Journal of the American Podiatric Medical Association最新文献

Background: The incidence of surgical site infections (SSIs) is well documented in orthopedic surgery. Benchmarking is necessary for elective foot and ankle surgery due to the limited data on this topic. The economic burden of SSI management is high. Identifying the epidemiology and potential risk factors of SSIs is critical to prevention. The primary aim of this meta-analysis was to perform a comprehensive systematic review of the literature to identify the SSI rate and risk factors for elective foot and ankle surgery.

Methods: A meta-analysis was performed of elective foot and ankle SSI articles between 1999 to 2017. The Centers for Disease Control and Prevention definition of SSIs was used for the metameter. Exclusion criteria included a history of infection, revision, pediatric cases, case studies, and nonelective surgeries.

Results: Seven articles met the selection criteria, which included 7,310 procedures in 6,257 patients. Meta-analysis of the data using a random-effects model demonstrated an SSI rate of 2.5% (0.025), with Q = 39.847.

Conclusions: An established benchmark for infection rates for elective foot and ankle surgery is needed. These results show that SSI rates with elective foot and ankle surgery are comparable with those documented in the literature. Due to a large amount of heterogeneity between studies, there is a need for higher-quality studies examining the infection rate in elective foot and ankle surgery. This is complicated by a multitude of confounding factors affecting the incidence rate of infection.

Damaged connective tissues between the bone and tendons or ligaments are common among adults regardless of activity level. Achilles tendinosis is one of the most common tissue defects and enthesopathies. This case report presents the novel application of Wharton's jelly to supplement tissue defects in the Achilles tendon and its insertion. The patient in this study is a 54-year-old female with slow-onset chronic Achilles tendinosis from chronic enthesopathy at the Achilles tendon insertion with a retrocalcaneal exostosis progressively worsening for 3 years, who failed standard-of-care practices for more than 3 years. Her previous care included rest, one successful inferior calcaneal osteotomy, and one minimally successful retrocalcaneal resection of the contralateral foot, both performed by prior surgeons. The patient received extracorporeal pulsed-activated therapy (EPAT) before applying 2 mL of CryoText, a Wharton's jelly tissue allograft. The patient then received class IV laser therapy treatments. The patient started with a 10/10 visual analog scale (VAS) at the initial visit, and by week 13, the patient rated her pain as 0/10 VAS. The improvement in patient-reported pain and functionality reported in this study after the application of Wharton's Jelly, EPAT, and class IV laser therapy warrants future research studying the safety and efficacy of these patient care modalities together as an alternative intervention for patients with Achilles Tendinosis who have failed other standard-of-care treatments. Future research will help identify additional application sites and solidify application and dosage protocols.

Background: The use of an escape room format for teaching podiatric surgery principles in residency programs offers a unique and engaging approach to surgical education. The escape room format of immersing residents in a simulated environment encourages active participation and problem-solving skills.

Methods: Through carefully designed scenarios, residents are challenged to apply their knowledge of podiatric surgery principles, critical-thinking abilities, and decision-making skills to solve puzzles and overcome obstacles within a time-constrained setting. The collaborative nature of escape rooms promotes teamwork and effective communication among residents, simulating the interprofessional dynamics often encountered in surgical settings. Furthermore, the realistic simulation provided by the escape room format allows residents to practice surgical techniques, enhance their intraoperative skills, and develop a deeper understanding of the intricacies involved in podiatric surgery.

Results: This innovative approach has the potential to enhance resident engagement, knowledge retention, and overall surgical competency, ultimately contributing to the delivery of high-quality patient care in the field of podiatry.

Conclusions: The purpose of our study was to highlight the benefits of combining the escape room format with the use of cadavers for teaching podiatric surgery principles to residents and students in a residency setting.

