Journal of the American Podiatric Medical Association最新文献

Background: Completion of patient-reported outcome measures (PROMs) is labor-intensive but paramount in improving patient-centered care, allowing for advancement of techniques and scrutinization of outcomes. We report the feasibility of PROM collection and reporting for patients seen in a high-volume, multidisciplinary, tertiary limb salvage center to determine pain and functionality outcomes.

Methods: The center received grant funding resources for large-scale PROM collection. Patients completed either tablet or paper surveys. Functionality and pain PROMs included 1) Neuro-QoL Lower Extremity Function-Mobility, 2) Numerical Rating Scale, 3) Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity, and 4) PROMIS Pain Interference. Research assistants attended clinic daily to administer surveys. Patients were categorized into the following groups: amputation, flap reconstruction, other surgical management, and nonsurgical management.

Results: Five hundred sets of each survey were administered to 420 patients across 2 months, with 16% of patients (n = 80) completing multiple sets at separate visits. The completion rate among eligible patients was 90% or greater for each PROM. Of the respondents, 133 (31.7%) were seen for previous amputation, 32 (7.6%) for local or free flap reconstruction, 68 (16.2%) for other surgical management (eg, debridement, arthroplasty), and 295 (70.2%) for nonsurgical management (eg, lymphedema, hidradenitis).

Conclusions: We report that integration of PROM collection in a high-volume limb salvage center is feasible. These metrics allow measurement of the impact and effectiveness of salvage or amputation surgeries from patients' perspectives, providing quantification of satisfaction and aspects of health-related quality of life, improved patient advocacy, and an evidence-based approach to surgical management.

Background: Recently, an increasing number of resistant-to-terbinafine dermatophytosis cases have been reported. Thus, identifying an alternative antifungal agent that possesses broad-spectrum activity, including against resistant strains, is needed.

Methods: We compared the antifungal activity of efinaconazole with that of fluconazole, itraconazole, and terbinafine against clinical isolates of dermatophytes, Candida, and molds using in vitro assays. Minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) of each antifungal agent were quantified and compared. Susceptible and resistant clinical isolates of Trichophyton mentagrophytes (n = 16), Trichophyton rubrum (n = 43), Trichophyton tonsurans (n = 18), Trichophyton violaceum (n = 4), Candida albicans (n = 55), Candida auris (n = 30), Fusarium spp, Scedosporium spp, and Scopulariopsis spp (n = 15 for each) were tested.

Results: Efinaconazole was the most active antifungal agent tested against dermatophytes, with MIC50 and MIC90 (concentrations that inhibited 50% and 90% of strains tested, respectively) values of 0.002 and 0.03 µg/mL, respectively. Fluconazole, itraconazole, and terbinafine showed MIC50 and MIC90 values of 1 and 8 µg/mL, 0.03 and 0.25 µg/mL, and 0.03 and 16 µg/mL, respectively. Against Candida isolates, efinaconazole MIC50 and MIC90 values were 0.016 and 0.25 µg/mL, respectively, whereas fluconazole, itraconazole, and terbinafine had MIC50 and MIC90 values of 1 and 16 µg/mL, 0.25 and 0.5 µg/mL, and 2 and 8 µg/mL, respectively. Against various mold species, efinaconazole MIC values ranged from 0.016 to 2 µg/mL versus 0.5 to greater than 64 µg/mL for the comparators.

Conclusions: Efinaconazole showed superior potent activity against a broad panel of susceptible and resistant dermatophyte, Candida, and mold isolates.

Background: As the incidence of diabetes mellitus increases, the incidence of diabetic foot also increases. This situation, which may lead to devastating complications and progress to limb loss for patients, exposes patients and their social environments to a big crisis. Thus, patients may seek secondary opinions from online sources about information they initially obtained from health institutions. We aimed to evaluate the information content related to diabetic foot on the Internet that is probably used by patients for Internet searching.

Methods: After software optimization and reset, related queries with the keyword diabetic foot were determined on Google Trends. Selected keywords were searched in three search engines, and the results were examined. Web sites were classified into five subcategories (nongovernmental health institution, governmental institution, academic, blog, and university) and evaluated with an information content scale (ICS) based on the literature, Journal of the American Medical Association benchmark criteria, the Flesch-Kincaid readability test, and presence of the Health On the Net Foundation Code of Conduct certificate. The search engines, keywords, and Web site subcategories were investigated with the evaluation criteria.

Results: In terms of finding Web sites eligible for assessment, the Google search engine listed more eligible Web sites than did Bing and Yahoo. Concerning the ICS, there was no significant difference between search engines for total scores (P > .05). Concerning ICS diagnosis and evaluation and ICS total score, academic Web sites scored significantly higher than other subcategories.

