Journal of the American Podiatric Medical Association

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Open AccessArticle

How to Create a Hot Foot Line to Prevent Diabetes-Related Amputations: Instant Triage for Emergency Department and Inpatient Consultations

by John D. Miller, Eric J. Lew, Nicholas A. Giovinco, Christian Ochoa, Vincent L. Rowe, Leonardo C. Clavijo, Fred Weaver and David G. Armstrong

J. Am. Podiatr. Med. Assoc. 2019, 109(2), 174-179; https://doi.org/10.7547/17-204 - 1 Mar 2019

Cited by 6 | Viewed by 52

Abstract

Emergency department visits for lower extremity complications of diabetes are extremely common throughout the world. Surprisingly, recent data suggest that such visits generate an 81.2% hospital admission rate with an annual bill of at least $1.2 billion in the United States alone. The [...] Read more.

Emergency department visits for lower extremity complications of diabetes are extremely common throughout the world. Surprisingly, recent data suggest that such visits generate an 81.2% hospital admission rate with an annual bill of at least $1.2 billion in the United States alone. The likelihood of amputation and other subsequent adverse outcomes is strongly associated with three factors: 1) wound severity (degree of tissue loss), 2) ischemia, and 3) foot infection. Using these factors, this article outlines the basic principles needed to create an evidence-based, rapid foot assessment for diabetic foot ulcers presenting to the emergency department, and suggests the establishment of a “hot foot line” for an organized, expeditious response from limb salvage team members. We present a nearly immediate assessment and referral system for patients with atraumatic tissue loss below the knee that has the potential to vastly expedite lower extremity triage in the emergency room setting through greater collaboration and organization. (J Am Podiatr Med Assoc 109(2): 174-179, 2019) Full article

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Open AccessArticle

A Rare Cause of Heel Pain: A Calcaneal Spur Fracture

by Mehmet Arican, Yalcin Turhan and Zekerya Okan Karaduman

J. Am. Podiatr. Med. Assoc. 2019, 109(2), 172-173; https://doi.org/10.7547/17-111 - 1 Mar 2019

Cited by 2 | Viewed by 60

Abstract

Heel pain is a complaint frequently encountered in orthopedic clinics that has peculiar symptoms and may have various etiologic causes. Calcaneal spur fracture is an extremely rare cause of heel pain, and only four cases had previously been reported in the English language [...] Read more.

Heel pain is a complaint frequently encountered in orthopedic clinics that has peculiar symptoms and may have various etiologic causes. Calcaneal spur fracture is an extremely rare cause of heel pain, and only four cases had previously been reported in the English language literature. We present a 45-year-old woman who had heel pain on her right foot after falling from a height onto the heel. Radiographic examination of her right foot showed a fractured calcaneal spur, which was successfully treated with conservative methods. Calcaneal heel pain is a complaint that may be attributable to many different etiologic causes, which often have specific symptoms, and we frequently encounter them in the orthopedic clinic. Calcaneal spur fracture after trauma should be remembered in the differential diagnosis of heel pain as a rare cause. Our case is the fifth reported case in the English language literature of this extremely rare condition. (J Am Podiatr Med Assoc 109(2): 172-173, 2019) Full article

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Open AccessArticle

The Misdiagnosis of Acral Lentiginous Melanoma: Three Case Presentations

by Bryan C. Markinson, Jered M. Stowers, Alexandra Black, Rosario Saccomanno and Garrett Desman

J. Am. Podiatr. Med. Assoc. 2019, 109(2), 166-171; https://doi.org/10.7547/17-038 - 1 Mar 2019

Cited by 7 | Viewed by 114

Abstract

Acral lentiginous melanoma (ALM) is a disease that is found on the palms, soles, and nail beds. Because these areas are not often examined during general medical examinations, the presence of ALM often goes unnoticed or the diagnosis is delayed. Research shows that [...] Read more.

