25-year-old Lingling (not her real name) stumbled and stumbled as if she was going to fall at any moment, and had to use crutches to help her walk. This has seriously affected her daily life, and under the introduction of a friend, Lingling came to the Second Department of Foot and Ankle Surgery of the North Hospital of Nanchang Hongdu Hospital of Traditional Chinese Medicine for treatment.
After receiving the doctor's examination, it was found that Lingling's feet were deformed from droop, and complications such as Achilles tendon contracture and claw toe had appeared. After detailed inquiry, it was learned that Lingling had symptoms such as limping and unsteady walking after being poisoned. After electromyography and ultrasound examination, it turned out that the culprit of Lingling's "difficulty in walking" was common peroneal nerve injury, which had developed into bilateral old common peroneal nerve injury due to a long period of time.
Loading...
Lingling's gait
EMG shows common peroneal nerve injury
In order to restore normal gait and improve motor function, after carefully understanding Lingling's demands, considering that she was already an old common peroneal nerve injury and the effect of nerve exploration was not good, the team of the Second Department of Foot and Ankle Surgery tailored a set of tendon transfer surgery for Lingling, which improved the muscle strength of her lower limbs by changing the position of the tendons in her lower limbs, and maintained the foot in a normal position through external fixation technology.
After perfecting the preoperative examination and ruling out the contraindications of surgery, the surgical team of the Second Department of Foot and Ankle Surgery performed bipedal tendon transposition + Achilles tendon release + claw-toe orthopedic surgery for Lingling, and the operation went smoothly and she returned to the ward.
Intraoperative diagram
Postoperative external fixation
Postoperative imaging
Common peroneal nerve injury
Common peroneal nerve injury is a common clinical disease, which is manifested by paralysis of the anterolateral extensor muscles of the lower leg, slight muscle weakness or even complete loss of motor function, which seriously affects the daily life of patients. Electromyography (EMG) and ultrasonography are important for diagnosing common peroneal nerve injury.
Clinical presentation
Patients with common peroneal nerve injury have atrophy of the extensor muscles of the anterior tibia and lateral calf, and the main symptoms are the inability to straighten the toes, the inability to extend and turn out the ankle joint, the hyposensation of the skin on the lateral calf and the dorsum of the foot, the dorsiflexion and valgus dysfunction of the foot, the deformity of drooping and varus, the foot is raised when walking, and the toe lands first in a straddle gait.
Tendon transfer surgery to treat common peroneal nerve injury
Clinically, it is found that the effect of nerve repair after common peroneal nerve injury is generally not good, especially in the later stage of common peroneal nerve injury, nerve severance or local injury forms scar tissue, and then nerve anastomosis or nerve grafting, the effect is limited, and foot drop deformity cannot be corrected. Therefore, the focus of post-treatment of common peroneal nerve injury is functional reconstruction and improvement of the function of the affected limb.
Dynamic tendon transposition is the gold standard for the treatment of foot ptosis deformities of common peroneal nerve injury. Because the main function of the tibialis posterior muscle is to maintain the arch of the foot and the plantar flexion function of the ankle joint, its muscle strength is second only to the triceps calf muscle. Therefore, although there are many surgical methods for dorsum extension, posterior tibial tendon transposition reconstruction can effectively improve ankle function.
Foot and Ankle Surgery
The Second Department of Foot and Ankle Surgery of Nanchang Hongdu Hospital of Traditional Chinese Medicine was officially established on June 17, 2023. The department has 1 deputy chief physician, 1 attending physician and 3 resident physicians.
The Second Department of Foot and Ankle Surgery is one of the sub-specialty departments of the Department of Orthopedics and Traumatology of the hospital, and its business scope covers the diagnosis and treatment of common and frequent diseases in foot and ankle surgery, and can complete a variety of difficult and complex surgeries, so as to realize the development of four characteristic professional directions: trauma, infection, deformity orthopedics and sports injuries.
The department adheres to the principle of people-oriented, patient-centered, medical quality as the core, precision medicine and minimally invasive medicine, vigorously introduces and promotes minimally invasive surgical technology and the concept of rapid recovery, deepens the construction of discipline connotation, improves the level of medical technology, optimizes the service process, and continuously improves the medical experience of patients. In the future, the Second Department of Foot and Ankle Surgery will rely on the Department of Orthopedics and Traumatology and the Orthopedic Research Laboratory, actively cooperate with domestic orthopedic centers, conduct academic research and exchanges with foot and ankle surgery at all levels of hospitals at home and abroad, develop teaching alliances with major medical colleges, implement the strategy of high-quality products, and adhere to the subject research as a link to promote the construction of disciplines and realize the leapfrog development of disciplines.
The department will adhere to the scientific training of "Chongde, Innovation, Unity, and Forge Ahead", and provide first-class technology, first-class concept and first-class medical services for the majority of patients.
Scope of treatment
1. Foot and ankle trauma: Achilles tendon rupture, calcaneal fracture, talus fracture, Lisfranc injury (metatarsal joint fracture and dislocation), foot closure and open fracture (metatarsophalangeal fracture), old fracture and dislocation of the foot and ankle, nonunion of the foot and ankle, sequelae of fracture, etc.
2. Foot and ankle bone disease: hallux valgus, hallux varus, little toe varus, hammer toe, cross toe, rheumatoid arthritis, flat feet, high arch feet, clubfoot, diabetic foot, metatarsal head necrosis, Morton neuroma (intermetatarsal neuroma), etc.
