Journal of the American Podiatric Medical Association最新文献

This case report aims to demonstrate a rare occurrence of tendon rupture attributable to levofloxacin use in Helicobacter pylori eradication. On the seventh day of treatment, the patient experienced severe foot pain and difficulty in walking, leading to a diagnosis of Achilles tendon rupture confirmed through magnetic resonance imaging. Levofloxacin-induced tendinopathy and/or rupture are rare complications that are often linked to age and sex. Health-care providers should exercise caution when prescribing fluoroquinolones, especially to at-risk patients, and should inform them about potential side effects.

Background: The formation of heterotopic ossification (HO) is a common complication after transosseous partial foot amputation. Development of HO in weightbearing and/or superficial areas can lead to increased pressures, which increases the likelihood of wound formation and pain. Current treatment modalities for HO of the foot include mechanical off-loading and surgical resection; however, prophylactic measures such as nonsteroidal anti-inflammatory drugs, bisphosphonates, and other medical therapies have been attempted previously with mixed efficacy. Radiation therapy is another prophylactic method that may be used for the prevention of HO in patients after transosseous partial foot amputation.

Methods: The present case series evaluated ten patients who underwent transosseous partial foot amputation for HO resection immediately followed by single low-dose radiation treatment. All of the patients received radiation between 700 and 800 cGy, with 6 MV photons directed at the area of concern within 48 hours of surgery.

Results: Postoperatively, 10% of patients had HO recurrence, 80% remained fully weightbearing, 90% went on to primarily heal their surgical incisions, and 80% had postoperative pain relief; however, 30% went on to below-the-knee amputation due to chronic pain and/or infectious or nonfunctional pathology.

Conclusions: Radiation therapy is a relatively available and safe modality for the prevention of HO that may be used prophylactically in cases of high suspicion of or known HO formation of the foot.

Background: Many factors, such as decreased spinal mobility, pain, and dysfunction can affect gait parameters in patients with ankylosing spondylitis. The purpose of this study was to investigate the effects of plantar fascia enthesitis and disease-specific measurements on gait parameters in patients with ankylosing spondylitis.

Methods: The Win-Track platform was used to evaluate spatiotemporal parameters in patients with ankylosing spondylitis and in healthy controls. The Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Bath Ankylosing Spondylitis Function Index (BASFI) were used for disease-related parameters in patients with ankylosing spondylitis, respectively. Tendon thickness in the plantar fascia was measured using ultrasound to evaluate enthesitis.

Results: Thirty-one patients with ankylosing spondylitis and 31 healthy participants were included in the study. Cadence and step-cycle duration had a significant relationship with enthesitis for all regions and disease-related measurements. In addition, step length had a significant relationship with enthesitis for the midfoot and metatarsal bones, BASMI, and BASDAI; the left step length had a significant relationship with enthesitis in the calcaneus. The double-support phase had a significant relationship with enthesitis and BASMI. In the regression analysis, a significant relationship was found between BASDAI and step cycle time. A significant correlation was observed between all ultrasonographic parameters and cadence and stride cycle time values.

Conclusions: Impaired gait parameters were found in ankylosing spondylitis patients, and we concluded that plantar fascia enthesitis, function, disease activity, and spinal mobility affect gait parameters for these patients. Therefore, therapy for enthesitis, and adding foot rehabilitation to the routine program should be considered for patients with ankylosing spondylitis.

Background: We sought to determine the wound complications associated with a straight midline incision overlying the Achilles tendon. Data on sex, age, body mass index (BMI), surgery performed, date of surgery, and wound development were collected.

Methods: We retrospectively collected data on 217 patients with a mean ± SD age of 46.16 ± 13.72 years and follow-up of 9.1 ± 12.42 months. The specific procedures performed with this incision included repair of ruptured Achilles tendon (n = 89), Haglund deformity correction (n = 75), and flexor hallucis longus tendon transfer (n = 63). Wound complication was defined as a delay in wound healing with necrosis of the incisional margins resulting in exposure of superficial or deep layers. Deep infection was defined as the need for intravenous antibiotics.

Results: We reported 15 wound complications (6.91%): ten (4.6%) were superficial and five (2.3%) were deep. All five patients with deep wound complications required operative debridement, and four patients required intravenous antibiotics. The infection rate of the midline incisional approach was 1.83%. Superficial wound complications were treated with local care and oral antibiotics, as necessary. There were no significant differences between age (P = .5986; P < .05), BMI (P = .7968; P < .05), smoking history (P = .6356; P < .05), or length of follow-up (P = .8338; P < .05). The overall wound rate of 6.91% is comparable with other literature with larger cohorts.

Conclusions: These results will help us better educate surgeons about the risk of wound development with the posterior midline Achilles tendon incision.

Total contact casting is the gold standard for plantar foot ulcers but has been questioned in heel pressure ulcers. Current offloading of heel ulcers is typically removable offloading boots. We describe using a modified posterior splint to offload heel ulcers in nonweightbearing patients. The posterior splint is readily available and familiar to practitioners, with less of a learning curve than a total contact cast. As part of the dressing, the posterior splint is less likely to be removed and leads to increased compliance. We hypothesize that this can translate to improved healing of pressure ulcers at the heel.

