Journal of the American Podiatric Medical Association最新文献

Calcified tissue exposed in a leg ulcer can become infected and develop into a nidus of infection leading to sepsis. This case details a patient with a leg wound secondary to skin biopsy. This leg ulceration did not heal due to an underlying calcified mass and led to five hospital admissions for sepsis. She was diagnosed as having calcinosis cutis, which was suspected to be the source of her infections. The calcified mass was resected, and she healed uneventfully without further infections. Calcified soft-tissue masses should be considered in nonhealing leg ulcers and ulcers with multiple recurrent infections. Radiographs can be used to diagnose this condition, and surgical excision can be considered in cases of infection.

Background: We evaluated adverse short-term outcomes after open lower-extremity bypass surgery in patients with diabetes mellitus with a comparison performed based on patient height.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was analyzed to select patients with Current Procedural Terminology codes 35533, 35540, 35556, 35558, 35565, 35566, 35570, and 35571 and with the diagnosis of diabetes mellitus. This resulted in 83 patients 60 inches or less in height, 1,084 between 60 and 72 inches, and 211 patients 72 inches and taller.

Results: No differences were observed among groups with respect to the development of a superficial surgical site infection (9.6% versus 6.4% versus 5.7%; P = .458), deep incisional infection (1.2% versus 1.4% versus 2.8%; P = .289), sepsis (2.4% versus 2.0% versus 2.8%; P = .751), unplanned reoperation (19.3% versus 15.6% versus 21.8%; P = .071), or unplanned hospital readmission (19.3% versus 14.8% versus 17.1%; P = .573). A significant difference was observed among groups in the development of a wound disruption (4.8% versus 1.3% versus 4.7%; P = .001). A multivariate regression analysis was performed of the wound disruption outcome with the variables of age, sex, race, ethnicity, height, weight, current smoker, and open wound/wound infection. Race (P = .025) and weight (P = .003) were found to be independently associated with wound disruption, but height was not (P = .701).

Conclusions: The results of this investigation demonstrate no significant differences in short-term adverse outcomes after lower-extremity bypass surgery based on patient height.

Background: Plantar fasciitis (PF) is becoming an increasingly common source of limitation in people's daily activities. As such, this study sought to investigate the effects of kinesiology taping (KT) and low-Dye taping treatments, used in conjunction with extracorporeal shockwave therapy (ESWT), on pain and function in patients with PF.

Methods: To conduct this randomized controlled study, 45 individuals with PF aged 18 to 65 years were included, with 15 individuals assigned to each group: the KT, low-Dye, and control groups. Pain intensity was evaluated using the visual analog scale, and functionality was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) scale before and after the study. Each group received three sessions of ESWT.

Results: When pretreatment and post-treatment differences were analyzed, first-step pain in the morning, pain with palpation, and pain after prolonged standing were reduced in the KT, low-Dye, and control groups (P < .05 for all). There were differences in the AOFAS total score in the KT (P <.001; r = 2.03), low-Dye (P < .001; r = 1.49), and control (P = .003; r = 0.92) groups. Low-Dye taping was more effective than the control in reducing pain with standing and improving AOFAS function scores (P < .05). Low-Dye taping and KT were effective in improving AOFAS total scores (P < .05) but were not superior to each other (P > .05).

Conclusions: Based on these findings, taping techniques such as KT and low-Dye, combined with conventional treatments such as ESWT, may be beneficial for improving pain and function in individuals with PF. Further randomized controlled trials with longer follow-up are needed to confirm this hypothesis.

