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Feet surgery

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Feet surgery

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The podiatric surgeon is taught to approach foot surgery by keeping the knowledge of normal foot function and biomechanics in mind. Because of the weightbearing nature of the foot, surgical procedures must be designed to be as stable as possible to withstand the forces of everyday standing and walking. Care is taken to understand the cause of the problem so as to provide a long-lasting cure, when possible. Greater than 99% of podiatric surgery is done in an outpatient setting such as a hospital outpatient department, a freestanding surgery center or in the podiatry office. Most procedures allow for immediate walking with a surgical sandal. Some procedures may require the use of a cane, crutches, or a cast. Specific surgical treatments for many common (and some less common) foot conditions will be discussed.

Flat Feet (Pes Planus)

Surgery for flat feet is generally reserved for the most symptomatic cases. Orthotics are often the first line course of treatment. Many people have what are referred to as “Flat Feet” but are relatively asymptomatic. Flat feet may result in significant foot pain and deformity because of excessive pronation which causes joint instability. Flat foot procedures are designed to provide for a more stable foot which pronates less. Most flat foot surgery is performed on patients in the adolescent age group. There are a large variety of specific surgical procedures that may be used. They may be grouped according to the region of the foot that is treated. Often, 2 or 3 procedures may be performed together from the different groups.

Rearfoot osteotomies
These are procedures which are designed to change the position of the heel into an inverted or supinated position (the opposite of everted and pronated which are found in flat feet.) An osteotomy is a surgical cut in the bone. Often, a wedge of bone is removed to change the angle of the heel bone (calcaneus). Other procedures are transpositional and involve sliding of one part of the bone along the other part of the bone. (E.g. the Koutsogianis procedure). Other procedures involve adding a bone graft and opening the wedge to change the angle of the calcaneus.( E.g. the Evans Procedure). These osteotomies are generally held together with special screws, pins or bone staples and require a period of casting and immobilization for several weeks.

Medial column stabilizations
These procedures involve fusing two or more of the bones along the medial side (inner side) of the foot. Common fusion sites are the navicular and medial cuneiform. These bones have often dropped in a flat foot and fusing them provides more stability. These osteotomies are generally held together with special screws, pins or bone staples and require a period of casting and immobilization for several weeks.

Tendon transfers
Sometimes the insertion sites of tendons are detached and then reattached to bones at different locations. The result is a dynamic stabilization. Repositioning of the tendons allows the muscles that pull them to exert their force in a more beneficial way to help support the arch. The Young tenosuspension procedure reattaches the Tibialis Anterior tendon to a better position beneath the medial arch where it can pull up on the arch to support it.

Tendon lengthening
Often, the Achilles tendon is tight and is a major deforming force contributing to flat foot conditions. A condition associated with a tight Achilles tendon is known as equinus. An Achilles tendon lengthening procedure is often effective at reducing this deforming force. The calf is made up of 2 gastrocnemius muscle bellies as well as the soleus muscle. The Achilles tendon attaches to all three. An Achilles tendon lengthening lengthens the whole group together. Sometimes, the gastrocnemius muscles are tight while the soleus is not. In this case, a gastrocnemius recession can be performed to lengthen only the gastrocnemius while leaving the soleus alone.

Arthroeresis
These are procedures in which a peg made of plastic or titanium is placed in front of a bone to limit its motion. A common location for placement of such a device is the Sinus Tarsi which is a cone-shaped space between the talus and calcaneus bones. The peg helps to limit pronation. This is often just a temporary measure with the peg left in for a few years and then removed.

Arthrodeses
An arthrodesis is a fusion of two bones. In addition to the medial column stabilization fusions discussed above, rearfoot bones may also be fused. Rearfoot fusions are generally reserved for the most severely deformed, arthritic and painful feet . A Triple Arthrodesis is a fusion of the Talo-calcaneal, Talo-navicular and Calcaneo-cuboid joints. This is one of the most complex foot surgeries performed since all three joints must be aligned and fused properly to achieve a satisfactory result. In addition, because motion in the rearfoot is eliminated, the ankle joint and other joints in the foot may be forced into compensating to provide additional motion which could result in future symptoms in those places. These fusions are generally held together with special screws, pins or bone staples and require a period of casting and immobilization for two or three months.

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Oats (Super Foods!)

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Oats (Super Foods!)

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The common oat (Avena sativa) is a species of cereal grain grown for its seed, which is known by the same name (usually in the plural, unlike other grains). While oats are suitable for human consumption as oatmeal and rolled oats, one of the most common uses is as livestock feed. Oats make up a large part of the diet of horses and are regularly fed to cattle as well. Oats are also used in some brands of dog and chicken feed.

Uses

Oats have numerous uses in food; most commonly, they are rolled or crushed into oatmeal, or ground into fine oat flour. Oatmeal is chiefly eaten as porridge, but may also be used in a variety of baked goods, such as oatcakes, oatmeal cookies, and oat bread. Oats are also an ingredient in many cold cereals, in particular muesli and granola. Oats may also be consumed raw, and cookies with raw oats are becoming popular.

Oats are also occasionally used in several different drinks. In Britain, it is used for brewing beer. Oatmeal stout is one variety brewed using a percentage of oats for the wort. The more rarely used Oat Malt is produced by the Thomas Fawcett & Sons Maltings and was used in the Maclay Oat Malt Stout before Maclay ceased independent brewing operations. A cold, sweet drink made of ground oats and milk is a popular refreshment throughout Latin America. Oatmeal caudle, made of ale and oatmeal with spices was a traditional British drink and a favorite of Oliver Cromwell.