Acral lentiginous melanoma (ALM) is a disease that is found on the palms, soles, and nail beds. Because these areas are not often examined during general medical examinations, the presence of ALM often goes unnoticed or the diagnosis is delayed. Research shows that the misdiagnosis of ALM is common, reported between 20% and 34%. We present three cases of ALM that were initially misdiagnosed and referred to the senior author (B.C.M.) in an effort to assess why misdiagnosis is common. The existing literature illuminates clinical pitfalls in diagnosing ALM. The differential diagnosis of many different podiatric skin and nail disorders should include ALM. Although making the correct diagnosis is essential, the prognosis is affected by the duration of the disease and level of invasiveness. Unfortunately, most of the reported misdiagnosed cases are of a later stage and worse prognosis. This review highlights that foot and ankle specialists should meet suspect lesions with a heightened index of suspicion and perform biopsy when acral nonhealing wounds and/or lesions are nonresponsive to treatment. (J Am Podiatr Med Assoc 109(2): 166-171, 2019) Full article

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Open AccessArticle

An Unusual Case of a Fibular Sesamoid Phalangeal Ligament Tear Caused By Chronic Trauma

by Michael Levi, Jacob I. Green, Paul M. Kim and Amol Saxena

J. Am. Podiatr. Med. Assoc. 2019, 109(2), 162-165; https://doi.org/10.7547/18-052 - 1 Mar 2019

Viewed by 74

Abstract

Injuries involving the first metatarsophalangeal joint and its associated structures are common, especially in athletes. However, injuries to the hallucal sesamoid complex constituted only 3% of all podiatric sports medicine injuries reported by Agosta. This case study reports a female ballet dancer with [...] Read more.

Injuries involving the first metatarsophalangeal joint and its associated structures are common, especially in athletes. However, injuries to the hallucal sesamoid complex constituted only 3% of all podiatric sports medicine injuries reported by Agosta. This case study reports a female ballet dancer with an isolated fibular sesamoid retraction injury that presented with a history of chronic microtrauma secondary to overuse. When consulting epidemiologic studies of forefoot injuries involving the hallucal sesamoid complex, we were unable to find a single instance of an isolated retraction of the fibular sesamoid resulting from chronic use, demonstrating the unusual nature of this case. (J Am Podiatr Med Assoc 109(2): 162-165, 2019) Full article

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Open AccessArticle

Crystal-Induced Arthritis After Total Ankle Arthroplasty

by Le Hoang Nam Dang, Jong-Kil Kim and Kwang-Bok Lee

J. Am. Podiatr. Med. Assoc. 2019, 109(2), 159-161; https://doi.org/10.7547/17-097 - 1 Mar 2019

Cited by 4 | Viewed by 37

Abstract

The causes of late-onset pain after total ankle replacement (TAR) are various, and include infection, subsidence, polyethylene spacer failure, osteolysis, and wear. There are few reports of late-onset pain caused by gouty attacks after total knee and hip arthroplasty. In addition, no research [...] Read more.

The causes of late-onset pain after total ankle replacement (TAR) are various, and include infection, subsidence, polyethylene spacer failure, osteolysis, and wear. There are few reports of late-onset pain caused by gouty attacks after total knee and hip arthroplasty. In addition, no research has reported gouty attacks after total ankle arthroplasty. Therefore, we report a case of a gouty attack after total ankle replacement. A 43-year-old man presented with pain after total ankle arthroplasty performed 5 years previously. We found a white-yellow crystalline deposit within the synovial tissue during ankle arthroscopy, confirmed by histologic examination. (J Am Podiatr Med Assoc 109(2): 159-161, 2019) Full article

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Open AccessArticle

Ciprofloxacin-Induced Bullae of the Lower Extremity: A Case of a Fixed Drug Reaction

by Anthony J. Mollica, Albert J. Mollica, Elaine Grant, Ali Malik and Marc Claydon

J. Am. Podiatr. Med. Assoc. 2019, 109(2), 155-158; https://doi.org/10.7547/17-088 - 1 Mar 2019

Cited by 3 | Viewed by 59

Abstract

Cutaneous adverse drug reactions make up 1% to 2% of all adverse drug reactions. From these adverse cutaneous drug reactions, 16% to 21% can be categorized as fixed drug reactions (FDR). Fixed drug reactions may show diverse morphology including but not limited to [...] Read more.

