Journal of the American Podiatric Medical Association

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Open AccessArticle

The Ring Verruca Plantaris in Cantharidin Use. A Case Report

by Christopher R. Hood, Jr. and Jason R. Miller

J. Am. Podiatr. Med. Assoc. 2018, 108(2), 189-193; https://doi.org/10.7547/16-115 - 1 Mar 2018

Cited by 9 | Viewed by 78

Verrucae (warts) are the most common viral infections of the skin, affecting 7% to 10% of the general population. Typically caused by human papillomavirus type 1, plantar warts manifest as benign proliferation of the epithelial cells on the feet. It has been cited [...] Read more.

Verrucae (warts) are the most common viral infections of the skin, affecting 7% to 10% of the general population. Typically caused by human papillomavirus type 1, plantar warts manifest as benign proliferation of the epithelial cells on the feet. It has been cited that up to one-third of nongenital warts become recalcitrant, and biopsy is often required to confirm diagnosis and direct appropriate treatment. These treatments can vary from various types of oral medications, acids, ablative modalities, and injections. In this article, we present a case of a recalcitrant plantar wart that appeared to circumferentially spread from the initial site after first-line treatment and presumed resolution with the product cantharidin. The development of ring warts is a known complication associated with cantharidin use, with little described rationale to the presentation. Full article

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Open AccessArticle

Paronychia with Sporangium Formation Causing an Ingrown Toenail. A Rare Case Report

by Chi-Yu Wang, Chung-Chih Hong, Ting-Fu Su and Shun-Cheng Chang

J. Am. Podiatr. Med. Assoc. 2018, 108(2), 186-188; https://doi.org/10.7547/16-185 - 1 Mar 2018

Viewed by 74

Abstract

Ingrown toenail, or onychocryptosis, is a common inflammatory disease of the hallux. It results from the alteration of fit of the nail plate in the lateral nail fold. Ingrown toenails are usually seen in adolescents and young adults and can affect daily activities [...] Read more.

Ingrown toenail, or onychocryptosis, is a common inflammatory disease of the hallux. It results from the alteration of fit of the nail plate in the lateral nail fold. Ingrown toenails are usually seen in adolescents and young adults and can affect daily activities and social life. Generally, ingrown toenails are classified into three stages, including the inflammatory stage, the abscess stage, and the granulation stage. In this article, we present the rare case of a man with a diagnosis of paronychia with sporangium formation causing an ingrown toenail. Full article

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Open AccessArticle

Lipofibromatous Hamartoma of the Plantar Nerve. An Extremely Rare Localization

by Murat Mert and Payam Hacısalihoglu

J. Am. Podiatr. Med. Assoc. 2018, 108(2), 182-185; https://doi.org/10.7547/16-168 - 1 Mar 2018

Cited by 5 | Viewed by 56

Abstract

Lipofibromatous hamartoma (LFH) is a rare, benign, tumor-like soft-tissue lesion that affects the peripheral nerves and forms a palpable neurogenic mass. Lipofibromatous hamartoma is associated with pain and sensory and/or motor deficits in the area of innervation of the affected nerve. This report [...] Read more.

Lipofibromatous hamartoma (LFH) is a rare, benign, tumor-like soft-tissue lesion that affects the peripheral nerves and forms a palpable neurogenic mass. Lipofibromatous hamartoma is associated with pain and sensory and/or motor deficits in the area of innervation of the affected nerve. This report describes a rare case of LFH of the plantar nerve. A 48-year-old woman presented to our outpatient orthopedic clinic with pain and a burning sensation on her left foot. The patient had a history of Morton's neuroma and had undergone a tarsal tunnel operation 2 years earlier at another center. None of her symptoms was alleviated by two previous operations. Magnetic resonance imaging with contrast revealed tenosynovitis of the flexor hallucis longus tendon and signal changes at deep tissue planes of the foot at the levels of the second and third toes, on the dorsal site and subcutaneous soft-tissue planes, suggesting edema and Morton's neuroma. The lesion was excised under spinal anesthesia, and histopathologic examination of the specimen revealed a diagnosis of LFH. The patient was discharged without any symptoms and her foot was normal at 8-month outpatient follow-up, with no indications of postoperative complications and/or recurrence. Full article