In Scotland a dish called Sowans was made by soaking the husks from oats for a week so that the fine, floury part of the meal remained as sediment to be strained off, boiled and eaten (Gauldie 1981). Oats are also widely used there as a thickener in soups, as barley or rice might be used in other countries.

Oats are also commonly used as feed for horses – as plain whole or rolled oats or as part of a blended food pellet. Cattle are also fed oats, either whole, or ground into a coarse flour using a roller mill, burr mill, or hammer mill.

Soluble fiber

Oat bran is the outer casing of the oat. Its consumption is believed to lower LDL (“bad”) cholesterol, and possibly to reduce the risk of heart disease.

Oats contain more soluble fiber than any other grain, resulting in slower digestion and an extended sensation of fullness. One type of soluble fibre, beta-glucans, has proven to help lower cholesterol.

After reports of research finding that dietary oats can help lower cholesterol, an “oat bran craze” swept the U.S. in the late 1980s, peaking in 1989, when potato chips with added oat bran were marketed. The food fad was short-lived and faded by the early 1990s. The popularity of oatmeal and other oat products again increased after the January 1998 decision by the Food and Drug Administration (FDA) when it issued its final rule allowing a health claim to be made on the labels of foods containing soluble fiber from whole oats (oat bran, oat flour and rolled oats), noting that 3.00 grams of soluble fiber daily from these foods, in conjunction with a diet low in saturated fat, cholesterol, and fat may reduce the risk of heart disease. In order to qualify for the health claim, the whole oat-containing food must provide at least 0.75 grams of soluble fiber per serving. The soluble fiber in whole oats comprises a class of polysaccharidesBeta-D-glucan. known as

Beta-D-glucans, usually referred to as beta-glucans, comprise a class of non-digestible polysaccharides widely found in nature in sources such as grains, barley, yeast, bacteria, algae and mushrooms. In oats, barley and other cereal grains, they are located primarily in the endosperm cell wall.barley, yeast, bacteria, algae and mushrooms. In oats, barley and other cereal grains, they are located primarily in the endosperm cell wall.

Health

Oats are generally considered “healthy”, or a health food, being touted commercially as nutritious. The discovery of the healthy cholesterol-lowering properties has led to wider appreciation of oats as human food.

Protein

Oat is the only cereal containing a globulin or legume-like protein, avenalin, as the major (80%) storage protein. Globulins are characterized by water solubility; because of this property, oats may be turned into milk but not into bread. The more typical cereal proteins such as gluten and zein are prolamines (prolamins). The minor protein of oat is a prolamine; avenin.

Oat protein is nearly equivalent in quality to soy protein, which has been shown by the World Health Organization to be equal to meat, milk, and egg protein The protein content of the hull-less oat kernel (groat) ranges from 12–24%, the highest among cereals.

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Arena weight-loss data expected to underwhelm

Arena weight-loss data expected to underwhelm

Upcoming trial results for lorcaserin, the experimental obesity drug being developed by Arena Pharmaceuticals Inc, will likely show it is about 4 percentage points more effective in promoting weight loss than a dummy pill

But that is well short of the 9.4 percent placebo-adjusted weight loss reported last week by Vivus Inc, which is developing Qnexa — a combination of phentermine and epilepsy treatment topiramate, both now sold as generics, that is designed to minimize side effects from the two drugs.

But Wall Street is not discounting the value of a viable treatment for obesity, a health-damaging condition afflicting more than one-quarter of all Americans. “Right now physicians have pretty much nothing,” said JMP Securities analyst Jason Butler.

Piper Jaffray has forecast lorcaserin sales of $3 billion in 2015.

One-year results from Vivus’ Qnexa trials sent the company’s stock up more than 70 percent on Wednesday.

“There is a lot less opportunity for that to happen with this (Arena) trial,” Butler said. “We’ve seen so much data already.”

Shares of Arena, which ended Nasdaq trading at $5.30 on Friday, closed as low as $2.26 in April and as high as $7.42 in February.

The phentermine used in Vivus’ Qnexa is a stimulant that was part of the fen-phen diet drug cocktail. Other drugs used in the cocktail, flenfluramine and dexfenfluramine, were recalled in 1997 after they were linked to heart valve damage.

SIDESTEPS HEART PROBLEMS

Lorcaserin is a serotonin activator like fenfluramine, but it is designed to selectively target only one variety of the chemical — and thereby sidestep heart-related side effects.

Earlier studies have found no heart problems associated with the drug. “There is no reason to expect anything different safety-wise,” from the new trial results expected this month, said Carol Werther, an analyst at Summer Street Research.

The company earlier this year said a large, year-long trial found that lorcaserin patients, on average, lost 5.8 percent of their body weight, while placebo patients lost 2.2 percent of their weight — a percentage point difference of 3.6 percent.

“No single agent has consistently shown a 5 percentage point difference,” said Werther.

U.S. Food and Drug Administration guidelines for obesity drugs require a 5 percent improvement in weight loss between the test drug and placebo or that the number of subjects who lose at least 5 percent of their body weight be at least 35 percent, and double the proportion in the placebo group, with a statistically significant difference between the groups.

The earlier lorcaserin trial found that 48 percent of patients on the drug lost 5 percent or more of their weight, while 20.3 percent of placebo patients achieved that goal

Dominic Behan, chief scientific officer and co-founder of Arena, said a major advantage of lorcaserin is that it is a single agent, and that doctors do not need to adjust doses for patients.

Moreover, he said lorcaserin improved cholesterol levels in patients. And data from earlier trials suggest it can be safely taken on a chronic basis, Behan said. By contrast, he said phentermine is currently approved only for short-term use.

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