Journal of the American Podiatric Medical Association最新文献

Background: Lower-extremity amputation for a diabetic foot is mainly performed under general or central neuraxial anesthesia. Ultrasound-guided peripheral nerve block (PNB) can be a good alternative, especially for patients who require continuous anticoagulation treatment and patients with additional comorbidities. We evaluated bleeding due to PNB application in patients with diabetic foot receiving antiplatelet or anticoagulant therapy. Perioperative morbidity and mortality and the need for intensive care hospitalization were analyzed.

Methods: This study included 105 patients with diabetic foot or debridement who underwent distal foot amputation or debridement between February and October 2020. Popliteal nerve block (17 mL of 5% bupivacaine and 3 mL of saline) and saphenous nerve block (5 mL of 2% lidocaine) were applied to the patients. Postoperative pain scores (at 4, 8, 12, and 24 hours) and complications due to PNB were evaluated. Intensive care admission and 1-month mortality were recorded.

Results: The most common diseases accompanying diabetes were hypertension and peripheral artery disease. No complications due to PNB were observed. Mean ± SD postoperative first analgesic need was determined to be 14.1 ± 4.1 hours. Except for one patient, this group was followed up without the need for postoperative intensive care. In 16 patients, bleeding occurred as leakage from the surgical area, and it was stopped with repeated pressure dressing. Mean ± SD patient satisfaction score was 8.36 ± 1.59. Perioperative mortality was not observed.

Conclusions: Ultrasound-guided PNB can be an effective and safe anesthetic technique for diabetic patients undergoing distal foot amputation, especially those receiving antiplatelet or anticoagulant therapy and considered high risk.

Background: The use of antibiotics (ABs) for the prevention and management of infections has been widespread for decades and, at this time, AB resistance is a global health crisis. The available evidence highlights the need to reduce the prophylactic and therapeutic use of ABs to avoid associated risks.

Methods: A preliminary study with a total sample of 56 Andalusian (Spain) podiatrists was surveyed. The purpose of this study was to identify whether there were changes in prescription habits from a situation before a subsequent training course on AB indications for the management of infections associated with ingrown toenails. An ad hoc questionnaire of 15 items related to therapeutic and prophylactic prescriptions of ABs was developed for this purpose, and the evaluation was carried out before and after the training course.

Results: The responses obtained before and after training were compared. The training activity led to improvements in the prescription habits of the participants, producing significant changes in the prescription pattern of the professionals in 10 of the 15 items.

Conclusions: The results of this preliminary study show that the podiatrists surveyed improved the rational use of systemic AB therapy in ingrown toenails infections.

Bony outgrowths of the distal phalanx of the great toe have been described in the literature but rarely. These subungual bony outgrowths can be caused by subungual exostosis or subungual osteochondromas. Both of these abnormalities are bony outgrowths with differences in the cartilage cap wherein the exostoses have fibrocartilage, and osteochondromas have hyaline cartilage. The subungual exostosis and osteochondroma that are protruding present symptoms of pain, redness, and deformed nail bed, whereas the nonprotruding osteochondromas have only a lump as the presenting symptom. In both conditions, excision of the lesion and curettage of the base helps prevent a recurrence. Curettage at the end of the excision of the bony outgrowth is required to avoid recurrence. After excision, the specimen should be sent for histopathologic examination to differentiate between the exostosis and osteochondromas, which are underreported in subungual locations, and to rule out malignant transformation. We present a 13-year-old girl with an isolated subungual nonprotruding exostosis of the great toe that was treated by excisional biopsy. The histopathologic examination confirmed it as osteochondroma, which is underreported.

Background: An abnormal hallux interphalangeal angle may be an important risk factor for the recurrence of ingrown toenails.

Methods: Sixty pediatric patients who underwent surgery for an ingrown toenail were evaluated retrospectively in terms of recurrence. The patients were divided into two groups. Group 1 included 30 patients (22 boys and eight girls) with hallux valgus interphalangeal deformity. Group 2 included 30 patients (20 boys and ten girls) without toe deformity.

Results: The mean ± SD patient age was 12.8 ± 1.42 years and 12.5 ± 1.45 years in groups 1 and 2, respectively. There was no significant difference between the patient and control groups in terms of age and sex (P > .05). The mean ± SD follow-up time was 30.2 ± 13.46 months in group 1 and 31.3 ± 12.86 months in group 2 (P = .286). We observed recurrence in six patients (20%) in group 1 and in two patients (6.7%) in group 2.