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Open AccessArticle

Acrokeratoelastoidosis of the Foot with Clinical, Dermoscopic, Ultrasonographic, and Histopathologic Correlation

by Pablo Uribe, Elena Ortiz, Ximena Wortsman and Sergio Gonzalez

J. Am. Podiatr. Med. Assoc. 2018, 108(2), 178-181; https://doi.org/10.7547/16-165 - 1 Mar 2018

Cited by 7 | Viewed by 52

Abstract

Acrokeratoelastoidosis (AKE) is a rare form of focal acral keratoderma of unknown cause that typically begins during childhood and manifests with multiple, small, hyperkeratotic papules located over the lateral margins of the hands and feet. The purpose of this article is to report [...] Read more.

Acrokeratoelastoidosis (AKE) is a rare form of focal acral keratoderma of unknown cause that typically begins during childhood and manifests with multiple, small, hyperkeratotic papules located over the lateral margins of the hands and feet. The purpose of this article is to report a pediatric case of AKE with dermoscopic, sonographic, and histopathologic descriptions, contributing to the awareness of this clinical diagnosis. We describe a 7-year-old girl with nonpainful yellowish papules on the lateral and medial aspects of both feet. Dermoscopy showed yellowish, structureless, linear areas. The sonographic appearance was suggestive of benignancy and ruled out the presence of piezogenic pedal papules and granulomas. Histopathology was consistent with AKE, showing acral skin with hyperorthokeratosis, hypergranulosis, and elastorrhexis in the reticular dermis. Acrokeratoelastoidosis may be difficult to recognize clinically because of its resemblance to other focal acral keratodermas. Color Doppler ultrasound can be a useful noninvasive tool for diagnosis and can confirm its benign appearance, although histopathology confirms the definitive diagnosis. To date, the dermoscopic description and ultrasound morphology of AKE have not been reported. Full article

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Open AccessArticle

Acral Fibrokeratoma. A Rare Pedal Soft-Tissue Mass

by Dyane E. Tower and Jeffrey R. Hammond

J. Am. Podiatr. Med. Assoc. 2018, 108(2), 172-177; https://doi.org/10.7547/16-134 - 1 Mar 2018

Cited by 3 | Viewed by 74

Abstract

Acral fibrokeratoma is a rare soft-tissue mass, more commonly found on the hands and rarely on the feet. This case report of a 40-year-old Hispanic man highlights an unusually located acral fibrokeratoma on the second toe, describes the clinical presentation and microscopic and [...] Read more.

Acral fibrokeratoma is a rare soft-tissue mass, more commonly found on the hands and rarely on the feet. This case report of a 40-year-old Hispanic man highlights an unusually located acral fibrokeratoma on the second toe, describes the clinical presentation and microscopic and pathologic findings, discusses differential diagnoses, and presents treatment options. Full article

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Open AccessArticle

Retained Wooden Foreign Body in the Second Metatarsal

by Ahmed Abdelbaki, Sadaf Assani, Neeraj Bhatt, Ian Karol and Alan Feldman

J. Am. Podiatr. Med. Assoc. 2018, 108(2), 168-171; https://doi.org/10.7547/16-095 - 1 Mar 2018

Cited by 5 | Viewed by 61

Abstract

The foot is considered the second most common location for foreign bodies. The most common foreign bodies include needles, metal, glass, wood, and plastic. Although metallic foreign bodies are readily seen on plain film radiographs, radiolucent bodies such as wood are visualized poorly, [...] Read more.

The foot is considered the second most common location for foreign bodies. The most common foreign bodies include needles, metal, glass, wood, and plastic. Although metallic foreign bodies are readily seen on plain film radiographs, radiolucent bodies such as wood are visualized poorly, if at all. Although plain radiography is known to be ineffective for demonstrating radiolucent foreign bodies, it is often the first imaging modality used. In such cases, complete surgical extraction cannot be guaranteed, and other imaging modalities should be considered. We present a case of a retained toothpick of the second metatarsal in a young male patient who presented with pain in the right foot of a few weeks' duration. Plain radiography showed an oval cyst at the base of the second metatarsal of the right foot. Magnetic resonance imaging revealed a toothpick penetrating the second metatarsal. The patient recalled stepping on a toothpick 8 years previously. Surgical exploration revealed a 2-cm toothpick embedded inside the second metatarsal. Full article

