Troy Watson - Academia.edu (original) (raw)
Papers by Troy Watson
Brief functional analysis and treatment of a vocal tic
Journal of Applied Behavior Analysis, Feb 1, 1998
This study sought to extend functional methodology to the assessment and treatment of habits. Aft... more This study sought to extend functional methodology to the assessment and treatment of habits. After a descriptive assessment indicated that coughing occurred while eating, a brief functional analysis suggested that social attention was the maintaining variable. Results demonstrated that treatment, derived from the assessment and analysis data, rapidly eliminated the cough. We discuss the appropriateness of using functional analysis procedures for deriving treatments for habits in a clinical setting.
Periarticular injuries to the hallux metatarsophalangeal joint in athletes
Foot and Ankle Clinics of North America
The magnitude of hallux MTP injuries can range from a mild sprain to a frank dislocation. The imp... more The magnitude of hallux MTP injuries can range from a mild sprain to a frank dislocation. The importance of coaches, trainers, and physicians recognizing the severity of a turf toe injury cannot be overstated. The late sequelae of hyperextension injuries can lead to retirement from professional athletics. With appropriate conservative treatment, most individuals can return to play, although many have some residual pain. Future study in this area should define the indications for acute repair versus late treatment following a period of conservative modalities. Hyper-plantarflexion injuries also can be debilitating injuries, but most respond to rest, taping, anti-inflammatories, ice, and strengthening exercises. Lastly, dislocations of the hallux MTP joint can be diagnosed and treated after physical examination and appropriate radiographs are obtained. All closed dislocations should undergo an attempt at reduction in the emergency department after adequate anesthesia is administered. The patient should be advised, especially in type I injuries, of the need for possible acute operative intervention.
Treatment of Lisfranc joint injury: current concepts
The Journal of the American Academy of Orthopaedic Surgeons, 2010
Injuries to the tarsometatarsal joint complex, also known as the Lisfranc joint, are relatively u... more Injuries to the tarsometatarsal joint complex, also known as the Lisfranc joint, are relatively uncommon. However, the importance of an accurate diagnosis cannot be overstated. These injuries, especially when missed, may result in considerable long-term disability as the result of posttraumatic arthritis. A high level of suspicion, recognition of the clinical signs of injury, and appropriate radiographic studies are needed for correct diagnosis. When surgery is indicated, closed reduction with percutaneous screw fixation should be attempted. If reduction is questionable, open reduction should be performed. Screw fixation remains the traditional fixation technique.
Dorsal Approach for Plantar Plate Repair With Weil Osteotomy: Operative Technique
Foot & ankle international, Jan 21, 2014
In recent years, the role of the plantar plate in lesser metatarsophalangeal joint stability has ... more In recent years, the role of the plantar plate in lesser metatarsophalangeal joint stability has increasingly been recognized. Tearing or attenuation of the plantar plate often will result in crossover or hammertoe deformity with hyperextension of the MTP joint. Some patients are able to have resolution of painful symptoms with conservative treatment but for those that fail these measures, surgical fixation of the plantar plate is indicated. While, there have been some described techniques for direct repair of the plantar plate, we present a surgical technique through a dorsal approach with a Weil osteotomy which accomplishes great clinical correction of the plantar plate tear and associated toe deformity as well as relief of patient's pain. Additionally, we believe this technique is safe, efficient and reproducible. Level V, expert opinion.
Foot & ankle international, 2014
The operative treatment for the moderate to severe bunion continues to present challenges. The in... more The operative treatment for the moderate to severe bunion continues to present challenges. The indications for a single, double, or triple first ray osteotomy remain controversial. In addition, it is not clear whether an opening wedge osteotomy leads to clinically relevant arthritis at the first metatarsophalangeal joint. However, it is this theoretical concern that has led the authors to develop an isometric correction of the first ray. Thirty-two patients underwent operative correction of hallux valgus with a double osteotomy of the first metatarsal using an opening wedge proximally and a closing wedge distally. The mean follow-up period was 59.3 months with a range of 55 to 65 months. The 1-2 intermetatarsal angle preoperatively was a mean of 18.9 degrees (range 17-23), correcting postoperatively to a mean angle of 8.6 degrees (range 5-12), for an average correction of 10.4 degrees (range 6-16). The postoperative AOFAS scores were 39.4 out of 40 points for pain, 42.4 out of 45 po...