Conclusions: The recurrence of an ingrown toenail may be associated with an increased hallux interphalangeal angle in pediatric patients. Factors related to the hallux interphalangeal angle abnormality, which increases the risk of ingrown toenails, also increase the recurrence rate in these patients. Therefore, it is surmised that hallux valgus interphalangeal deformity should be evaluated before surgery, and patients and their families should be informed about the increased risk of recurrence.

Background: Socks are mainly used to give the foot more comfort while wearing shoes. Stitch density of the knitted fabric used in socks can significantly affect the sock properties because it is one of the most important fabric structural factors influencing the mechanical properties. Continuous plantar pressures can cause serious damage, particularly under the metatarsal heads, and it is deduced that using socks redistributes and reduces peak plantar pressures. If peak pressure under the metatarsal heads is predicted, then it will be possible to produce socks with the best mechanical properties to reduce the pressure in these critical areas.

Methods: Plain knitted socks with three different stitch lengths (high, medium, and low) were produced. Static plantar pressure measurements by the Gaitview system were accomplished on ten women and then compared with the barefoot situation. Also, the peak plantar pressure of three types of socks under the metatarsal heads are theoretically predicted using the Hertz contact theory.

Results: Experimental results indicate that all socks redistribute the plantar pressure from high to low plantar pressure regions compared with barefoot. In particular, socks with high stitch length have the best performance. By increasing the stitch length, we can significantly reduce the peak plantar pressure of the socks. Correspondingly, the Hertz contact theory resulted in a trend of mean peak pressure reductions in the forefoot region similar to the socks with different stitch densities.

Conclusions: The theoretical results show that by using the Hertz contact theory, static plantar pressure in the forefoot region can be well predicted at a mean error of approximately 9% compared with the other experimental findings.

The management of complex and severe lower-extremity injuries is challenging for the orthopedic surgeon. When the primary or secondary closure of the defect is not feasible, complex procedures with graft (split-thickness or full-thickness) or flap (pedicled or free) are required. These procedures are performed by specialized plastic surgeons and are at high risk for adverse effects, even high morbidity among both the donor and acceptor sites. Furthermore, split-thickness skin grafts (STSGs) often lead to unsatisfactory results in terms of mechanical stability, flexibility, and aesthetics due to the lack of underlying dermal tissue. Consequently, dermal substitutes, such as MatriDerm (MedSkin Solutions Dr Suwelack AG, Billerbeck, Germany), have been proposed and further developed as a treatment option addressing the management of full-thickness wound defects in conjunction with STSGs. We aimed to present a case of post-traumatic full-thickness wound defect of the left foot after traumatic amputation of the digits that was treated with MatriDerm combined with autologous STSG. In addition, we performed a systematic review of the literature to delineate the efficacy of the use of MatriDerm combined with STSGs in orthopedic cases exclusively.

Background: The aim of this study was to measure the quality of information about "flatfoot" and "pes planus" presented online on the social media site YouTube and to determine the trends of viewers to medical information on YouTube.

Methods: "Flatfoot and pes planus" was typed into the YouTube search module. From the search results, videos with 50,000 views or more, longer than 45 seconds, and containing information about flatfoot and pes planus disease were selected. DISCERN and JAMA scoring, daily average views, number of likes, and number of comments were collected from 53 videos that met the criteria. The profession of the sharer was evaluated in terms of the information quality of the sharing and the orientation of the audience.

Results: The mean number of views per day of the examined videos was 2,047. The mean video presentation time was 8 minutes 50 seconds. The mean JAMA score was 2 of 4 and the mean DISCERN score was 38.16 of 75. According to the DISCERN score according to the professions, the video quality was moderate for doctors (41.44 ± 12.99), moderate for physiotherapists (41.91 ± 9.04), poor for coaches (32.78 ± 7.87), poor for patients (34.50 ± 5.32), and weak for others (34.89 ± 14.00). According to the Spearman correlation between DISCERN score and mean daily viewing, significant relationships were found for the doctors (P = .0102) and others groups (P = .0033); however, no significant relationships were observed for the physiotherapists group (P = .1073), the flatfoot patients group (P = .5363), and the coaches group (P = .9111). There were significant relationships between like and comment counts in all groups (doctors, P = .0088; coaches, P = .0069; physiotherapists, P = .0007; others, P =.0018; and patients, P = .0066).