Cutaneous adverse drug reactions make up 1% to 2% of all adverse drug reactions. From these adverse cutaneous drug reactions, 16% to 21% can be categorized as fixed drug reactions (FDR). Fixed drug reactions may show diverse morphology including but not limited to the following: dermatitis, Stevens-Johnson syndrome, urticaria, morbilliform exanthema, hypersensitivity syndrome, pigmentary changes, acute generalized exanthematous pustulosis, photosensitivity, and vasculitis. An FDR will occur at the same site because of repeated exposure to the offending agent, causing a corresponding immune reaction. There are many drugs that can cause an FDR, such as analgesics, antibiotics, muscle relaxants, and anticonvulsants. The antibiotic ciprofloxacin has been shown to be a cause of cutaneous adverse drug reactions; however, the fixed drug reaction bullous variant is rare. This case study was published to demonstrate a rare adverse side effect to a commonly used antibiotic in podiatric medicine. (J Am Podiatr Med Assoc 109(2): 155-158, 2019) Full article

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Open AccessArticle

Levamisole-Induced Vasculitis in the Lower Extremities: A Case Report

by Vi Nguyen, Deepal Dalal and Mark Razzante

J. Am. Podiatr. Med. Assoc. 2019, 109(2), 150-154; https://doi.org/10.7547/17-047 - 1 Mar 2019

Cited by 5 | Viewed by 79

Abstract

Background: Since 2006 there have been increased reports of severe agranulocytosis and vasculitis associated with levamisole use. Historically, levamisole was an immunomodulatory agent used in various cancer treatments in the United States. Currently the drug is used as an antihelminthic veterinary medication, but [...] Read more.

Background: Since 2006 there have been increased reports of severe agranulocytosis and vasculitis associated with levamisole use. Historically, levamisole was an immunomodulatory agent used in various cancer treatments in the United States. Currently the drug is used as an antihelminthic veterinary medication, but it is also used as an additive in freebase cocaine. There are multiple reports of levamisole-induced vasculitis in the head and neck but limited reported cases in the lower extremities. This article describes a 60-year-old woman who presented to the emergency department with multiple painful lower-extremity ulcerations. Results: Radiographs, laboratory studies, and punch biopsy were performed. Physical examination findings and laboratory results were negative for signs of infection. Treatment included local wound care and education on cocaine cessation, and the patient was transferred to a skilled nursing facility. Her continued use of cocaine, however, prevented her ulcers from healing. Conclusions: Local wound care and cocaine cessation is the optimal treatment for levamisole-induced lesions. With the increase in the number of patients with levamisole-induced vasculitis, podiatric physicians and surgeons would benefit from the immediate identification of these ulcerations, as their appearance alone can be distinct and pathognomonic. Early identification of levamisole-induced ulcers is important for favorable treatment outcomes. A complete medical and social history is necessary for physicians to treat these lesions with local wound care and provide therapy for patients with addictions. (J Am Podiatr Med Assoc 109(2): 150-154, 2019) Full article

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Open AccessArticle

The Role of Shoe and Sock Sanitization in the Management of Superficial Fungal Infections of the Feet

by Aditya K. Gupta and Sarah G. Versteeg

J. Am. Podiatr. Med. Assoc. 2019, 109(2), 141-149; https://doi.org/10.7547/17-043 - 1 Mar 2019

Cited by 21 | Viewed by 188

Abstract

Because of the ubiquitous nature of dermatophytes and a lack of an adaptive immune response in the nail plate, recurrence and relapse rates associated with superficial fungal infections are high (10%–53%). Cured or improved dermatophytosis patients could become reinfected if exposed to fungal [...] Read more.