Charcot's neuroarthropathy complicated by calcaneal osteomyelitis can be difficult to treat. Various surgical techniques describe how to manage these conditions. Eggshell-type debridement with application of antibiotic-impregnated bone substitute is a viable option that eliminates infected bone and allows staged reconstructive surgery. A 50-year-old woman with right midfoot Charcot's neuroarthropathy presented with osteomyelitis of the cuboid and fourth and fifth metatarsal bases after resection and failed antibiotic therapy. The patient eventually developed adductovarus, septic shock, and hematogenous osteomyelitis of the calcaneus, navicular, and lateral cuneiform. Vacuum-assisted eggshell-type debridement was performed, and the calcaneal defect was filled with antibiotic-impregnated calcium sulfate and calcium phosphate. Eight weeks after the initial surgery, the infection resolved; however, the patient had trouble walking. She underwent staged Charcot's reconstructive surgery with application of a dynamic multiplanar external fixator with gradual deformity and split-thickness skin graft to cover the residual plantar lateral foot wound. The second stage included septic fusion of the midfoot and subtalar joint from the frame. Twelve weeks postoperatively, radiographic union was achieved, the external fixator was removed, and the patient demonstrated a plantigrade foot. She was transitioned to a total-contact cast and allowed to bear weight as tolerated. Eighteen months after the initial procedure, the patient is wound-free and weightbearing in a CROW boot. This innovative eggshell-type debridement technique aspirates osteomyelitic cancellous bone while preserving cortical bone. It can be particularly useful in hematogenous osteomyelitis, where cortical integrity is not breached, or in situations where there is minimal cortical involvement. Specifically preserving the calcaneus, a major weightbearing bone, permits subsequent reconstructive surgical planning. At 18 months, there were no signs of osteomyelitis recurrence.

Background: Plantar keratoma are common hyperkeratinized, deep-seated lesions, often located on weightbearing areas of the foot. Such lesions are frequently associated with pain and disability. Intractable plantar keratomata (IPK) are highly recurrent and, in most patients, require regular, palliative treatment visits with a significant impact on patient time, cost, and quality of life.

Methods: We undertook a retrospective chart review of 9 patients (with a total of 21 lesions) who underwent a minimum of two treatments using microwave therapy to their IPK. Pain levels were assessed at each of their treatments using a 10-point scale and patients were invited for review for follow-up in the following year. A total of seven patients undertook four treatments and were included in the final analysis.

Results: Mean baseline pain scores significantly dropped with each subsequent treatment, equating to a 90.4% mean reduction in pain between the first and fourth visits, with 71.4% of patients reporting a zero-pain rating at their final treatment visit.

Conclusions: The use of microwave therapy has been shown to be effective in producing significant and prolonged pain reduction in a cohort of patients with painful IPK.

Background: To investigate the relationships among nail disorders, various clinical factors, and commonly used quality of life scales.

Methods: A prospective cross-sectional study was conducted on 188 patients older than 18 years who applied to the Dermatology and Venereology Department of Ufuk University Hospital (Ankara, Turkey). The Turkish Quality of Life instrument, the Hospital Anxiety and Depression Scale, and the 36-Item Short-Form Health Survey were used for the analyses. Eight groups were formed based on 1) sex, 2) age (18-45 years, >45 years), 3) duration of nail disease (≤1 year, >1 year), 4) number of affected nails (1, 2, ≥3), 5) type of nail disease (nail thickening, ingrown toenail, pincer nail, and other nail diseases), 6) presence of onychomycosis, 7) fingernail involvement, and 8) pain score (0-5, 6-10), and the quality of life scales were compared between these groups. In addition, correlation analyses were performed between age, number of affected nails, duration of disease, presence of onychomycosis, chronic diseases and medications, and body mass index and the quality of life scale scores.

Results: Nail disorders were associated with decreased quality of life in affected individuals. Moreover, age, duration of disease, type of nail disorder, body mass index, comorbid conditions, and pain scores had significant effects on quality of life scale scores.

Conclusions: Management of nail disorders is challenging, and generally, a long period is necessary to achieve favorable outcomes. Both physcians and patients should be persistent during the treatment process. In addition, emotional and social support should be provided to patients.

Background: Arthroscopy-assisted closed reduction and percutaneous internal fixation is a minimally invasive technique for medial malleolus fracture treatment. The purpose of the study was to assess the quality and functional outcomes of this technique.

Methods: Seventy-eight patients with combined medial malleolus fractures were treated with arthroscopy-assisted closed reduction and percutaneous screw fixation technique. The surgical procedure was described in detail; the clinical efficacy of this method was evaluated in terms of time of operation, postoperative complications, and fracture healing time; and functional outcomes were analyzed.