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Open AccessArticle

Teaching of Manual Clinical Skills in Podiatric Medicine. Theory and Recommendations

by Ryan S. Causby, Lloyd Reed, Michelle N. McDonnell and Susan L. Hillier

J. Am. Podiatr. Med. Assoc. 2018, 108(2), 158-167; https://doi.org/10.7547/15-223 - 1 Mar 2018

Cited by 9 | Viewed by 61

Abstract

In the podiatric medicine profession, there are a variety of manual tasks that require precision and skill beyond what would be usually expected in everyday living. It is the expectation of employers, regulatory bodies, and the public that graduating podiatric physicians sufficiently meet [...] Read more.

In the podiatric medicine profession, there are a variety of manual tasks that require precision and skill beyond what would be usually expected in everyday living. It is the expectation of employers, regulatory bodies, and the public that graduating podiatric physicians sufficiently meet certain minimum competencies for that profession, including those for manual skills. However, teaching and evaluation methods seem to be inconsistent between countries, institutions, and programs. This may be the consequence of uncertainty regarding the safest and most effective methods to do so. A review of available international literature pertaining to psychomotor learning across a range of health professions was undertaken. As a result of this broad review, we present herein the available evidence and make recommendations for the teaching of psychomotor skills in the podiatric medicine profession. Specific aspects considered important include methods of teaching, practice, and feedback. Full article

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Open AccessArticle

A Survey of Patient Care Handoff and Sign-Out Practices Among Podiatric Surgical Residency Programs

by Laura E. Sansosti, Amanda Crowell, Whitney Ellis-McConnell and Andrew J. Meyr

J. Am. Podiatr. Med. Assoc. 2018, 108(2), 151-157; https://doi.org/10.7547/16-094 - 1 Mar 2018

Cited by 2 | Viewed by 54

Abstract

Background: A patient “handoff,” or the “sign-out” process, is an episode during which the responsibility of a patient transitions from one health-care provider to another. These are important events that affect patient safety, particularly because a significant proportion of adverse events have been [...] Read more.

Background: A patient “handoff,” or the “sign-out” process, is an episode during which the responsibility of a patient transitions from one health-care provider to another. These are important events that affect patient safety, particularly because a significant proportion of adverse events have been associated with a relative lack of physician communication. The objective of this investigation was to survey podiatric surgical residency programs with respect to patient care handoff and sign-out practices. Methods: A survey was initially developed and subsequently administered to the chief residents of 40 Council on Podiatric Medical Education–approved podiatric surgical residency programs attempting to elucidate patient care handoff protocols and procedures and on-call practices. Results: Although it was most common for patient care handoffs to occur in person (60.0%), programs also reported that handoffs regularly occurred by telephone (52.5%) and with no direct personal communication whatsoever other than the electronic passing of information (50.0%). In fact, 27.5% of programs reported that their most common means of patient care handoff was without direct resident communication and was instead purely electronic. We observed that few residents reported receiving formal education or assessment/feedback (17.5%) regarding their handoff proficiency, and only 5.0% of programs reported that attending physicians regularly took part in the handoff/sign-out process. Although most programs felt that their sign-out practices were safe and effective, 67.5% also believed that their process could be improved. Conclusions: These results provide unique information on a potentially underappreciated aspect of podiatric medical education and might point to some common deficiencies regarding the development of interprofessional communication within our profession during residency training. Full article

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Open AccessArticle

Differences in Faculty and Standardized Patient Scores on Professionalism for Second-Year Podiatric Medical Students During a Standardized Simulated Patient Encounter

by James M. Mahoney, Vassilios Vardaxis, Noreen Anwar and Jacob Hagenbucher

J. Am. Podiatr. Med. Assoc. 2018, 108(2), 145-150; https://doi.org/10.7547/15-175 - 1 Mar 2018

Cited by 3 | Viewed by 53

Abstract

Background: This study examined the differences between faculty and trained standardized patient (SP) evaluations on student professionalism during a second-year podiatric medicine standardized simulated patient encounter. Methods: Forty-nine second-year podiatric medicine students were evaluated for their professionalism behavior. Eleven SPs performed an assessment [...] Read more.