Because of the ubiquitous nature of dermatophytes and a lack of an adaptive immune response in the nail plate, recurrence and relapse rates associated with superficial fungal infections are high (10%–53%). Cured or improved dermatophytosis patients could become reinfected if exposed to fungal reservoirs, such as an infected shoe, sock, or textile. To prevent this, footwear, sock, and textile sanitization methods can be used. To provide insight into effective sanitization options, the focus of this article is to review footwear, sock, and textile sanitization studies conducted throughout history (1920–2016). Thirty-three studies are covered in this review, encompassing techniques ranging from formaldehyde fumigation and foot powder application, to more modern approaches such as UV light and silver-light irradiation technologies. Older sanitization methods (eg, boiling, use of chlorine and salts) are quite limited in their practicality, as they can result in health complications and ruin shoe integrity. Newer approaches to shoe and sock sanitization, such as ozone application and UV irradiation, have shown very promising results. Further research is still needed with these modern techniques, as knowledge gaps and cost prevent the creation of standardized parameters for successful use. By combining sanitization methods with other preventative measures, protection against reinfection may be enhanced. (J Am Podiatr Med Assoc 109(2): 141-149, 2019) Full article

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Open AccessArticle

A Review of the Effect of Lower-Extremity Pathology on Automobile Driving Function

by Andrew J. Meyr and Laura E. Sansosti

J. Am. Podiatr. Med. Assoc. 2019, 109(2), 132-140; https://doi.org/10.7547/16-089 (registering DOI) - 1 Mar 2019

Cited by 2 | Viewed by 56

Abstract

The effect of lower-extremity pathology and surgical intervention on automobile driving function has been a topic of contemporary interest in the medical literature. The objective of this review was to summarize the topic of driving function in the setting of lower-extremity impairment. Included [...] Read more.

The effect of lower-extremity pathology and surgical intervention on automobile driving function has been a topic of contemporary interest in the medical literature. The objective of this review was to summarize the topic of driving function in the setting of lower-extremity impairment. Included studies involved lower-extremity immobilization devices, elective and traumatic lower-limb surgery, chronic musculoskeletal pathology, and diabetes as it relates to the foot and ankle, focusing on the effect each may have on driving function. We also discuss the basic US state regulations with respect to impaired driving and changes to automobile structure that can be made in the setting of lower-extremity pathology. (J Am Podiatr Med Assoc 109(2): 132-140, 2019) Full article

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Open AccessArticle

Trends in the Types of Physicians Performing Partial Foot Amputations

by Ronald Renzi, Rodmehr Ajdari and Brandon Bosque

J. Am. Podiatr. Med. Assoc. 2019, 109(2), 127-131; https://doi.org/10.7547/15-101 - 1 Mar 2019

Viewed by 56

Abstract

Background: Partial foot amputations (PFAs) are often indicated for the treatment of severe infection, osteomyelitis, and critical limb ischemia, which consequently leads to irreversible necrosis. Many patients who undergo PFAs have concomitant comorbidities and generally present with a severe acute manifestation of the [...] Read more.