Background: This study aimed to evaluate and compare stiffness and load to failure values of a novel medial malleolus compression plate (MP) and a 3.5-mm one-third tubular plate (TP) in the treatment of vertical shear fractures of the medial malleolus.

Methods: Fourteen identical synthetic third-generation composite polyurethane bone models of the right distal tibia were randomly separated into two groups. Fracture models were created with a custom-made osteotomy guide to provide the same fracture characteristics in every sample (AO/OTA type 44A2). Fractures were reduced, and a novel MP was applied to bone models in the MP group and a TP was applied in the TP group. All of the samples were evaluated biomechanically, and force/displacement and load to failure values were recorded.

Results: The force required to create displacement in the MP group was twice of that in the TP group. There was a significant difference between the two groups in all of the amounts of displacement (P = .006, P = .005, P = .007 and P = .015 for 0.5, 1.0, 1.5, and 2.0 mm, respectively).

Conclusions: In the treatment of vertical shear fractures of the medial malleolus, the strength of fixation with the novel MP is biomechanically higher than that with the one-third semi-TP.

Tissue selective ultrasonic debridement is a new method of debriding chronic wounds that prepares the wound for advanced tissue application. This article presents the case of an 89-year-old woman with a chronic nonhealing wound to her lateral distal leg. The wound had a significant amount of biofilm and fibrous slough. Conservative treatment consisting of debridement and multilayer compression was attempted for 4 weeks. After 4 weeks, the patient was taken to the operating room for tissue selective ultrasonic debridement with placement of cryopreserved human skin allograft. With local wound care and multiple applications of graft, the chronic wound fully epithelialized. This study highlights the use of tissue selective ultrasonic debridement combined with cryopreserved human skin allograft to successfully heal a chronic wound. To our knowledge, this method of operative debridement and application of graft has not been documented in the literature.

Background: The aim of study was to biomechanically compare the fixation of Jones fracture using headless cannulated screw, tension band, and two Kirschner wires.

Methods: A total of 60 fourth-generation, fifth metatarsal synthetic bone models were divided into three groups according to the fixation techniques. A vertical load, oriented from plantar to dorsal and lateral to medial, was applied to the metatarsal specimen that were potted with molding material. The stiffness and fatigue values were compared between the three fixation groups.

Results: In the plantar to dorsal load test, the stiffness values were found to be significantly higher in Group 1 compared to the other groups (P = .034, P = .013). No significant difference was found in the analysis in terms of fatigue values in plantar to dorsal load testing (P = .348, P = .416). No significant difference was found between compression screw and tension band groups in lateral to medial loading test, in terms of stiffness and fatigue values (P = .096, P = .762). However, the stiffness values and fatigue values of these two groups were found to be statistically significantly higher than the Kirschner wire group (P = .003, P = .002, P = .016, P = .023).

Conclusions: The result of this study showed that the bicortical fixation of headless compression screw provides a more stable fixation than other fixation methods, especially in plantar to dorsal loading.

This case report describes an otherwise healthy 43-year-old female who presented with severe pain, foot drop, and critical limb ischemia to her left foot caused by thrombosis of a peripheral artery secondary to antiphospholipid syndrome. Antiphospholipid syndrome is an autoimmune disease that frequently manifests as recurrent arterial and/or venous thrombotic events, ischemic strokes, and miscarriages. Antiphospholipid syndrome affecting primarily the arteries is less common as compared to venous thrombosis. Our patient underwent several vascular surgical interventions and anticoagulant treatment; despite this, she ultimately underwent a below-the-knee amputation due to worsening ischemia. The purpose of the current case report is to emphasize that antiphospholipid syndrome should be kept on the differential for arterial ischemic events such as critical limb ischemia without another known cause and should be managed with an interprofessional team approach.

Background: The incidence of diabetic foot infections is increasing due to the rising number of persons with diabetes and the prolonged life expectancy. It is vital to differentiate soft-tissue infection (STI) from diabetic foot osteomyelitis (DFO), as treatment modalities and durations vary widely, but this can be challenging. We aimed to assess the blood concentration levels of the high mobility group box 1 protein (HMGB-1) in STI and DFO compared to healthy subjects, and to investigate whether this protein could contribute to differentiating STI from DFO.

Methods: Data from patients with suspected soft-tissue infection or diabetic foot osteomyelitis and healthy volunteers were prospectively recorded. Mean C-reactive protein, erythrocyte sedimentation rate, white blood cell, and HMGB-1 values in the groups were analyzed. Cut-off values of HMGB-1 between the three groups were also determined. A three-phase bone scintigraphy was accepted as the diagnostic method for differentiating STI and DFO.

Results: A total of 92 volunteers, were included in the study. Group 1 comprised 28 healthy individuals who composed the control group. Group 2 comprised the 35 patients diagnosed with STI, and Group 3 comprised 29 patients diagnosed with DFO. The HMGB-1 was significantly higher in DFO. The sensitivity, specificity, and accuracy of HMGB-1 in differentiating between STI and DFO was 55%, 94%, and 77%, respectively.

Conclusions: We concluded that measurement of the serum HMGB-1 level could be an adjunctive test in the differential diagnosis of diabetic foot infections.