Journal of the American Podiatric Medical Association最新文献

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.

Background: Management of tibial pilon fracture in elderly patients with psychiatric illness remains challenging for orthopedic doctors because of patients' poor bone quality and inability for self-care. This study aimed to ascertain the viability and reliability of primary arthrodesis by using retrograde hindfoot nail for these difficult cases.

Methods: We retrospectively reviewed eight elderly consecutive patients (age older than 65 years) with tibial pilon fractures and psychiatric illness from January of 2012 to December of 2019 in our institute. Primary tibiotalocalcaneal arthrodesis with retrograde hindfoot nail was used as a definitive procedure. The bone union time, wound complication rate, ankle alignment, necessity for narcotic agents, and ambulation status were evaluated.

Results: The average length of follow-up was 22.25 months (range, 15-36 months). Additional bone grafting surgery was performed for one patient because of fusion-site nonunion 6 months postoperatively. Another patient required debridement and removal of posterior calcaneal screw because of implant prominence and local infection. Osseous union with angular deformity less than 10° was achieved in all patients finally. The average bone union time was 6.6 months (range, 4-12 months). In terms of walking ability, six patients were capable of outdoor ambulation (classes 2 and 3). Two patients required oral pain medication at the final visit.

Conclusions: The current study involved only a small number of patients, and two of the eight cases encountered undesired complications (one local infection and one bone nonunion); however, we believe that our method may serve as a valuable alternative for the treatment of tibial pilon fractures in elderly patients with psychiatric illness, considering the specificity of this fragile population.

Background: Angioleiomyoma is a benign soft-tissue tumor that arises from the smooth muscle cells in the tunica media of the blood vessels. Although the most common location for these neoplasms is the uterine wall, they can also originate from lower limbs. Altogether, these neoplasms account for 0.2% of all those located in the foot and ankle region. Signs and symptoms of foot angioleiomyoma can be a localized pain, swelling, and functional impairment. To date, only case reports and case series with small populations have been reported in the literature to describe the clinical picture of these neoplasms and the effectiveness of surgical treatment. In this study, we report our results of surgical treatment for angioleiomyomas of the foot.

Methods: Thirteen cases suffering from angioleiomyoma of the foot underwent surgical resection in our institution between January of 2017 and January of 2022. For each case, we recorded preoperative and postoperative symptoms, and their preoperative and postoperative functional status according to both Musculoskeletal Tumor Society Score (MSTS) and American Orthopedic Foot and Ankle Society Score (AOFAS). Eventual complications and local recurrence were reported.

Results: Each patient had at least mild pain before surgical treatment. The mean preoperative MSTS and AOFAS were 22.1 and 76.8, respectively. The mean tumor size was 17.7mm. Preoperatively, each patient underwent resection with wide margins. None had local recurrences or major complications at their latest follow-up. After surgery, the mean postoperative MSTS and AOFAS increased to 29.5 and 98.8, respectively. Each case had a marked increment of their functionality and a reduction of their pain after surgery.

Conclusions: Our results suggest that surgical approach with tumor resection should be considered a safe and reliable treatment for foot angioleiomyomas in light of the extremely low risk of local recurrence and because of the good postoperative pain relief and functional restoration that can be obtained after the treatment.

Background: Although comminuted fractures, osteomyelitis, large skin ulcers, and malignant tumors are rarely seen in the calcaneus, it is a problematic region to treat because it is not an actual compartment and has insufficient blood supply. Few foot and ankle surgeons would recommend total calcanectomy in various cases of malignant tumors, comminuted fractures, ulcerations of the heel often seen in diabetic patients, and chronic osteomyelitis. After calcanectomy, if functional reconstruction is not performed, the patient will experience loss of function, pain, wound problems, talonavicular dislocations, and additional surgical interventions. In this study, we demonstrate calcanectomy and simultaneous functional reconstruction techniques while discussing the patients' results.

Methods: We retrospectively evaluated three patients who underwent total calcanectomy between January 1, 2001, and December 31, 2020.Two of these procedures were due to osteomyelitis of the calcaneus after trauma, and one was due to a chondroblastic osteosarcoma of the calcaneus.

Results: The patients were followed up for an average of 116 months. None of the patients developed problems with their wounds in the postoperative term or during follow-up.

Conclusions: Total calcanectomy as a surgical method of limb salvage yields successful results. We believe that these results can be improved with functional reconstruction and rehabilitation with custom-made shoes, and the results do not entail additional morbidity or require additional hindfoot bone reconstruction.

Background: We present prospective short-term results of a limited patient series treated with two innovative partial ankle arthroplasties: talar dome resurfacing for mild-to-moderate ankle osteoarthritis and talar shoulder hemiarthroplasty for chronic medial osteochondral lesions of the talus.

Methods: Eleven patients underwent talus resurfacing and six patients had talar hemiarthroplasty. The outcome was followed by patient-reported measures and by pursuing serious adverse events or implant failures over a 2-year period. Progression of ankle osteoarthritis, peri-implant bone changes, and implant migration were followed radiographically.

Results: Active dorsiflexion increased from 3° to 10° in resurfacing and from 15° to 22° in hemiarthroplasty. Patient-reported ankle function, quality of life, and activity level tended to improve only slightly after resurfacing (cumulative Foot and Ankle Outcome Score, from 41 to 42; Foot and Ankle Ability Measures for daily activities [FAAM-ADL], from 43 to 46; EQ-5D-3L time trade-off, from 0.38 to 0.39; Tegner activity scale score, from 1.6 to 2.0) but moderately after hemiarthroplasty (cumulative Foot and Ankle Outcome Score, from 58 to 68; FAAM-ADL, from 37 to 71; EQ-5D-3L time trade-off, from 0.53 to 0.72; Tegner activity scale score, from 3.1 to 3.1). No implant-related radiographic changes, implant failures, or implant-related revision surgeries were recorded.

Conclusions: Based on a small and heterogeneous prospective case series, both partial ankle implants investigated were safe and stable over 2-year follow-up, without any radiographic osteoarthritis progression of the remaining joint. However, patient-reported ankle function, quality of life, and activity level showed a tendency toward only minor improvement after resurfacing but a moderate increase after hemiarthroplasty.