Background: Partial foot amputations (PFAs) are often indicated for the treatment of severe infection, osteomyelitis, and critical limb ischemia, which consequently leads to irreversible necrosis. Many patients who undergo PFAs have concomitant comorbidities and generally present with a severe acute manifestation of the condition, such as gangrenous changes, systemic infection, or debilitating pain, which would then require emergency amputation on an inpatient basis. Methods: The purpose of this study was to track the recent prevalence of PFAs and to investigate the current demographic trends of the physicians managing and performing PFAs, specifically regarding medical degree and specialty. Doctors of podiatric medicine are striving to achieve parity with their allopathic and osteopathic surgical counterparts and become a more prominent part of the multidisciplinary approach to limb salvage and emergency surgical treatment. This study evaluated 4 years (2009–2012) of PFA data from the Pennsylvania state inpatient database in the two most populated areas of Pennsylvania: Philadelphia and Allegheny counties. Statistics on medical schools were obtained directly from the accrediting bodies of allopathic, osteopathic, and podiatric medical schools. The goal of this study was to evaluate the general trends of patients undergoing a PFA and to quantify the upswing of podiatric surgeons intervening in the surgical care of these patients. Results: The number of partial foot amputations in the United States rose from 2006 to 2012. Podiatric surgeons performed 46% of theses procedures for residents of Philadelphia County from 2009 to 2012. In Allegheny County podiatric physicians performed 42% of these procedures during the same time frame. Conclusions: Partial foot amputations are increasing over time. Podiatric Surgeons perform a significant share of these operations. This share is increasing in the most populated areas of Pennsylvania. (J Am Podiatr Med Assoc 109(2): 127-131, 2019) Full article

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Open AccessArticle

Analysis of YouTube as a Source of Information for Diabetic Foot Care

by Peter E. Smith, James McGuire, Michael Falci, Dilli Ram Poudel, Richard Kaufman, Mary Ann Patterson, Benjamin Pelleschi and Esther Shin

J. Am. Podiatr. Med. Assoc. 2019, 109(2), 122-126; https://doi.org/10.7547/16-149 - 1 Mar 2019

Cited by 22 | Viewed by 51

Abstract

Background: Increasing amounts of diabetes-focused content is being posted to YouTube with little regulation as to the quality of the content. Diabetic education has been shown to reduce the risk of ulceration and amputation. YouTube is a frequently visited site for instructional and [...] Read more.

Background: Increasing amounts of diabetes-focused content is being posted to YouTube with little regulation as to the quality of the content. Diabetic education has been shown to reduce the risk of ulceration and amputation. YouTube is a frequently visited site for instructional and demonstrational videos posted by individuals, advertisers, companies, and health-care organizations. We sought to evaluate the usefulness of diabetic foot care video information on YouTube. Methods: YouTube was queried using the keyword phrase diabetic foot care. Original videos in English, with audio, less than 10 min long within the first 100 video results were evaluated. Two reviewers classified each video as useful or nonuseful/misleading. A 14-point usefulness criteria checklist was used to further categorize videos as most useful, somewhat useful, or nonuseful/misleading. Video sources were categorized by user type, and additional video metrics were collected. Results: Of 87 included videos, 56 (64.4%), were classified as useful and 31 (35.6%) as nonuseful/misleading. A significant difference in the mean length of useful videos vs nonuseful/misleading videos was observed (3.33 versus 1.73 min; P < .0001). There was no significant difference in terms of popularity metrics (likes, views, subscriptions, etc) between useful and nonuseful/misleading videos. Conclusions: This study demonstrates that although most diabetic foot care videos on YouTube are useful, many are still nonuseful/misleading. More concerning is the lack of difference in popularity between useful and nonuseful videos. Podiatric physicians should alert patients to possibly misleading information and offer a curated list of videos. (J Am Podiatr Med Assoc 109(2): 122-126, 2019) Full article

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Kinematic and Kinetic Comparison of Fresh Frozen and Thiel-Embalmed Human Feet for Suitability for Biomechanical Educational and Research Settings

by Alfred Gatt, Pierre Schembri-Wismayer, Nachiappan Chockalingam and Cynthia Formosa

J. Am. Podiatr. Med. Assoc. 2019, 109(2), 113-121; https://doi.org/10.7547/16-130 - 1 Mar 2019

Cited by 6 | Viewed by 52

Abstract

Background: In vitro biomechanical testing of the human foot often involves the use of fresh frozen cadaveric specimens to investigate interventions that would be detrimental to human subjects. The Thiel method is an alternative embalming technique that maintains soft-tissue consistency similar to that [...] Read more.

