Category: S

Surgery considerations for patients with dementia

Posted on April 17, 2023 by Steve - Neurology, S

Perioperative considerations for patients with dementia, a condition characterized by cognitive decline and memory impairment, require special attention to ensure their safety, comfort, and optimal outcomes during the surgical process. Here are some important considerations:

Preoperative assessment: Comprehensive preoperative assessment of patients with dementia should include a thorough evaluation of their cognitive status, functional abilities, medical history, and medications. This assessment can help identify potential risks and guide the development of an individualized care plan. It’s important to involve the patient’s caregivers or family members in the assessment process to gather relevant information about the patient’s condition and provide support.
Communication and consent: Communication with patients with dementia should be clear, simple, and tailored to their cognitive abilities. Information about the surgical procedure, risks, benefits, and alternatives should be provided in a way that the patient can understand. Informed consent should be obtained from the patient, following legal and ethical guidelines, and documented appropriately.
Anesthesia considerations: Anesthesia management for patients with dementia requires careful consideration. Older adults with dementia may have altered responses to anesthesia and sedation, and may be at increased risk of complications such as delirium or agitation. The type and dosage of anesthesia should be carefully chosen, considering the patient’s cognitive status, comorbidities, and medications. Close monitoring during and after the surgery is important to manage any potential complications.
Comfort and safety: Patients with dementia may be more susceptible to confusion, agitation, and anxiety in the perioperative setting. Creating a calm and familiar environment, providing reassurance, and involving caregivers can help reduce anxiety and agitation. Attention should be paid to fall prevention measures, as patients with dementia may be at increased risk of falls due to their cognitive impairment.
Medication management: Medication management for patients with dementia is critical during the perioperative period. It’s important to review the patient’s current medications and consider potential interactions with anesthesia and other perioperative medications. Medication schedules should be carefully coordinated to ensure continued management of chronic conditions while minimizing the risk of adverse drug events.
Postoperative care: Postoperative care for patients with dementia should include close monitoring for complications such as delirium, infections, or changes in cognitive status. Pain management should be carefully addressed, as patients with dementia may have difficulty communicating their pain levels. Coordination with caregivers and family members for postoperative care and follow-up is important to ensure a safe and smooth recovery process.
Multidisciplinary approach: Providing perioperative care for patients with dementia requires a multidisciplinary approach, involving collaboration among healthcare providers, including surgeons, anesthesiologists, geriatricians, nurses, and caregivers. This can help ensure that the patient’s physical, cognitive, and emotional needs are addressed comprehensively.

In summary, perioperative care for patients with dementia requires special attention to their cognitive status, communication, anesthesia management, comfort, safety, medication management, postoperative care, and a multidisciplinary approach. Customized care plans that consider the unique needs of each patient with dementia can help promote optimal outcomes and ensure their safety and well-being throughout the surgical process.

Smoking & your feet

Posted on April 17, 2023 by Steve - S

Smoking can have several detrimental effects on foot health. Some potential impacts of smoking on foot health include:

Reduced circulation: Smoking damages blood vessels, including those in the feet. This can lead to reduced circulation, as the blood vessels constrict and become less efficient at delivering oxygen and nutrients to the tissues in the feet. Poor circulation can result in a variety of foot problems, such as slow healing of wounds, increased risk of infections, and a higher likelihood of developing foot ulcers.
Delayed wound healing: Smoking can impair the body’s ability to heal wounds, including those in the feet. Slower healing can increase the risk of complications from foot injuries, surgeries, or other wounds, such as infections or non-healing ulcers. This can be especially concerning for individuals with diabetes, as they are already at a higher risk for foot complications due to their underlying condition.
Increased risk of infections: Smoking weakens the immune system, making it harder for the body to fight off infections, including those that can affect the feet. Foot infections, such as fungal infections (e.g., athlete’s foot) or bacterial infections, can be more difficult to treat in individuals who smoke, as their immune system may be compromised.
Increased risk of peripheral artery disease (PAD): Smoking is a well-known risk factor for peripheral artery disease (PAD), which is a condition that affects the blood vessels in the extremities, including the feet. PAD can cause symptoms such as pain, cramping, and weakness in the legs and feet, and it can also increase the risk of developing foot ulcers and other complications.
Reduced bone health: Smoking has been shown to decrease bone density and overall bone health, which can increase the risk of fractures in the feet. Fractures in the feet can be painful and may require prolonged healing time, especially in individuals who smoke.
Increased risk of foot deformities: Smoking has been linked to an increased risk of foot deformities such as hammertoes, which are characterized by an abnormal bending of the toes. Hammertoes can cause pain, discomfort, and difficulty wearing certain types of footwear.