Conclusions: Looking at previous studies, it was observed that the quality of online health information was historically inadequate. Likewise, in our study on YouTube, we found that the quality of flatfoot and pes planus information was poor to moderate.

Background: There are various factors affecting the use of prostheses. This study was aimed to examine satisfaction, psychological state, quality of life, and the factors affecting these in individuals who use prostheses because of lower-extremity amputation.

Methods: Sixty-three patients were included in this study. Demographic data and features related amputation and prosthesis were recorded. Quality of life was evaluated with the Nottingham Health Profile (NHP), anxiety and depression levels were evaluated with the Hospital Anxiety Depression Scale (HADS), body image was evaluated by the Amputee Body Image Scale (ABIS), prosthesis satisfaction was evaluated with the Prosthesis Satisfaction Questionnaire (PSQ), and the relationship between them was examined.

Results: There was a positive correlation between all HADS scores, NHP-emotional reactions, NHP-sleep, NHP-social isolation, NHP-total, and ABIS (P < .05). A negative correlation was found between HADS-anxiety and PSQ results (r = -0.394, P = .003). A positive correlation was found between HADS-depression scores and NHP-pain, NHP-emotional reactions, NHP-social isolation, NHP-total, and ABIS (P < .05); and a negative correlation was found with PSQ questionnaire scores (r = -0.427, P = .001). There was a positive correlation between HADS-total scores and all parameters except NHP-energy level and ABIS (P < .05). A positive correlation was found between ABIS and all parameters except NHP-energy level (P < .05). A negative correlation was found between PSQ and NHP-social isolation, NHP-physical activity, and NHP-total scores (r = -0.312, P = 0.019; r = -0.312, P = .019; and r = -0.277, P = .039, respectively). The presence of residual extremity pain was found to be an effective factor on the psychological state (β = 0.429, P = .001). The presence of residual limb pain and phantom pain were found to be effective factors on the prosthesis satisfaction (β = -0.41, P = .001; and β = -0.406, P = .001, respectively). The presence of residual extremity pain and anxiety level were found independent risk factors on the NHP (β = -0.401, P = .006; and β = -0.445, P = .006, respectively).

Conclusions: Individuals using prostheses because of lower-extremity amputation should be examined in detail from various perspectives.

Background: First metatarsophalangeal joint arthrodesis with isolated dorsal plating without a lag screw and without a compressive mechanism incorporated into the plate is not well studied. Although surface area for bony fusion is increased, there is concern for lower fusion rates and progressive loss of sagittal plane positioning. We present fusion rates and progressive sagittal plane deviation with isolated dorsal plate fixation.

Methods: A retrospective review was performed of 41 patients (43 feet) who underwent first metatarsophalangeal joint arthrodesis with isolated dorsal plate fixation. Patients were excluded if another form of fixation was used, if there was a compressive feature to the dorsal plate, or if a lag screw was used. Preoperative, immediate postoperative, and final postoperative radiographs were reviewed to assess radiographic alignment and fusion about the first metatarsophalangeal joint. Specific attention was placed on hallux dorsiflexion in relation to the first metatarsal. Statistical significance was set at P ≤ .05 a priori.

Results: Patients were followed for an average of 55.7 weeks. Overall union rate was 97.62%. The average time to union was 42.55 days. Reoperation rate was 4.65%, with one patient requiring revisional arthrodesis with a lag screw construct. Hallux abduction and first-second intermetatarsal angle correction reached significance (P < .00001). Hallux dorsiflexion increased by 1.05° between initial postoperative and final postoperative radiographs (P = .542).

Conclusions: Although fusion rates and progressive loss of sagittal plane position have been concerns for first metatarsophalangeal joint arthrodesis with an isolated dorsal plate construct, these results suggest this to be a stable construct without loss of positioning over time.

Os subtibiale is a rare accessory ossicle of the ankle, considered not of clinical significance. But its presence in trauma patients may cause misdiagnosis as malleolar fracture and over-treatment. Because the ossicle is attached to the deltoid ligament, ankle trauma that cause medial compartment injury may detach os subtibiale from medial malleolus. In these situations, MR imaging may help to diagnose the deltoid injury, demonstrate the features of the ossicle, and guide treatment.