Background: In vitro biomechanical testing of the human foot often involves the use of fresh frozen cadaveric specimens to investigate interventions that would be detrimental to human subjects. The Thiel method is an alternative embalming technique that maintains soft-tissue consistency similar to that of living tissue. However, its suitability for biomechanical testing is unknown. Thus, the aim of this study was to determine whether Thiel-embalmed foot specimens exhibit kinematic and kinetic biomechanical properties similar to those of fresh frozen specimens. Methods: An observational study design was conducted at a university biomechanics laboratory. Three cadavers had both limbs amputated, with one being fresh frozen and the other preserved by Thiel's embalming. Each foot was tested while undergoing plantarflexion and dorsiflexion in three states: unloaded and under loads of 10 and 20 kg. Their segment kinematics and foot pressure mapping were assessed simultaneously. Results: No statistically significant differences were detected between fresh frozen and Thiel-embalmed sample pairs regarding kinematics and kinetics. Conclusions: These findings highlight similar kinematic and kinetic properties between fresh frozen and Thiel-embalmed foot specimens, thus possibly enabling these specimens to be interchanged due to the latter specimens' advantage of delayed decomposition. This can open innovative opportunities for the use of these specimens in applications related to the investigation of dynamic foot function in research and education. (J Am Podiatr Med Assoc 109(2): 113-121, 2019) Full article

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Open AccessArticle

Extracorporeal Pulse-Activated Therapy versus Injection. Treatment of Recalcitrant Plantar Fasciitis

by John Grady, Yelena Boumendjel, Kathryn LaViolette and Trevor Smolinski

J. Am. Podiatr. Med. Assoc. 2019, 109(2), 108-112; https://doi.org/10.7547/17-075 - 1 Mar 2019

Cited by 3 | Viewed by 72

Abstract

Background: Plantar fasciitis is one of the most common clinical presentations seen by podiatric clinicians today. With corticosteroid injection being a classic treatment modality and extracorporeal pulse-activated therapy (EPAT) technology improving, the purpose of this study was to retrospectively compare pain and functional [...] Read more.

Background: Plantar fasciitis is one of the most common clinical presentations seen by podiatric clinicians today. With corticosteroid injection being a classic treatment modality and extracorporeal pulse-activated therapy (EPAT) technology improving, the purpose of this study was to retrospectively compare pain and functional outcomes of patients with plantar fasciitis treated with either injection or EPAT. Methods: Between November 1, 2014, and April 30, 2016, 60 patients who met the inclusion criteria were treated with either corticosteroid injection or EPAT. Patients were evaluated with both the visual analog scale (VAS) and the American Orthopaedic Foot & Ankle Society Hindfoot Score at each visit. Results: The EPAT was found to reduce pain on the VAS by a mean of 1.98 points, whereas corticosteroid injection reduced pain by a mean of 0.94 points. This was a significant reduction in the VAS score for EPAT compared with corticosteroid injection (P = .035). Conclusions: Extracorporeal pulse-activated therapy is as effective as corticosteroid injection, if not more so, for the treatment of recalcitrant plantar fasciitis and should be considered earlier in the treatment course of plantar fasciitis. (J Am Podiatr Med Assoc 109(2): 108-112, 2019) Full article

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Analysis of Insole Geometry and Deformity by Using a Three-Dimensional Image Processing Technique: A Preliminary Study

by Kit-Lun Yick, Wai-Ting Lo, Sun-Pui Ng, Joanne Yip, Hung-Hei Kwan, Yan-Yee Kwong and Fai-Chun Cheng

J. Am. Podiatr. Med. Assoc. 2019, 109(2), 98-107; https://doi.org/10.7547/16-116 - 1 Mar 2019

Cited by 3 | Viewed by 56

Abstract

Background: Accurate representation of the insole geometry is crucial for the development and performance evaluation of foot orthoses designed to redistribute plantar pressure, especially for diabetic patients. Methods: Considering the limitations in the type of equipment and space available in clinical practices, this [...] Read more.