Background: This study examined the differences between faculty and trained standardized patient (SP) evaluations on student professionalism during a second-year podiatric medicine standardized simulated patient encounter. Methods: Forty-nine second-year podiatric medicine students were evaluated for their professionalism behavior. Eleven SPs performed an assessment in real-time, and one faculty member performed a secondary assessment after observing a videotape of the encounter. Five domains were chosen for evaluation from a validated professionalism assessment tool. Results: Significant differences were identified in the professionalism domains of “build a relationship” (P = .008), “gather information” (P = .001), and share information (P = .002), where the faculty scored the students higher than the SP for 24.5%, 18.9%, and 26.5% of the cases, respectively. In addition, the faculty scores were higher than the SP scores in all of the “gather information” subdomains; however, the difference in scores was significant only in the “question appropriately” (P = .001) and “listen and clarify” (P = .003) subdomains. Conclusions: This study showed that professionalism scores for second-year podiatric medical students during a simulated patient encounter varied significantly between faculty and SPs. Further consideration needs to be given to determine the source of these differences. Full article

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Open AccessArticle

Diffuse Pigmented Villonodular Synovitis Around the Ankle

by Keiichi Muramatsu, Ryuta Iwanaga, Yasuhiro Tominaga, Takahiro Hashimoto and Toshihiko Taguchi

J. Am. Podiatr. Med. Assoc. 2018, 108(2), 140-144; https://doi.org/10.7547/16-100 - 1 Mar 2018

Cited by 7 | Viewed by 60

Abstract

Background: Pigmented villonodular synovitis (PVNS) is a rare disorder around the ankle joint. The optimal treatment for diffuse-type PVNS is still controversial because of the high incidence of recurrence. We present the clinical features of our patients and review the current diagnostic and [...] Read more.

Background: Pigmented villonodular synovitis (PVNS) is a rare disorder around the ankle joint. The optimal treatment for diffuse-type PVNS is still controversial because of the high incidence of recurrence. We present the clinical features of our patients and review the current diagnostic and treatment modalities. Methods: Five patients with PVNS located around the ankle were surgically treated. In three patients, diffuse PVNS arose from the ankle joint, and in the other two it arose from the calcaneocuboid and intercuneiform joints. The average follow-up time after surgery was 2.9 years (range, 2–4.6 years). Results: The average time between onset of pain and diagnosis of PVNS was 6.4 years (range, 4–10 years). Arthrotomic tumor resection was performed in all of the patients. In the three patients with ankle joint PVNS, both medial and lateral approaches were used. One patient experienced mild infection at the surgical site, but this healed conservatively. No tumor recurrences had occurred after minimum follow-up of 2 years, although mild pain persisted in the three patients with ankle PVNS. Conclusions: Diagnosis of diffuse PVNS is frequently delayed due to vague symptoms and variable growth patterns. Orthopedic clinicians should be aware of the existence of this lesion, and it should be suspected in patients with persistent ankle swelling. To prevent tumor recurrence, accurate evaluation of tumor location and careful operative planning are mandatory. A combined surgical approach involving medial and lateral incision is necessary to expose the entire joint cavity. Full article

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Open AccessArticle

Foot Problems in Older Adults. Associations with Incident Falls, Frailty Syndrome, and Sensor-Derived Gait, Balance, and Physical Activity Measures

by Amy Muchna, Bijan Najafi, Christopher S. Wendel, Michael Schwenk, David G. Armstrong and Jane Mohler

J. Am. Podiatr. Med. Assoc. 2018, 108(2), 126-139; https://doi.org/10.7547/15-186 - 1 Mar 2018

Cited by 65 | Viewed by 74

Abstract

Background: Research on foot problems and frailty is sparse and could advance using wearable sensor–based measures of gait, balance, and physical activity (PA). This study examined the effect of foot problems on the likelihood of falls, frailty syndrome, motor performance, and PA in [...] Read more.