Conclusions: Results that can be obtained with an Internet search for diabetic foot depend on the proper keyword selection, Web site type, and search engine to help patients reach more appropriate content.

Background: Isolated medial malleolar fractures are observed less often than are lateral malleolar fractures, bimalleolar fractures, and trimalleolar fractures. The aim of treatment is to provide anatomical reduction, protect this reduction until the fracture heals, and to regain normal ankle function. The aim of our study was to evaluate the clinical and radiological outcomes of patients with isolated medial malleolus fracture treated with cross-screw fixation.

Methods: The study included 13 patients: 9 males with a mean age of 37.1 years (range, 25-64 years) and 4 females with a mean age of 40.2 years (range, 24-62 years) who were treated with the cross-screw fixation method for an isolated medial malleolar fracture. The fracture union status was evaluated on the 3-month postoperative radiographs, and the functional outcomes with the American Orthopaedic Foot and Ankle Scale (AOFAS) ankle score.

Results: The mean AOFAS score was 82 at 3 months postoperatively, evaluated as an excellent outcome in 2 patients, good in 9, and fair in 2. At the 24th month postoperatively, the mean AOFAS score was determined to be 92.2, evaluated as excellent in 11 patients and good in 2. On palpation of the medial malleolus, the mean VAS pain score was 2 (range, 1-3.8) at 3 months postoperatively, and a mean of 0.6 (range, 0.2-3) at 24 months.

Conclusions: Cross-screw fixation can be preferred for the fixation of isolated medial malleolar fractures as it causes less soft-tissue damage because it can be performed percutaneously, and the screw head has a low profile, thereby eliminating the need for a Kirschner wire to be applied together with the screw to prevent rotational deformity.

Pathologic fractures and marrow lesions of bones in the human foot and ankle can occur secondary to a variety of risk factors. The calcaneus is a rearfoot bone that provides support during weightbearing activities and walking. Although low-risk stress injuries to the bones in the foot and ankle are predominantly treated conservatively in low-demand patients, there are situations where surgical intervention is warranted. Surgical treatment options for calcaneal bone marrow lesions (BML) secondary to stress fractures are dearth with limited evidence supporting the use of the subchondroplasty (SCP) technique. This case report discusses surgical treatment with SCP of a chronic calcaneal BML sustained secondary to a insufficiency/fragility fracture.

Background: Recent advancements in minimally invasive surgery for correction of hallux abductovalgus has increased the popularity of this technique. To date, the incidence of complications with this updated technique has not been evaluated.

Methods: The purpose of this systematic review was to determine the incidence of complications of third-generation minimally invasive chevron osteotomy, with or without an Akin osteotomy, for the correction of hallux abductovalgus. We conducted a systematic review of electronic databases and relevant peer-reviewed sources as outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for the preparation of systematic reviews. Studies that reported hallux abductovalgus deformities corrected with minimally invasive surgery and fixated with one or two screws, provided detailed descriptions of all complications, and had mean follow-up of 12 months or more were included.

Results: Of 80 studies identified, nine (11.25%) met the inclusion criteria (N = 766 feet). Three of these studies were prospective and involved 426 feet. The weighted mean age for the entire cohort was 50.88 years (17-87 years), and the weighted mean follow-up was 27.65 months (12-66 months). The total incidence of complications was 21.28% (163 of 766 feet). Among the most reported complications were reoperation, postoperative infection, reoccurrence of hallux abductovalgus, and nerve injury.

Conclusions: This systematic review revealed that this updated minimally invasive surgery technique provides a safe and reproducible surgical option to correct hallux abductovalgus deformities, with an incidence of complications comparable with that of open correction for this forefoot deformity.

Background: The primary aim of this study is to examine the effect of the stiffness of rehabilitation material on muscle activation in individuals with low medial longitudinal arch. The secondary aim is to compare the effects of single-leg balancing and single-leg squat exercises on the activation of the muscles around the ankle in the same individuals.

Methods: Twelve individuals with low medial longitudinal arch and 18 healthy control participants were included. Participants were asked to perform the single-leg balance and single-leg squat exercises on Theraband stability trainers of three different stiffness levels. Activation of the peroneus longus, peroneus brevis, tibialis anterior, medial and lateral gastrocnemius muscles during exercises was evaluated by surface electromyography.

Results: The single-leg balancing exercise performed on soft and very soft ground was more effective than single-leg squat in increasing the activation of the lateral gastrocnemius muscle in participants with a low medial longitudinal arch. It was determined that performing single-leg squat exercise on a very soft surface instead of hard ground caused more muscular activation in the peroneus brevis, tibialis anterior, and medial gastrocnemius in the same individuals.