This case report highlights the unusual presence of Hafnia alvei, a gram-negative bacillus, as the causative agent in a severe diabetic foot ulcer. While diabetic foot ulcers are typically associated with gram-positive cocci, this case underscores the importance of considering atypical pathogens. The patient, a long-term diabetic, presented with a nonresponsive wound that had progressed to a severe grade 4 ulcer, despite antibiotic treatment. A multidisciplinary medical team, including infectious disease specialists, surgeons, and endocrinologists, advocated for surgical intervention, involving debridement, VAC therapy, and hyperbaric oxygen treatment. Surprisingly, post-treatment cultures revealed the presence of Hafnia alvei and Proteus spp. Despite rigorous antibiotic therapy and debridement, wound complications persisted, leading to a unanimous decision for amputation. The patient underwent Chopart amputation, followed by a 21-day course of antibiotics due to the absence of microbial growth in post-amputation cultures. At the 6-month follow-up, the wound had completely healed, and effective glycemic control had been achieved. Key takeaways from this case include the need to consider unusual pathogens in diabetic foot ulcers, the importance of a multidisciplinary approach, cautious consideration of amputation in severe cases, and the significance of tailored antibiotic therapy. This case report serves as a reminder of the complexities involved in managing diabetic foot ulcers and the potential involvement of nontypical pathogens.

Background: The American Orthopaedic Foot and Ankle Society (AOFAS) scale is used to evaluate foot and ankle complaints, both in the general population and in athletes. The objective of this study was to review different versions of the AOFAS scale for hindfoot and ankle problems and to evaluate the methodological quality of studies published in this respect.

Methods: The study design was a systematic review, and a search was conducted in five databases: PubMed, Scopus, CINAHL, PEDro: Physiotherapy Evidence Database, and PROSPERO from inception to January 2023. The following inclusion criteria were applied: validation studies of the AOFAS scale, in different languages, with no time limit, in a population aged 18 years and older. Two of us (J.G.-M. and S.S.-M.) independently assessed the quality of the studies located and extracted the relevant data. The COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) checklist was used to assess methodological quality.

Results: Six instruments were analyzed in this review. In many cases, significant methodological flaws were detected, mostly regarding internal consistency and criterion validity.

Conclusions: The Dutch (ankle fractures) version of the AOFAS scale presents the best quality and is considered valid and reliable. Further studies, with greater methodological rigor, are required of the cultural adaptations of this measurement instrument.

Background: Pedal fissures present challenges for affected individuals, from cosmetic concerns to potential infection risks. Urea 40% was previously a common treatment for pedal fissures, particularly in its prescription form, but its use has declined and it is now widely available over the counter and is no longer covered by many insurance plans. Alternatives to prescription urea 40% often contain additional ingredients, such as salicylic acid. Although a common exfoliant in dermatologic treatments, salicylic acid can cause burning and exacerbate irritation, particularly when used on pedal fissures, thus hindering healing. This study aimed to assess the efficacy of urea 40% compared with a novel skin barrier repair cream designed to address pedal fissures without the irritation while still providing healing results. The novel skin barrier repair cream uses natural ingredients without fragrances or dyes and incorporates hyaluronic acid, which helps the skin retain moisture and stay hydrated without breaking down the surrounding tissue.

Methods: This double-blind study enrolled 48 participants who were assessed every 2 weeks over 28 days of treatment. Participants were divided into two groups, each receiving either urea 40% or the novel skin barrier repair cream for daily use. Follow-up visits included detailed records of xerosis and fissure progression, with parameters analyzed for comparative efficacy.

Results: Significant improvement in function was observed in the group treated with the novel skin barrier repair cream. The results showed minimal statistical difference in healing between the novel skin barrier repair cream and urea 40% across all measured parameters.

Conclusions: The novel skin barrier repair cream provides a comparably effective treatment for pedal fissures without additional side effects. This finding highlights the potential of the novel skin barrier repair cream as a viable alternative to the currently available over-the-counter formulations, addressing both effectiveness and affordability in managing pedal fissures.