The Proximal Opening Wedge Osteotomy for the Correction of Hallux Valgus Deformity
Techniques in Foot & Ankle Surgery, 2008
... Special Focus. The Proximal Opening Wedge Osteotomy for the Correction of Hallux Valgus Defor... more ... Special Focus. The Proximal Opening Wedge Osteotomy for the Correction of Hallux Valgus Deformity. Watson, Troy S. MD 1 ; Shurnas, Paul S. MD 2. ... Address correspondence and reprint requests to Troy S. Watson, MD, 2800 E Desert Inn Rd, Suite 100, Las Vegas, NV 89121. ...
Distal tarsal tunnel release with partial plantar fasciotomy for chronic heel pain: an outcome analysis
Foot & ankle international, 2002
This study evaluated the effectiveness of distal tarsal tunnel release with a partial plantar fas... more This study evaluated the effectiveness of distal tarsal tunnel release with a partial plantar fasciotomy for chronic subcalcaneal pain syndrome in patients who failed nonoperative management through a retrospective review of all patients undergoing this procedure between 1994 and 1999. Distal tarsal tunnel release and a partial plantar fasciotomy were offered only to those patients with disabling heel pain and were performed under general anesthesia or ankle block. Seventy-five patients (80 heels), averaging 20 months of nonoperative treatment, were identified (group I). Postoperative outcome questionnaires (SF-36 and Foot Function Index [FFI]) were sent to these patients and 44 (46 heels) responded (group II). In group I, 88% of patients had a good to excellent result. Many continued with mild to moderate residual symptoms, which typically did not limit their activity. In group II, 91% of patients were somewhat to very satisfied with their outcome. Visual analogue scale scores for ...
Treatment of Chronic Achilles Tendon Ruptures with an Acellular Dermal Matrix Augmentation
The Achilles Tendon, 2008
20 Treatment of Chronic Achilles Tendon Ruptures with an Acellular Dermal Matrix Augmentation Tro... more 20 Treatment of Chronic Achilles Tendon Ruptures with an Acellular Dermal Matrix Augmentation Troy S. Watson and James A. Nunley Although Achilles tendon repairs have been augmented using fascia lata, gas-trocnemius flaps, plantaris tendon grafts, the palmaris longus ...
Pulsed Ho:YAG laser meniscectomy: Effect of pulsewidth on tissue penetration rate and lateral thermal damage
Lasers in Surgery and Medicine, 1995
Studies need to define the optimal parameters under which the holmium laser should operate for ar... more Studies need to define the optimal parameters under which the holmium laser should operate for arthroscopic meniscectomy. This study was designed to analyze the effect of various Holmium wavelength pulsewidths on human meniscal tissue penetration rates and lateral thermal injury. Using a pulsed Holmium: YAG laser at a wavelength of 2.1 microns, the effect of various pulse-widths on tissue penetration rates as well as the degree of accompanying thermal damage in human meniscal tissue was evaluated in a specially designed jig. Holding the energy constant at 500 mJ per pulse, the pulsewidth was varied between 100 and 600 microseconds. Fiber penetration of meniscal tissue was found to be fastest at a pulsewidth of 250 microseconds. As the pulsewidth was increased or decreased around this number, the observed penetration time decreased, although no statistical difference was found. The size of the hole created was inversely related to the penetration time. Microscopic examination revealed zones of lateral thermal effect extending 800 microns from the ablation site. No relationship between the pulsewidth and the lateral thermal effect could be found.