3. Foot and ankle arthritis: traumatic ankle arthritis, ankle osteoarthritis, metatarsophalangeal osteoarthritis, midfoot osteoarthritis, subtalar arthritis, etc.
4. Foot and ankle sports injuries: soft tissue injuries such as tendons and ligaments caused by sports, such as ankle joint instability, subtalar joint instability, transverse tarsal joint, metatarsal joint, metatarsophalangeal joint instability, talus cartilage injury, etc., as well as the use of arthroscopy to treat various foot and ankle sports injuries.
5. Chronic pain of foot and ankle: heel pain, plantar aponeurositis, Achilles tendon insertion disease, plantar pain and foot nail disease.
6. Platelet-rich plasma (PRP) for the treatment of ankle arthritis, chronic pain of foot and ankle and refractory ulcer wounds, such as chronic Achilles tendonitis, plantar fasciitis, diabetic foot, etc.
Outpatient arrangement
General outpatient clinic: Orthopedic and traumatology outpatient room No. 7 on the first floor of the outpatient department of the North Hospital
Specialist Outpatient Clinic: Room 12, Orthopedic and Traumatology Outpatient Clinic, 1st Floor, North Hospital Outpatient Department (Wednesday afternoon, Saturday afternoon)
Recommend an expert
Deng Xiongwei: Deputy Chief Physician of the Second Department of Foot and Ankle Surgery
Master tutor of Jiangxi University of Traditional Chinese Medicine, selected as the first Jiangxi Provincial Traditional Chinese Medicine Young and Middle-aged Backbone Talent Training Object and Nanchang Health Science Popularization Expert Database, Jiangxi Provincial Health Commission Traditional Chinese Medicine Administration Science and Technology Program Project Evaluation Expert, Jiangxi Provincial Traditional Chinese Medicine Medical Skills Specialist Physician Qualification Assessment Expert. He is currently a member of the Bone Injury Special Committee of the China Medical Education Association, a member of the Traumatology Group of the Orthopedic and Traumatology Branch of the Jiangxi Association of Traditional Chinese Medicine, a youth member of the Orthopedic Branch of the Jiangxi Health Care Association, a member of the Bone and Joint Disease Prevention and Control Professional Committee of the Jiangxi Preventive Medicine Association, a member of the Standing Committee of the Trauma Rehabilitation Professional Committee of the Jiangxi Rehabilitation and Health Association, and a member of the Traumatology Group of the Orthopedic Minimally Invasive Professional Committee of the Jiangxi Association of Integrative Traditional and Western Medicine.
He has been engaged in orthopedics and traumatology for 15 years, went to Shanghai Sixth People's Hospital for further study in foot and ankle surgery, has solid theoretical knowledge of orthopedics and traumatology and strong scientific research ability, and has rich clinical experience in the treatment of orthopedic diseases, especially good at minimally invasive treatment of foot and ankle bone diseases and fractures, and can proficiently complete foot and ankle fracture surgery, hallux valgus osteotomy and orthopedics, ankle arthropesis, high arch foot orthopedics, etc. He has published more than 20 papers in domestic core journals and SCI journals, presided over 2 projects of the Natural Science Foundation of Jiangxi Province, participated in 1 project of the National Natural Science Foundation of China, presided over the completion of 6 municipal and departmental projects, participated in more than 10 provincial and municipal projects, published 1 monograph, and has 3 patents.
Li Qiang: Attending physician of the Second Department of Foot and Ankle Surgery
He graduated from Tongji Medical College of Huazhong University of Science and Technology with a master's degree in orthopedic surgery. He is a member of the Bone Disease Repair and Reconstruction Group of the Bone Disease Professional Committee of the China Medical Education Association, a member of the Bone Microscopic Repair and Reconstruction Special Committee of the Orthopedics and Traumatology Branch of the China Association for the Promotion of Traditional Chinese Medicine, and a standing member of the Microscopic (Hand) Surgery Professional Committee of the Jiangxi Provincial Association of Social Medical Institutions. He is engaged in the work and research of orthopedics and traumatology, and is good at the diagnosis and treatment of foot and ankle diseases such as foot fractures, hallux valgus, plantar fasciitis, Achilles tendonitis, high arched feet, flat feet, etc., and has published more than 10 professional papers.
Yuan Haitao: Resident Chinese medicine physician in the Second Department of Foot and Ankle Surgery
He graduated from Jiangxi University of Traditional Chinese Medicine with a master's degree in orthopedics and traumatology, under the tutelage of Professor Wan Xiaoming, a famous veteran physician in Jiangxi Province. He specializes in the diagnosis and treatment of foot fractures, hallux valgus, plantar fasciitis, Achilles tendonitis, high arched feet, flat feet and other foot and ankle diseases. He presided over 1 project of Jiangxi Graduate Innovation Fund and participated in a number of national, provincial and municipal projects.
Author: Yuan Haitao, Department of Foot and Ankle Surgery, Nanchang Hongdu Hospital of Traditional Chinese Medicine
Correspondents: Qiu Peijun Zeng Huilan
Editor: Huang Menglin
Reviewer: Chen Shirui
Issued: Daley Red
Picture: Some of the pictures in this article are from the Internet, the copyright belongs to the original author, if there is any infringement, please contact us to delete.