Background: Research on foot problems and frailty is sparse and could advance using wearable sensor–based measures of gait, balance, and physical activity (PA). This study examined the effect of foot problems on the likelihood of falls, frailty syndrome, motor performance, and PA in community-dwelling older adults. Methods: Arizona Frailty Cohort Study participants (community-dwelling adults aged ≥65 years without baseline cognitive deficit, severe movement disorders, or recent stroke) underwent Fried frailty and foot assessment. Gait, balance (bipedal eyes open and eyes closed), and spontaneous PA over 48 hours were measured using validated wearable sensor technologies. Results: Of 117 participants, 41 (35%) were nonfrail, 56 (48%) prefrail, and 20 (17%) frail. Prevalence of foot problems (pain, peripheral neuropathy, or deformity) increased significantly as frailty category worsened (any problem: 63% in nonfrail, 80% in prefrail [odds ratio (OR) = 2.0], and 95% in frail [OR = 8.3]; P = .03 for trend) due to associations between foot problems and both weakness and exhaustion. Foot problems were associated with fear of falling but not with fall history or incident falls over 6 months. Foot pain and peripheral neuropathy were associated with lower gait speed and stride length; increased double support time; increased mediolateral sway of center of mass during walking, age adjusted; decreased eyes open sway of center of mass and ankle during quiet standing, age adjusted; and lower percentage walking, percentage standing, and total steps per day. Conclusions: Foot problems were associated with frailty level and decreased motor performance and PA. Wearable technology is a practical way to screen for deterioration in gait, balance, and PA that may be associated with foot problems. Routine assessment and management of foot problems could promote earlier intervention to retain motor performance and manage fear of falling in older adults, which may ultimately improve healthy aging and reduce risk of frailty. Full article

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Open AccessArticle

Measurement of Toe-Brachial Indices in People with Subnormal Toe Pressures. Complexities and Revelations

by Sylvia McAra and Robert Trevethan

J. Am. Podiatr. Med. Assoc. 2018, 108(2), 115-125; https://doi.org/10.7547/16-036 - 1 Mar 2018

Cited by 4 | Viewed by 52

Abstract

Background: Insufficient information exists about the nature of toe-brachial indices (TBIs) and how best to obtain them, yet their validity may be particularly important for the identification and management of peripheral artery disease and cardiovascular disease risk. We explore ways in which valid [...] Read more.

Background: Insufficient information exists about the nature of toe-brachial indices (TBIs) and how best to obtain them, yet their validity may be particularly important for the identification and management of peripheral artery disease and cardiovascular disease risk. We explore ways in which valid TBI measurements might be obtained. Methods: The TBI data were recorded from 97 people with subnormal toe pressures. Most people provided three TBI readings from each foot on six different occasions over a 6-month period. The foot with the lower baseline TBI was noted. Results: For most people, only small inconsistencies existed among the three readings taken from each foot on a single occasion, and there were no consistent differences based on sequence. However, for some people there were noticeable and unsystematic differences among the measures. Selecting any specific one of the three readings based on its sequential position, or averaging specific readings, did not yield TBIs that were unequivocally typical for a person, and taking the lowest reading of each set seemed to offer the most expedient solution in this context. That permitted baseline descriptive statistics to be produced for both the higher and lower pressure feet, between which there was a statistically significant TBI difference. Conclusions: Accurate and consistent TBI readings cannot be assumed for people with subnormal toe pressures, and taking only a single reading or indiscriminately averaging readings seems inadvisable. Two readings and, if they are discrepant, additional readings, are recommended for each foot, ideally on several occasions, and careful consideration should be given to determine the most representative reading for each foot. Cuff sizes and other sources of inaccuracy or distortion should not be ignored, and standardized protocols for obtaining TBIs are recommended. Full article

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Open AccessArticle

Effectiveness of Diagnosis and Treatment of Spiral Fracture of the Distal Third of the Tibia Combined with Posterior Malleolus Fracture. A Series of Ten Cases

by Qun Chen, Lijun Song, Jiahu Fang, Xiaodong Qin, Tianrun Lv and Xiang Li

J. Am. Podiatr. Med. Assoc. 2018, 108(2), 106-114; https://doi.org/10.7547/15-181 - 1 Mar 2018

Cited by 13 | Viewed by 87

Abstract

Background: Spiral fractures of the tibia are often the result of torsion trauma. In clinical practice, this type of fracture is frequently complicated by posterior malleolus fractures. This study aimed to observe the effectiveness of diagnosis and treatment of these fractures in a [...] Read more.