Proximal First Metatarsal Opening Wedge Osteotomy with a Low Profile Plate
Foot & Ankle International, 2009
Many surgical procedures have been described for the correction of metatarsus primus varus associ... more Many surgical procedures have been described for the correction of metatarsus primus varus associated with hallux valgus deformity. The purpose of this study was to present the results of the proximal metatarsal opening wedge (PMOW) osteotomy using the Arthrex LPS(R) first metatarsal system. Eighty-four patients (90 feet) underwent PMOW osteotomy with distal bunionectomy. There were 78 patients (93%) and 84 (93%) feet available for followup. Mean followup was 2.4 (range, 2.0 to 3.2) years from the time of the index surgery. Pre- and postoperative clinical examination, level of activity, patient derived subjective satisfaction score, radiographic measurements, and visual analogue scale (VAS) score for pain were obtained and evaluated retrospectively. The mean preoperative VAS score was 5.9 (+/- 2.2), compared with a mean postoperative score of 0.5 (+/- 0.8). The mean 1-2 IMA preoperatively was 14.5 (+/-3.3) degrees, compared with postoperative measurements of 4.6 (+/- 2.8) degrees. The mean hallux valgus angle (HVA) improved from a mean of 30 (range, 22 to 64) degrees preoperatively to 10 (range, -15 to +18) degrees. The mean time to radiographic union was 5.9 (range, 4 to 14) weeks. There was one nonunion, one delayed union, mild hallux varus in two patients, severe hallux varus in two patients, recurrent hallux valgus in three patients (including the nonunion) and no instances of plate failure there was no significant difference in mean preoperative (74.8 degrees +/- 11) compared to postoperative (67.9 degrees +/- 10) total MTP joint range of motion. Ninety percent of patients reported good to excellent subjective results after the index surgery. We believe PMOW osteotomy was near ideal in terms of reliable, predictable correction and healing. Length of the first metatarsal was maintained and patients ambulated safely in a CAM walking boot immediately after surgery. We believe a first web space release may result in hallux varus and increased distal metatarsal articular angle (DMAA) was associated with hallux valgus recurrence.
Presidential Welcome and Announcements
Brief functional analysis and treatment of a vocal tic
Journal of Applied Behavior Analysis, Feb 1, 1998
This study sought to extend functional methodology to the assessment and treatment of habits. Aft... more This study sought to extend functional methodology to the assessment and treatment of habits. After a descriptive assessment indicated that coughing occurred while eating, a brief functional analysis suggested that social attention was the maintaining variable. Results demonstrated that treatment, derived from the assessment and analysis data, rapidly eliminated the cough. We discuss the appropriateness of using functional analysis procedures for deriving treatments for habits in a clinical setting.
Periarticular injuries to the hallux metatarsophalangeal joint in athletes
Foot and Ankle Clinics of North America
The magnitude of hallux MTP injuries can range from a mild sprain to a frank dislocation. The imp... more The magnitude of hallux MTP injuries can range from a mild sprain to a frank dislocation. The importance of coaches, trainers, and physicians recognizing the severity of a turf toe injury cannot be overstated. The late sequelae of hyperextension injuries can lead to retirement from professional athletics. With appropriate conservative treatment, most individuals can return to play, although many have some residual pain. Future study in this area should define the indications for acute repair versus late treatment following a period of conservative modalities. Hyper-plantarflexion injuries also can be debilitating injuries, but most respond to rest, taping, anti-inflammatories, ice, and strengthening exercises. Lastly, dislocations of the hallux MTP joint can be diagnosed and treated after physical examination and appropriate radiographs are obtained. All closed dislocations should undergo an attempt at reduction in the emergency department after adequate anesthesia is administered. The patient should be advised, especially in type I injuries, of the need for possible acute operative intervention.