Background: Minority disparities have been documented in the diabetic community since the late 1990s. Historically, the literature acknowledges that higher rates of diabetes-related complications occur in this subgroup. Despite this, disparities among patients with Charcot's neuroarthropathy have yet to be explored. We compared incidence and management among patients with Charcot's neuroarthropathy with emphasis on racial and geographic differences.

Methods: We retrospectively reviewed patients from two hospitals, an inner-city tertiary center and a suburban facility, between 2013 and 2022. Patients were managed by the same attending physician as either referrals or initial consultations for a diagnosis of Charcot's neuroarthropathy of the foot and ankle. Patient selection was performed via International Classification of Diseases, 10th Revision codes associated with Charcot's joint of the foot.

Results: Of 120 patients identified, 87.5% were nonminority white individuals. The minority community had an increased frequency of medical comorbidities. Minorities were two times more likely to undergo a staged reconstruction. Compared with suburban patients, inner-city patients, on average, had higher hemoglobin A1c levels and more ulceration and osteomyelitis. Similarly, this cohort was more apt to undergo reconstructive surgery and had a reduced mortality rate.

Conclusions: Although there may be a correlation with medical comorbidities in minority communities, there does not seem to be a difference in the management of Charcot's neuroarthropathy. Location has the potential to play a role in diagnosis, management, and potential outcomes, likely due to access to health care and community education. More prospective studies are warranted to better understand the influence of racial and geographic differences on management of the Charcot foot.

Background: From traumatic injury to diabetic foot infections, minor amputations of the foot and ankle rely on viable and adequate soft-tissue coverage. When employing a plantar foot flap, coverage often determines amputation level. This study examined the relative plantar foot flap length needed to cover various levels of minor foot amputations.

Methods: Demographic data and plantar flap length of ten cadaver specimens were recorded. The minimum plantar flap length needed to cover transmetatarsal, Lisfranc, and Chopart amputations was measured following each amputation. Absolute and percentage of total flap length were determined. The Pearson correlation coefficient among demographic and anthropometric data was calculated. The threshold for statistical significance was set at P ≤ .05. Among the 14 dissected cadavers, eight were male and six were female.

Results: The height and weight were 177.21 ± 10.42 cm and 171.79 ± 58.18 pounds, respectively. The minimum percent lengths of the total plantar flap needed to cover transmetatarsal, Lisfranc, and Chopart amputations were 85.35 ± 3.75%, 75.31 ± 3.43%, and 63.55 ± 5.08%, respectively. There existed a statistically significant relationship between cadaver height and plantar flap needed to close Lisfranc (P = .04) and Chopart (P = .04) amputations.

Conclusions: In the clinical and surgical setting, these results provide an estimation of the level of amputation based on available plantar flap length. Future studies may examine the application of these estimates both surgically and preoperatively when discussing predicted amputation level with patients.

Background: Ankle fractures represent the most common type of intra-articular fracture. The standard treatment for unstable ankle fractures is open reduction and internal fixation through a lateral approach. Recently, intramedullary nail fixation has become popular for distal fibula fractures to limit soft-tissue damage.

Methods: A prospective cohort study was conducted of 61 consecutive ankle fracture patients treated with a fibular nail.

Results: The median follow-up time was 15.9 months (interquartile range, 13.6-23.2 months). Open reduction of the fibula fracture with an incision measuring between 3 and 5 cm was performed on 54 patients (88.5%). The overall complication rate was 24.6%. The complication rate of fibular fixation or lateral approach was 16.4%. The most common complications were minor infection (8.2%) and hardware removal (8.2%). Two deep infections (3.3%) occurred. Malreduction occurred at a rate of 1.6% (n = 1). Relevant comorbidities included diabetes (14.8%), renal disease (3.3%), and current or former smoking (24.5%). There were no statistically significant associations between patient demographics (age, body mass index, sex, smoking status, diabetes) and complications.

Conclusions: Given the complication rate, our data suggest that the benefit of fibular nailing is limited when open reduction is used. Further study comparing fibular nail fixation with percutaneous versus open reduction is warranted.