Results: All of the patients were followed up for a minimum of 12 months without complications of the medial malleolus wound, and all of the medial malleolus fractures healed within 6 to 8 weeks. At the last follow-up, the visual analog scale scores ranged from 0 to 3 and the American Orthopaedic Foot and Ankle Society ankle and hindfoot function scores ranged from 75 to 95.

Conclusions: Arthroscopy-assisted closed reduction and percutaneous internal fixation makes the treatment of medial malleolus fractures less invasive compared with traditional surgical methods and allows simultaneous exploration and management of the articular surface.

Background: Muscle disorders may cause a change in plantar pressures by the misalignment on the foot during gait phases. Therefore, corns or calluses develop at the plantar regions, and diabetic foot ulcers follow for severe cases, although it can be prevented and even treated by podiatric approaches with patient-specific therapeutic insoles and footwear. Although the importance of a threshold value of 200 kPa in peak plantar pressure reduction has been highlighted as a standard to prevent reulceration in the diabetic foot, it may not be possible to ensure this pressure reduction for each patient.

Methods: In this study, three types of ethylene-vinyl acetate have been used to optimize the off-loading performance for predetermined early-stage diabetic foot ulcer scenarios by means of baropodometric plantar pressure analyses and finite element method for each gait phase.

Results: The total cost of the manufacturing for this study was reduced to $10.26 and it was performed in 24.6 minutes. In addition, the off-loaded pressure was increased by 2.3 times and the volume of the off-loading geometry was increased 8.12 times based on the foam polymer used.

Conclusions: Consequently, improved off-loading was obtained and a standard was proposed for the first time to calculate the off-loading performance before manufacturing of the therapeutic insole model to ensure a better recovery period.

Background: Dermatofibroma (DF) is a common benign soft-tissue tumor. It occurs anywhere on the body but is commonly seen on the upper and lower extremities. It is frequently found in young to middle-aged adults and predominantly in females.

Methods: Thirty-one patients with DF on the foot and ankle diagnosed and treated during a 6-year period were characterized.

Results: The patients (16 males, 15 females) were aged 7 to 75 years (average, 55 years). Clinically, 17 patients noted painful symptoms, and 14 were painless. Grossly, DF manifested as a raised red, pink, tan, or skin-colored soft mass. The tumor size ranged from 0.3 to 1.5 cm (average, 0.67 cm in diameter). Twenty-six DFs (84%) were localized on the dorsal surface of the foot and ankle, and five (16%) were found on the plantar aspect. Eighteen patients were treated by surgical excision of the tumor (>0.5 cm), and 13 patients had observational follow-up after punch biopsy due to the small size (≤0.5 cm) and benign nature of these lesions. Further follow-up found that only one patient (3.2%) had a local recurrence, 37 months after surgical excision, which was completely reexcised. Histologically, DF is characterized by proliferation of spindle fibroblasts and histiocytes, in a vague fascicular pattern, and thickened collagen bundles.

Conclusions: Dermatofibroma on the foot and ankle predominantly occurs in patients in their 50s, without a preponderance by sex. It needs to be differentiated from other benign and malignant tumors with histologic analysis and immunostaining with factor XIIIa, CD68, and other biomarkers. Treatment options include either surgical excision or observational follow-up after biopsy, depending on the clinical characteristics and effect on functional activity.

Lower-extremity amputations are a major concern for the current state and future of healthcare, with ischemia contributing significantly to this issue. This is an infrequent but serious complication of vasopressor use. Unfortunately, there is little research existing on the topic and even fewer guidelines on treatment options. Vasopressors are often used to treat life-threatening hypotension. However, ischemic changes associated with vasopressor use often do not present for several days. It is frequently recommended that patients undergo amputation when the first signs of ischemia occur. This approach, however, does not allow for the full process of demarcation, making it difficult to determine which portions of the lower extremity will remain viable. This is a case study of a 37-year-old man who developed severe complications from COVID-19 and was subsequently admitted. Because of a complicated hospital course, he required the use of vasopressor medication that subsequently led to the development of ischemic changes to his bilateral forefeet and hands. Through a prolonged period of demarcation and the collaboration of multiple specialties, the patient was able to salvage each limb and maintain his functionality.