Treatment of Lisfranc joint injury: current concepts
The Journal of the American Academy of Orthopaedic Surgeons, 2010
Injuries to the tarsometatarsal joint complex, also known as the Lisfranc joint, are relatively u... more Injuries to the tarsometatarsal joint complex, also known as the Lisfranc joint, are relatively uncommon. However, the importance of an accurate diagnosis cannot be overstated. These injuries, especially when missed, may result in considerable long-term disability as the result of posttraumatic arthritis. A high level of suspicion, recognition of the clinical signs of injury, and appropriate radiographic studies are needed for correct diagnosis. When surgery is indicated, closed reduction with percutaneous screw fixation should be attempted. If reduction is questionable, open reduction should be performed. Screw fixation remains the traditional fixation technique.
Dorsal Approach for Plantar Plate Repair With Weil Osteotomy: Operative Technique
Foot & ankle international, Jan 21, 2014
In recent years, the role of the plantar plate in lesser metatarsophalangeal joint stability has ... more In recent years, the role of the plantar plate in lesser metatarsophalangeal joint stability has increasingly been recognized. Tearing or attenuation of the plantar plate often will result in crossover or hammertoe deformity with hyperextension of the MTP joint. Some patients are able to have resolution of painful symptoms with conservative treatment but for those that fail these measures, surgical fixation of the plantar plate is indicated. While, there have been some described techniques for direct repair of the plantar plate, we present a surgical technique through a dorsal approach with a Weil osteotomy which accomplishes great clinical correction of the plantar plate tear and associated toe deformity as well as relief of patient's pain. Additionally, we believe this technique is safe, efficient and reproducible. Level V, expert opinion.
Foot & ankle international, 2014
The operative treatment for the moderate to severe bunion continues to present challenges. The in... more The operative treatment for the moderate to severe bunion continues to present challenges. The indications for a single, double, or triple first ray osteotomy remain controversial. In addition, it is not clear whether an opening wedge osteotomy leads to clinically relevant arthritis at the first metatarsophalangeal joint. However, it is this theoretical concern that has led the authors to develop an isometric correction of the first ray. Thirty-two patients underwent operative correction of hallux valgus with a double osteotomy of the first metatarsal using an opening wedge proximally and a closing wedge distally. The mean follow-up period was 59.3 months with a range of 55 to 65 months. The 1-2 intermetatarsal angle preoperatively was a mean of 18.9 degrees (range 17-23), correcting postoperatively to a mean angle of 8.6 degrees (range 5-12), for an average correction of 10.4 degrees (range 6-16). The postoperative AOFAS scores were 39.4 out of 40 points for pain, 42.4 out of 45 po...
The Proximal Opening Wedge Osteotomy for the Correction of Hallux Valgus Deformity
Techniques in Foot & Ankle Surgery, 2008
... Special Focus. The Proximal Opening Wedge Osteotomy for the Correction of Hallux Valgus Defor... more ... Special Focus. The Proximal Opening Wedge Osteotomy for the Correction of Hallux Valgus Deformity. Watson, Troy S. MD 1 ; Shurnas, Paul S. MD 2. ... Address correspondence and reprint requests to Troy S. Watson, MD, 2800 E Desert Inn Rd, Suite 100, Las Vegas, NV 89121. ...
Distal tarsal tunnel release with partial plantar fasciotomy for chronic heel pain: an outcome analysis
Foot & ankle international, 2002
This study evaluated the effectiveness of distal tarsal tunnel release with a partial plantar fas... more This study evaluated the effectiveness of distal tarsal tunnel release with a partial plantar fasciotomy for chronic subcalcaneal pain syndrome in patients who failed nonoperative management through a retrospective review of all patients undergoing this procedure between 1994 and 1999. Distal tarsal tunnel release and a partial plantar fasciotomy were offered only to those patients with disabling heel pain and were performed under general anesthesia or ankle block. Seventy-five patients (80 heels), averaging 20 months of nonoperative treatment, were identified (group I). Postoperative outcome questionnaires (SF-36 and Foot Function Index [FFI]) were sent to these patients and 44 (46 heels) responded (group II). In group I, 88% of patients had a good to excellent result. Many continued with mild to moderate residual symptoms, which typically did not limit their activity. In group II, 91% of patients were somewhat to very satisfied with their outcome. Visual analogue scale scores for ...