It’s important to note that quitting smoking can have significant health benefits, including improved foot health. If you smoke and are concerned about the impact it may have on your feet, it’s recommended to seek advice from a healthcare professional and consider quitting smoking as part of a comprehensive approach to maintaining overall foot health.

Sinus tarsi syndrome

Posted on April 11, 2023 by Steve - Hindfoot, Rheumatology, S

Sinus tarsi syndrome is a condition that affects the foot and ankle. It is characterized by pain and discomfort in the sinus tarsi, which is a small bony canal located between the talus bone (ankle bone) and the calcaneus bone (heel bone). The sinus tarsi serves as a passage for nerves, blood vessels, and ligaments that are important for foot and ankle function.

Sinus tarsi syndrome is typically caused by injury or trauma to the foot and ankle, such as ankle sprains, repetitive overuse, or chronic instability. Other potential causes can include arthritis, ligamentous laxity, or anatomical variations that lead to compression or irritation of the nerves or tissues within the sinus tarsi.

Symptoms of sinus tarsi syndrome may include:

Pain: Pain in the lateral (outer) aspect of the foot, specifically in the area of the sinus tarsi, is the hallmark symptom of this condition. The pain may be sharp or dull and may worsen with weight-bearing activities or prolonged standing.
Swelling: Swelling around the sinus tarsi may be present, although it is usually mild compared to other foot and ankle conditions.
Tenderness: Tenderness to touch over the sinus tarsi area may be present, and pressure on the area may exacerbate the pain.
Instability: Some patients with sinus tarsi syndrome may experience a feeling of instability or a sense of “giving way” in the foot or ankle.
Limited range of motion: Reduced range of motion in the ankle joint may be observed, particularly with movements that involve inversion (inward rolling) or eversion (outward rolling) of the foot.

Diagnosis of sinus tarsi syndrome typically involves a thorough clinical evaluation by a healthcare provider, including a physical examination, assessment of medical history, and imaging studies such as X-rays or MRI to rule out other potential causes of foot and ankle pain.

Treatment for sinus tarsi syndrome may include conservative measures such as rest, ice, compression, and elevation (RICE), nonsteroidal anti-inflammatory drugs (NSAIDs), orthotics or shoe modifications, physical therapy, and activity modification. In some cases, corticosteroid injections may be used to reduce inflammation and alleviate pain. If conservative measures are not effective, more advanced treatments such as extracorporeal shockwave therapy, prolotherapy, or platelet-rich plasma (PRP) injections may be considered. In rare cases, surgical intervention may be necessary to address any underlying structural issues or persistent symptoms.

It is important to consult with a qualified healthcare provider for an accurate diagnosis and appropriate treatment plan if you suspect you may have sinus tarsi syndrome or are experiencing foot and ankle pain.

Subtalar joint arthrodesis

Posted on March 29, 2023 by Steve - Hindfoot, S, Surgical

A subtalar joint arthrodesis is a surgical procedure in which the subtalar joint, which is located between the heel bone (calcaneus) and the ankle bone (talus), is fused together to create a single, solid bone. This procedure is typically performed to treat conditions such as severe arthritis, instability, or deformity of the subtalar joint.

During the procedure, the surgeon makes an incision on the side of the foot and removes the damaged cartilage from the subtalar joint. The bones are then positioned in the desired alignment and held in place with screws or other hardware. Over time, the bones grow together and fuse into a single, solid bone.

Subtalar joint arthrodesis is typically performed under general anesthesia and requires a period of immobilization in a cast or brace. Physical therapy is also recommended to help regain strength and mobility in the affected foot. While this procedure can be highly effective in treating certain conditions, it does limit the range of motion in the foot and ankle and may lead to an increased risk of arthritis in adjacent joints over time. It is important to discuss the potential risks and benefits of subtalar joint arthrodesis with a qualified healthcare professional before undergoing the procedure.