Background: Spiral fractures of the tibia are often the result of torsion trauma. In clinical practice, this type of fracture is frequently complicated by posterior malleolus fractures. This study aimed to observe the effectiveness of diagnosis and treatment of these fractures in a single hospital in China. Posterior malleolus fractures are sometimes occult, occurring alongside spiral fractures of the distal third of the tibia; posttraumatic arthritis can result if they are missed. Methods: This study includes 128 consecutive patients with tibia fractures between May 1, 2008, and April 30, 2012. Patients in the early study period underwent radiography only, and subsequent patients underwent both radiography and computed tomography (CT). The causes of the fractures were evaluated. Intramedullar nailing was performed for the tibia fractures. Percutaneous cannulated screw fixation was used for the posterior malleolus fractures. Patients were followed up for a minimum of 3 months. Results: Twenty-eight patients had spiral fractures of the mid-distal third of the tibia. Ten of the 28 patients were complicated by posterior malleolus fractures. Diagnosis was initially missed in one early patient who underwent radiography only. Three cases of posterior malleolus fractures were identified by radiography. A CT was performed in all ten patients and showed that approximately 25% to 50% of the ankle joint surface of posterior malleolus fractures was involved. One early diagnosis was missed that had a displaced posterior malleolus fracture after intramedullary nailing. Using CT as the gold standard, radiography had sensitivity of 33.3%, specificity of 100.0%, positive predictive value of 100%, and negative predictive value of 73.9%. All correctly diagnosed patients healed well, without ankle pain. Conclusions: Computed tomography helped identify most posterior malleolus fractures, and radiography alone might miss it. Intramedullary nailing and posterior malleolus screw fixation were straightforward and effective treatments. Full article

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Open AccessArticle

Assessment of the Efficacy of Extracorporeal Shockwave Therapy for Plantar Fasciitis with Magnetic Resonance Imaging Findings

by Mualla Bicer, Elif Hocaoglu, Sema Aksoy, Ercan İnci and İlknur Aktaş

J. Am. Podiatr. Med. Assoc. 2018, 108(2), 100-105; https://doi.org/10.7547/15-106 - 1 Mar 2018

Cited by 18 | Viewed by 84

Abstract

Background: Extracorporeal shockwave therapy (ESWT) has recently been used as a new treatment modality for plantar fasciitis. We aimed to determine the efficacy of ESWT by magnetic resonance imaging (MRI) findings. Methods: Thirty patients with plantar fasciitis who had received no treatment for [...] Read more.

Background: Extracorporeal shockwave therapy (ESWT) has recently been used as a new treatment modality for plantar fasciitis. We aimed to determine the efficacy of ESWT by magnetic resonance imaging (MRI) findings. Methods: Thirty patients with plantar fasciitis who had received no treatment for 6 months were included. Extracorporeal shockwave therapy was applied once a week for a total of three sessions (frequency of 12–15 Hz, 2–3 bars, and 2,500 pulses). All of the patients were assessed with the visual analog scale, a 6-point evaluation scale, the Foot and Ankle Outcome Score (FAOS), and MRI findings before and 3 months after ESWT. Visual analog scale scores were used in determining the pain level of patients in the morning, during activity, and at rest. Foot and ankle–related problems were evaluated with the FAOS. Results: The duration of painless walking according to the 6-point rating scale, the FAOS, and pain showed significant improvements after ESWT (P < .05). Significant decreases in MRI findings, including thickening of the plantar fascia, soft-tissue edema, and bone marrow edema, were observed after treatment (P < .05). Conclusions: Extracorporeal shockwave therapy is a safe and effective treatment that yields favorable results in improvement of pain and function for plantar fasciitis. An MRI is useful for determining response to ESWT for these patients. Full article

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An Explorative Study on the Efficacy and Feasibility of the Use of Motivational Interviewing to Improve Footwear Adherence in Persons with Diabetes at High Risk for Foot Ulceration

by Renske Keukenkamp, Maarten J. Merkx, Tessa E. Busch-Westbroek and Sicco A. Bus

J. Am. Podiatr. Med. Assoc. 2018, 108(2), 90-99; https://doi.org/10.7547/16-171 - 1 Mar 2018

Cited by 55 | Viewed by 52

Abstract

Background: In this explorative study, we assessed the effect and feasibility of using motivational interviewing to improve footwear adherence in persons with diabetes who are at high risk for foot ulceration and show low adherence to wearing prescribed custom-made footwear. Methods: Thirteen individuals [...] Read more.