Treatment of Chronic Achilles Tendon Ruptures with an Acellular Dermal Matrix Augmentation
The Achilles Tendon, 2008
20 Treatment of Chronic Achilles Tendon Ruptures with an Acellular Dermal Matrix Augmentation Tro... more 20 Treatment of Chronic Achilles Tendon Ruptures with an Acellular Dermal Matrix Augmentation Troy S. Watson and James A. Nunley Although Achilles tendon repairs have been augmented using fascia lata, gas-trocnemius flaps, plantaris tendon grafts, the palmaris longus ...
Pulsed Ho:YAG laser meniscectomy: Effect of pulsewidth on tissue penetration rate and lateral thermal damage
Lasers in Surgery and Medicine, 1995
Studies need to define the optimal parameters under which the holmium laser should operate for ar... more Studies need to define the optimal parameters under which the holmium laser should operate for arthroscopic meniscectomy. This study was designed to analyze the effect of various Holmium wavelength pulsewidths on human meniscal tissue penetration rates and lateral thermal injury. Using a pulsed Holmium: YAG laser at a wavelength of 2.1 microns, the effect of various pulse-widths on tissue penetration rates as well as the degree of accompanying thermal damage in human meniscal tissue was evaluated in a specially designed jig. Holding the energy constant at 500 mJ per pulse, the pulsewidth was varied between 100 and 600 microseconds. Fiber penetration of meniscal tissue was found to be fastest at a pulsewidth of 250 microseconds. As the pulsewidth was increased or decreased around this number, the observed penetration time decreased, although no statistical difference was found. The size of the hole created was inversely related to the penetration time. Microscopic examination revealed zones of lateral thermal effect extending 800 microns from the ablation site. No relationship between the pulsewidth and the lateral thermal effect could be found.
Proximal First Metatarsal Opening Wedge Osteotomy with a Low Profile Plate
Foot & Ankle International, 2009
Many surgical procedures have been described for the correction of metatarsus primus varus associ... more Many surgical procedures have been described for the correction of metatarsus primus varus associated with hallux valgus deformity. The purpose of this study was to present the results of the proximal metatarsal opening wedge (PMOW) osteotomy using the Arthrex LPS(R) first metatarsal system. Eighty-four patients (90 feet) underwent PMOW osteotomy with distal bunionectomy. There were 78 patients (93%) and 84 (93%) feet available for followup. Mean followup was 2.4 (range, 2.0 to 3.2) years from the time of the index surgery. Pre- and postoperative clinical examination, level of activity, patient derived subjective satisfaction score, radiographic measurements, and visual analogue scale (VAS) score for pain were obtained and evaluated retrospectively. The mean preoperative VAS score was 5.9 (+/- 2.2), compared with a mean postoperative score of 0.5 (+/- 0.8). The mean 1-2 IMA preoperatively was 14.5 (+/-3.3) degrees, compared with postoperative measurements of 4.6 (+/- 2.8) degrees. The mean hallux valgus angle (HVA) improved from a mean of 30 (range, 22 to 64) degrees preoperatively to 10 (range, -15 to +18) degrees. The mean time to radiographic union was 5.9 (range, 4 to 14) weeks. There was one nonunion, one delayed union, mild hallux varus in two patients, severe hallux varus in two patients, recurrent hallux valgus in three patients (including the nonunion) and no instances of plate failure there was no significant difference in mean preoperative (74.8 degrees +/- 11) compared to postoperative (67.9 degrees +/- 10) total MTP joint range of motion. Ninety percent of patients reported good to excellent subjective results after the index surgery. We believe PMOW osteotomy was near ideal in terms of reliable, predictable correction and healing. Length of the first metatarsal was maintained and patients ambulated safely in a CAM walking boot immediately after surgery. We believe a first web space release may result in hallux varus and increased distal metatarsal articular angle (DMAA) was associated with hallux valgus recurrence.
Presidential Welcome and Announcements