Scintigraphy (bone scan) for feet

Posted on March 15, 2023 by Steve - Radiology, S

Scintigraphy, also known as a bone scan, is a medical imaging technique that uses a small amount of radioactive material to produce images of bones in the body. It is often used to evaluate the bones of the feet and to diagnose and monitor conditions such as fractures, infections, arthritis, and tumors.

During a scintigraphy procedure, a small amount of a radioactive tracer material is injected into a vein in the patient’s arm. The tracer material then travels through the bloodstream and accumulates in areas of bone that are undergoing active changes or have an increased blood supply. A special camera then captures images of the foot, showing areas of the bone that have taken up the tracer.

Scintigraphy is a safe and non-invasive procedure that typically takes between 1-3 hours to complete. Patients may be asked to lie still on a table during the procedure. The amount of radiation exposure from a bone scan is generally considered to be very low and poses little risk to the patient.

Scintigraphy for the feet can help identify bone abnormalities that may not be visible on X-rays or other imaging tests. It can also provide valuable information about the extent and severity of conditions affecting the bones of the feet, which can help guide treatment decisions.

Your doctor may recommend scintigraphy for the feet if you have symptoms such as foot pain, swelling, or limited mobility, or if they suspect a bone abnormality that cannot be identified through other imaging techniques.

SPECT-CT for feet

Posted on March 15, 2023 by Steve - Radiology, S

SPECT-CT (Single Photon Emission Computed Tomography-Computed Tomography) is a medical imaging technique that combines two imaging modalities, SPECT and CT, to create a three-dimensional image of the body. It is often used to diagnose and evaluate conditions in the feet, such as fractures, infections, and tumors.

SPECT uses a small amount of a radioactive substance called a tracer, which is injected into the patient’s bloodstream. The tracer emits gamma rays, which are detected by a specialized camera to create images of the foot’s internal structures. CT uses X-rays to create detailed images of the bones and soft tissues in the foot. Combining the two modalities allows for more accurate and detailed images than either technique alone.

SPECT-CT for the feet is a non-invasive procedure that typically takes between 30-60 minutes to complete. Patients are asked to lie down on a table and remain still while the images are being taken. The procedure is generally considered safe, but as with any medical imaging test, there is a small risk of exposure to radiation.

SPECT-CT for feet can help diagnose a variety of conditions and can aid in treatment planning by providing detailed information about the location and extent of abnormalities in the feet. Your doctor will determine if this imaging test is appropriate for your specific situation.

Skew foot

Posted on March 15, 2023 by Steve - Paediatrics, S

Skewfoot, also known as oblique foot or serpentine foot, is a rare foot deformity that can be present at birth or develop over time. It is characterized by an abnormal position of the heel bone (calcaneus) and the midfoot bones, resulting in a foot that is twisted and tilted inwards.

The exact cause of skewfoot is not fully understood, but it is believed to be related to abnormal development of the bones and joints in the foot. The condition can also be associated with other foot and leg problems, such as flat feet, high arches, and hip dysplasia.

The symptoms of skewfoot can include pain, stiffness, and difficulty walking or standing for long periods of time. Treatment options may include wearing orthotics or special shoes, physical therapy to improve foot alignment and range of motion, or surgery to correct the deformity in severe cases.

If you suspect you have skewfoot, it is recommended that you consult with a podiatrist or orthopedic surgeon who specializes in foot and ankle conditions for a proper diagnosis and treatment plan.

Salter-Harris classification for growth plate fractures

Posted on March 10, 2023 by Steve - Fractures, Paediatrics, Radiology, S

The Salter-Harris classification is a system used to classify fractures that involve the growth plate, also known as the epiphyseal plate, in pediatric patients. The growth plate is a cartilage-rich area at the ends of long bones that allows for bone growth and development.

The Salter-Harris classification divides growth plate fractures into five categories, based on the location and extent of the fracture:

Type I: This is a transverse fracture that runs through the growth plate, separating the epiphysis (the end of the bone) from the metaphysis (the shaft of the bone). This is the most common type of growth plate fracture and is usually treated with immobilization and close monitoring.