Conclusions: The exercise progression to be applied on different surfaces to increase the activation of the muscles around the ankle in individuals with a low medial longitudinal arch and in healthy individuals without a low medial longitudinal arch was different.

Background: Reamputations are frequent after minor amputations performed for diabetic foot osteomyelitis (DFO). Whether the type of amputation is associated with a particular outcome is unknown. The aim of this study was to evaluate whether amputations of the transarticular compared with the transosseous type have different rates of clinical and microbiological failure.

Methods: We actively followed 284 patients with DFO (543 episodes of minor foot amputations: 203 transarticular and 340 transosseous) for 1 year. We assessed the long-term effect of transarticular compared with transosseous amputations on the rates of clinical and microbiological failure using comparative statistics, log-rank survival analyses, Kaplan-Meier curves, and multivariate Cox regressions.

Results: In 122 episodes (22.5%) there was clinical failure that led to reamputation. The difference in the risk of clinical failure of transarticular versus transosseous amputations was nonsignificant (44 [21.7%] versus 78 [22.9%]; Pearson χ2 test: P = .73). Similarly, the difference in microbiological failure (32 episodes, 5.9% overall) between groups was nonsignificant (11 [5.4%] and 21 [6.2%], respectively; P = .72). The mean time between the index surgery and clinical failure was 2.2 months for transarticular and 3.2 months for transosseous amputations (Mann-Whitney U test; P = .39). Survival analyses showed similar evolutions for each group (log-rank test; P = .85). In the multivariate Cox regression analysis, the type of amputation did not significantly influence clinical or microbiological failures.

Conclusions: In DFO, there is no significant difference between transarticular and transosseous amputations within 1 year in the incidence of clinical or microbiological failures.

Background: We compared the effectiveness of metatarsal osteotomy, specifically using the osteoclasis (OC) technique, with that of metatarsal head resection (MHR) in healing distal metatarsal plantar ulcers.

Methods: This retrospective study reviewed patients who underwent OC or MHR for the treatment of submetatarsal ulcers between January 1, 2014, and December 31, 2017. Patients with infected ulcers or osteomyelitis were excluded. A 1-year follow-up was used to evaluate the results.

Results: Of the 31 study patients (seven women and 24 men; mean ± SD age, 55.3 ± 11.7 years), 17 underwent MHR and 14 underwent OC. All of the patients had diabetic neuropathy and distal submetatarsal ulcer. Four of 17 patients in the MHR group and three of 14 patients in the OC group had moderate peripheral vascular disease. All of the patients in the MHR group healed their ulcers in a mean ± SD of 5.8 ± 2.3 weeks. During 12-month follow-up of the MHR group, one patient needed revision, one developed a transfer ulcer, and two developed toe ulcers. In the OC group, all of the patients healed after surgery in a mean ± SD of 4.2 ± 1.8 weeks. During the 12-month follow-up of the OC group, one patient developed Charcot's neuropathy and two developed transfer ulcers.

Conclusions: For metatarsal head neuropathic ulcers, both OC and MHR achieved healing in a relatively short time, with few complications. A prospective study with a larger patient population is needed to better compare the two procedures.

Background: Results of recent studies suggest that high levels of endogenous testosterone decrease the risk of diabetes. Testosterone therapy may delay the transition from prediabetes to diabetes and accelerate healing of diabetic foot ulcers in hypogonadal men. We investigated whether testosterone therapy in this population decreases the occurrence of diabetic foot complications within 1 and 5 years of diabetes diagnosis.

Methods: Optum's deidentified Clinformatics Data Mart database was searched for male patients with diabetes. Associations between testosterone therapy and the occurrence of ulceration or the use of wound care were explored in the entire population and in those with and without hypogonadism using both bivariate and multivariate analyses.

Results: Contrary to the hypotheses, testosterone therapy seems to confer increased risk of diabetic foot complications. In hypogonadal men with at least 1 year of follow-up after diabetes diagnosis, any use of testosterone therapy increased the odds of wound care utilization by a factor of 1.10 (95% confidence interval, 1.03-1.17), and the odds of ulceration by a factor of 1.13 (95% confidence interval, 1.03-1.24). Similar results are seen in all men, both with and without hypogonadism. Further exploration reveals that hypogonadism also increases the risk of wounds among people with diabetes with care utilization in the entire population.

Conclusions: Further research is needed to elucidate the mechanisms by which hypogonadism and testosterone therapy impact diabetic foot complications, and whether these mechanisms are mediated by vascular or neurologic factors.