various conditions, such as arthritis, back pain, and neck pain. During the procedure, a small needle is inserted into the affected area, and a special electrode is used to deliver radiofrequency energy to the nerves that are causing the pain. This energy heats up and destroys the nerve tissue, thus interrupting the pain signals being sent to the brain.

Benefits:

  • Effective pain relief: RFA can provide long-lasting pain relief, often for several months or even years.
  • Minimally invasive: RFA is a minimally invasive procedure that can be performed on an outpatient basis with a relatively quick recovery time.
  • Targeted treatment: RFA can be used to treat specific nerves or areas of the body, providing more targeted treatment than systemic pain medication.
  • Reduced need for medication: RFA can reduce the need for pain medication, which can have side effects and potential risks.

Risks and Complications:

  • Discomfort: Patients may experience mild discomfort during and after the procedure, which can be managed with pain medication.
  • Nerve damage: There is a risk of nerve damage during the procedure, although this is rare.
  • Infection: There is a risk of infection at the injection site, although this is also rare.
  • Bleeding: There is a risk of bleeding at the injection site, although this is rare.
  • Temporary numbness: Patients may experience temporary numbness or tingling in the affected area after the procedure.

It is important to discuss the potential benefits, risks, and complications of RFA with a healthcare provider before undergoing the procedure. RFA may not be suitable for everyone, and alternative treatments may be recommended in some cases.