Type II: This is an oblique fracture that runs through the growth plate and into the metaphysis. This type of fracture is also treated with immobilization and monitoring, and may require more frequent follow-up to ensure proper healing.

Type III: This is a fracture that runs through the growth plate and into the epiphysis. This type of fracture may require more aggressive treatment, such as surgery, to prevent long-term complications such as growth disturbances or joint deformities.

Type IV: This is a fracture that runs through the growth plate, the epiphysis, and the metaphysis. This type of fracture is relatively rare and may require surgical intervention to prevent long-term complications.

Type V: This is a crush injury to the growth plate that results in damage to the cells responsible for bone growth. This type of fracture is also relatively rare and may require surgical intervention to prevent growth disturbances.

The Salter-Harris classification is a useful tool for healthcare professionals in assessing and managing growth plate fractures in pediatric patients. Treatment options for growth plate fractures may include immobilization, closed reduction (manipulation of the bones to restore proper alignment), and surgery in some cases.

Overall, prompt and appropriate treatment of growth plate fractures is important to minimize the risk of long-term complications and ensure proper bone growth and development.

Sanders classification for calcaneal fractures

Posted on March 10, 2023 by Steve - Classification systems, Fractures, Radiology, S

The Sanders classification is a system used to categorize calcaneal fractures, which are fractures of the heel bone in the foot. The classification was developed by Dr. Roy W. Sanders, an American orthopedic surgeon, in 1993.

The Sanders classification divides calcaneal fractures into four categories, based on the location and severity of the fracture:

Type I: This is a simple, non-displaced fracture of the posterior calcaneal tuberosity, which is a bony protrusion at the back of the heel bone. This type of fracture is considered to be relatively minor, and is often treated non-surgically with immobilization and rest.

Type II: This is a displaced fracture of the posterior calcaneal facet, which is the portion of the heel bone that articulates with the talus bone in the ankle joint. This type of fracture can result in joint incongruity (misalignment) and can be associated with long-term complications.

Type III: This is a fracture involving both the posterior calcaneal facet and the middle facet of the heel bone. This type of fracture is more severe than Type II, and is associated with a higher risk of complications.

Type IV: This is a fracture involving the entire calcaneus bone, and is the most severe type of calcaneal fracture. This type of fracture can result in significant joint incongruity and is associated with a high risk of long-term complications.

The Sanders classification can be useful in guiding treatment decisions for calcaneal fractures, as the severity and location of the fracture can impact the likelihood of complications such as joint incongruity and post-traumatic arthritis. Treatment options for calcaneal fractures may include immobilization with a cast or brace, surgery to realign the bones and stabilize the joint, and in some cases, joint replacement surgery.

Overall, the Sanders classification is a valuable tool for healthcare professionals in assessing and managing calcaneal fractures, and can help improve patient outcomes through more targeted and effective treatment.

Simmonds test

Posted on March 10, 2023 by Steve - Biomechanics, S

The Simmonds test, also known as the Thompson test, is a clinical assessment tool used by podiatrists and other healthcare professionals to evaluate the integrity of the Achilles tendon in the foot and ankle. The test is named after the British surgeon, Sir William John Simmonds, who first described the technique in the early 20th century.

During the Simmonds test, the patient is asked to lie prone (face down) with the feet hanging off the edge of a table or examination bed. The examiner then squeezes the calf muscle with one hand while observing the movement of the foot with the other hand.

If the Achilles tendon is intact, the foot should plantar flex or point downwards when the calf muscle is squeezed. However, if the Achilles tendon is ruptured, there will be no movement of the foot, indicating a complete tear of the tendon.

The Simmonds test can be useful in diagnosing Achilles tendon ruptures, which can occur as a result of overuse injuries or trauma to the foot and ankle. Treatment options for Achilles tendon ruptures may include immobilization with a cast or brace, physical therapy, and in some cases, surgery to repair the torn tendon.

Overall, the Simmonds test is a simple, non-invasive clinical tool that can provide valuable information about the integrity of the Achilles tendon in the foot and ankle, and help guide treatment decisions for a range of foot and ankle conditions.