Background: In this explorative study, we assessed the effect and feasibility of using motivational interviewing to improve footwear adherence in persons with diabetes who are at high risk for foot ulceration and show low adherence to wearing prescribed custom-made footwear. Methods: Thirteen individuals with diabetes, ulcer history, and low footwear adherence (ie, <80% of steps taken in prescription footwear) were randomly assigned to standard education (ie, verbal and written instructions) or to standard education plus two 45-min sessions of motivational interviewing. Adherence was objectively measured over 7 days using ankle- and shoe-worn sensors and was calculated as the percentage of total steps that prescribed footwear was worn. Adherence was assessed at home and away from home at baseline and 1 week and 3 months after the intervention. Feasibility was assessed for interviewer proficiency to apply motivational interviewing and for protocol executability. Results: Median (range) baseline, 1-week, and 3-month adherence at home was 49% (6%–63%), 84% (5%–98%), and 40% (4%–80%), respectively, in the motivational interviewing group and 35% (13%–64%), 33% (15%–55%), and 31% (3%–66%), respectively, in the standard education group. Baseline, 1-week, and 3-month adherence away from home was 91% (79%–100%), 97% (62%–99%) and 92% (86%–98%), respectively, in the motivational interviewing group and 78% (32%–97%), 91% (28%–98%), and 93% (57%–100%), respectively, in the standard education group. None of the differences were statistically significant. Interviewer proficiency was good, and the protocol could be successfully executed in the given time frame. Conclusions: Footwear adherence at home increases 1 week after motivational interviewing to clinically relevant but not statistically significant levels (ie, 80%) but then returns over time to baseline levels. Away from home, adherence is already sufficient at baseline and remains so over time. The use of motivational interviewing seems feasible for the given purpose and patient group. These findings provide input to larger trials and provisionally suggest that additional or adjunctive therapy may be needed to better preserve adherence. Full article

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Open AccessArticle

Use of Dehydrated Human Amnion/Chorion Membrane Allografts in More Than 100 Patients with Six Major Types of Refractory Nonhealing Wounds

by Matthew Garoufalis, Darshan Nagesh, Patrick J. Sanchez, Robin Lenz, Sarah J. Park, Jake G. Ruff, Anna Tien, Justin Goldsmith and Andrea Seat

J. Am. Podiatr. Med. Assoc. 2018, 108(2), 84-89; https://doi.org/10.7547/17-039 - 1 Mar 2018

Cited by 28 | Viewed by 90

Abstract

Background: Biochemical properties of the amniotic membrane help modulate inflammation and enhance soft-tissue healing. In controlled trials, the efficacy of dehydrated human amnion/chorion membrane (dHACM) allografts has been established. Our purpose is to describe our experience with using dHACM to treat nonhealing wounds [...] Read more.

Background: Biochemical properties of the amniotic membrane help modulate inflammation and enhance soft-tissue healing. In controlled trials, the efficacy of dehydrated human amnion/chorion membrane (dHACM) allografts has been established. Our purpose is to describe our experience with using dHACM to treat nonhealing wounds of various etiologies. Methods: We conducted a retrospective review of deidentified data from 117 consecutive patients treated in an outpatient clinic with dHACM allografts with wounds of various etiologies over 2 years. The decision to use advanced wound-care treatments is based on rate of healing observed after initiation of standard wound care and patient risk factors. Eligibility for treatments such as amniotic membrane allografts includes wounds without 50% reduction after 4 weeks, or earlier in patients deemed to be at high risk for nonhealing or with a history of chronic wounds. In micronized or sheet formulation, dHACM is applied to the wound weekly after sharp/mechanical debridement as necessary, and wound-care practices appropriate for wound type and location are continued. Results: Thirty-four percent of allograft recipients had diabetic foot ulcers, 25% had venous leg ulcers, 20% had surgical wounds, 14% had pressure ulcers, 6% had ischemic wounds, and 2% had traumatic wounds. Complete healing occurred in 91.1% of treated patients, with a mean ± SD number of weekly applications per healed wound of 5.1 ± 4.2. Conclusions: In addition to wounds of diabetic origin, dHACM can significantly expedite healing in refractory wounds of varying etiologies. Full article

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J. Am. Podiatr. Med. Assoc., Volume 108, Issue 2 (03 2018) – 16 articles , Pages 84-193

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