Background: Accurate representation of the insole geometry is crucial for the development and performance evaluation of foot orthoses designed to redistribute plantar pressure, especially for diabetic patients. Methods: Considering the limitations in the type of equipment and space available in clinical practices, this study adopted a simple portable three-dimensional (3-D) desktop scanner to evaluate the 3-D geometry of an orthotic insole and the corresponding deformities after the insole has been worn. The shape of the insole structure along horizontal cross sections is defined with 3-D scanning and image processing. Accompanied by an in-shoe pressure measurement system, plantar pressure distribution in four foot regions (hallux, metatarsal heads, midfoot, and heel) is analyzed and evaluated for insole deformity. Results: Insole deformities are quantified across the four foot regions. The hallux region tends to show the greatest changes in shape geometry (17%–50%) compared with the other foot regions after 2 months of insole wear. As a result of insole deformities, plantar peak pressures change considerably (–4.3% to +69.5%) during the course of treatment. Conclusions: Changes in shape geometry of the insoles could be objectively quantified with 3-D scanning techniques and image processing. This investigation finds that, in general, the design of orthotic insoles may not be adequate for diabetic individuals with similar foot problems. The drastic changes in the insole shape geometry and cross-sectional areas during orthotic treatment may reduce insole fit and conformity. An inadequate insole design may also affect plantar pressure reduction. The approach proposed herein, therefore, allows for objective quantification of insole shape geometry, which results in effective and optimal orthotic treatment. (J Am Podiatr Med Assoc 109(2): 98-107, 2019) Full article

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Risk Factors for Below-the-Knee Amputation in Diabetic Foot Osteomyelitis After Minor Amputation

by Whitney Miller, Chrystal Berg, Michael L. Wilson, Susan Heard, Bryan Knepper and Heather Young

J. Am. Podiatr. Med. Assoc. 2019, 109(2), 91-97; https://doi.org/10.7547/16-143 - 1 Mar 2019

Cited by 16 | Viewed by 141

Abstract

Background: Below-the-knee amputation (BKA) can be a detrimental outcome of diabetic foot osteomyelitis (DFO). Ideal treatment of DFO is controversial, but studies suggest minor amputation reduces the risk of BKA. We evaluated risk factors for BKA after minor amputation for DFO. Methods: This [...] Read more.

Background: Below-the-knee amputation (BKA) can be a detrimental outcome of diabetic foot osteomyelitis (DFO). Ideal treatment of DFO is controversial, but studies suggest minor amputation reduces the risk of BKA. We evaluated risk factors for BKA after minor amputation for DFO. Methods: This is a retrospective cohort of patients discharged from Denver Health Medical Center from February 1, 2012, through December 31, 2014. Patients who underwent minor amputation for diagnosis of DFO were eligible for inclusion. The outcome evaluated was BKA in the 6 months after minor amputation. Results: Of 153 episodes with DFO that met the study criteria, 11 (7%) had BKA. Failure to heal surgical incision at 3 months (P < .001) and transmetatarsal amputation (P = .009) were associated with BKA in the 6 months after minor amputation. Peripheral vascular disease was associated with failure to heal but not with BKA (P = .009). Severe infection, bacteremia, hemoglobin A_1c, and positive histopathologic margins of bone and soft tissue were not associated with BKA. The median antibiotic duration was 42 days for positive histopathologic bone resection margin (interquartile range, 32–47 days) and 16 days for negative margin (interquartile range, 8–29 days). Longer duration of antibiotics was not associated with lower risk of BKA. Conclusions: Patients who fail to heal amputation sites in 3 months or who have transmetatarsal amputation are at increased risk for BKA. Future studies should evaluate the impact of aggressive wound care or whether failure to heal is a marker of another variable. (J Am Podiatr Med Assoc 109(2): 91-97, 2019) Full article

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J. Am. Podiatr. Med. Assoc., Volume 109, Issue 2 (03 2019) – 15 articles , Pages 91-179

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