Journal of the American Podiatric Medical Association

408 KB

Open AccessArticle

Cost of Treatment of Neuroischemic Ulcers of the Lower Extremity in Patients with Peripheral Artery Disease in the United States

by Paul A. Saatsoglou, Susan Pitman Lowenthal and David G. Armstrong

J. Am. Podiatr. Med. Assoc. 2022, 112(6), 21193; https://doi.org/10.7547/21-193 - 1 Nov 2022

Cited by 1 | Viewed by 275

Abstract

Background: We evaluated the cost of treating neuroischemic ulcers of the lower extremity in patients with peripheral artery disease by using medical and hospital claims records submitted for reimbursement to payers (private insurance, Medicare, Medicaid). Methods: Adjudicated claims and remittance data on claims [...] Read more.

Background: We evaluated the cost of treating neuroischemic ulcers of the lower extremity in patients with peripheral artery disease by using medical and hospital claims records submitted for reimbursement to payers (private insurance, Medicare, Medicaid). Methods: Adjudicated claims and remittance data on claims that include submitted charges, line items paid by insurers directly to providers and patient payments of copays, deductibles and co-insurance were used. Eligible patients from a commercial database containing more than 60% of US patients with health insurance were analyzed. Patient selection, performed using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10- CM) codes, yielded a study population of 42,837 unique anonymized patients. Results: Using the metric of “submitted charges” to overcome differences in levels of reimbursement across insurance payers and Medicare/Medicaid, we identified 34,348 patients with ulcers with an average treatment cost of $94,100 per patient ($41,800 annualized) The costliest ulcer subtype was nonpressure ulcer of the heel/midfoot among 13,184 patients with $121,400 per patient ($53,900 annualized), 29% higher than across all ulcer types. The subset of 22,281 ulcer patients who also had a surgical procedure incurred costs of $121,000 per patient ($53,800 annualized). The costliest surgical codes were complications of vascular prosthetic devices, implants, grafts among 6444 patients with $146,900 per patient ($65,300 annualized). The combination of most expensive ulcer and most expensive surgery yielded a cohort of 2355 patients with the highest average cost of $177,400 per patient ($78,800 annualized). Conclusions: The resource burden for management of neuroischemic ulcers of the lower extremity in patients with peripheral artery disease is substantial. Mitigating this burden may help reduce significant resource utilization. Full article

► Show Figures

Figure 1

653 KB

Open AccessArticle

The Resident-Run Clinic in Podiatric Medical Foot and Ankle Surgery Residency Training: A Study of Resident-Perceived Benefit

by Alex J. Bischoff, Ryan Stone, Tung Dao, Randall Thomas, Amanda Quisno and Mallory Faherty

J. Am. Podiatr. Med. Assoc. 2022, 112(6), 21152; https://doi.org/10.7547/21-152 - 1 Nov 2022

Cited by 1 | Viewed by 200

Abstract

Background: Resident-run clinics provide autonomy and skill development for resident physicians. Many residency programs have such a clinic. No study has been performed investigating the effectiveness of these clinics in podiatric medical residency training. The purpose of this study was to gauge the [...] Read more.

Background: Resident-run clinics provide autonomy and skill development for resident physicians. Many residency programs have such a clinic. No study has been performed investigating the effectiveness of these clinics in podiatric medical residency training. The purpose of this study was to gauge the resident physician–perceived benefit of such a clinic. Methods: A survey examining aspects of a resident-run clinic and resident clinical performance was distributed to all Doctor of Podiatric Medicine residency programs recognized by the Council on Podiatric Medical Education. To be included, a program must have had a contact e-mail listed in the Central Application Service for Podiatric Residencies residency contact directory; 208 residency programs met the criteria. Statistical analysis was performed using independent-samples t tests or Mann-Whitney U tests and χ² tests. Significance was set a priori at P < .05. Results: Of 97 residents included, 58 (59.79%) had a resident-run clinic. Of those, 89.66% of residents stated they liked having such a clinic, and 53.85% of those without a residentrun clinic stated they would like to have one. No statistically significant differences were noted between groups in how many patients each resident felt they could manage per hour or regarding their level of confidence in the following clinical scenarios: billing, coding, writing a note, placing orders, conversing with a patient, working with staff, diagnosing and treating basic pathology, and diagnosing and treating unique pathology. Conclusions: Resident-run clinics provide autonomy and skill development for podiatric medical residents. This preliminary study found there was no difference in resident-perceived benefit of such a clinic. Further research is needed to understand the utility of a resident- run clinic in podiatric medical residency training. Full article

► Show Figures

Figure 1

1293 KB

Open AccessArticle

Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type on the Dorsal Foot in a Senior Woman: A Case Report

by Joel Kelly, Gene Mirkin, Joon Yim and Xingpei Hao

J. Am. Podiatr. Med. Assoc. 2022, 112(6), 21143; https://doi.org/10.7547/21-143 - 1 Nov 2022

Cited by 1 | Viewed by 187

Abstract

Primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT) is a rare variant of the cutaneous B-cell lymphomas, with rapid growth and poor prognosis. Here, we report a case of PCDLBCL-LT on the foot in a senior woman. An 81-year-old woman presented with [...] Read more.

Primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT) is a rare variant of the cutaneous B-cell lymphomas, with rapid growth and poor prognosis. Here, we report a case of PCDLBCL-LT on the foot in a senior woman. An 81-year-old woman presented with a rapidly growing mass on her left foot, and discoloration in both lower legs over the past 2 months was analyzed. Physical examination revealed hyperpigmented macules and papules on both lower extremities and a 3.0 × 2.0 × 0.5-cm, gray-dark nodule on the dorsal surface of the left foot. Histologic observation of the punch biopsy specimen revealed a sheet of atypical large centroblast/immunoblast-like lymphocytes; diffusely and evenly distributed in the dermis; with the immunophenotypes of CD45-positive, CD20-positive, Melan A-negative, Sox10-negative, S-100–negative, and CK20-negative; and a very high Ki-67 proliferative index (>90%). Further punch biopsy specimens of papules in the patient’s lower extremities and bone marrow did not reveal atypical lymphoid tissues. Positron emission tomography/computed tomography did not show any metastatic lesions in distant organs and lymph nodes. The lesion was diagnosed as PCDLBCL-LT stage T1N0M0. The patient was treated with four cycles of combined therapy of rituximab and cyclophosphamide, hydroxydaunorubicin, vincristine (Oncovin), and prednisolone and the tumor was further treated with local radiotherapy. The tumor size was significantly shrunken. Primary cutaneous diffuse large B-cell lymphoma, leg type is a rare entity on the foot, characterized by a confluent sheet of diffuse large centroblast- and or immunoblast-like B cells with B-cell immunophenotyping. The combined therapy of rituximab and cyclophosphamide, hydroxydaunorubicin, vincristine (Oncovin), and prednisolone is the first-line treatment regimen, with increased survival. Full article

► Show Figures

Figure 1

396 KB

Open AccessArticle

Is the Anterolateral Thigh Flap the Solution for Orthopedic Trauma Complication Reconstructions?: A Case Series

by Kaan Gürbüz, Fatih Doğar and Yalçın Yontar

J. Am. Podiatr. Med. Assoc. 2022, 112(6), 21132; https://doi.org/10.7547/21-132 - 1 Nov 2022

Cited by 3 | Viewed by 129

Abstract

The anterolateral thigh (ALT) flap, which can be applied as a free or pedicled flap, is supplied by musculocutaneous or septocutaneous perforators belonging to the descending branch of the lateral circumflex femoral artery. Because local or regional flap options that can be used [...] Read more.

The anterolateral thigh (ALT) flap, which can be applied as a free or pedicled flap, is supplied by musculocutaneous or septocutaneous perforators belonging to the descending branch of the lateral circumflex femoral artery. Because local or regional flap options that can be used for the reconstruction of large tissue losses in the distal third of the tibia and foot are limited, ALT and other free flaps are frequently used when needed. The aim of this report is to present our experience with and clinical results of free ALT flaps in a tertiary health-care institution. Between June of 2017 and April of 2020, lower extremity reconstruction with free ALT flaps was performed in seven patients. In the preoperative period, dominant perforators were determined in each patient by Doppler ultrasonography, and surgery was planned considering the size and localization of the defect. All the patients were men, with an average age of 41.7 years. Three patients were operated on for implant exposition on the distal-medial third of the tibia after fracture repair, one patient for posttraumatic calcaneal deformity with osteomyelitis, and two patients because of localized posttraumatic tissue loss in the anterior aspect of the tibia and one patient in the dorsum of the foot. Secondary recovery was achieved in two patients and localized linear necrosis was observed at the flap suture line. No infection was observed in the donor or recipient site. In all patients, the donor site was closed primarily and no wound healing problem was encountered. This is one of the primary reconstruction options for the free ALT flap, especially in cases of large tissue losses in which local and/or regional flap alternatives are insufficient. Full article

► Show Figures

Figure 1

460 KB

Open AccessArticle

Cubonavicular Coalition in a Middle-Aged Woman: A Case Report

by Konstantinos G. Makiev, Ioannis S. Vasios, Athanasios N. Ververidis, Paraskevas Georgoulas, Konstantinos Frigkas and Konstantinos Tilkeridis

J. Am. Podiatr. Med. Assoc. 2022, 112(6), 21123; https://doi.org/10.7547/21-123 - 1 Nov 2022

Cited by 1 | Viewed by 157

Abstract

Cubonavicular coalition is a rare type of tarsal coalition that can be described as osseous or nonosseous (fibrous, cartilaginous, or fibrocartilaginous). Typically, it manifests symptoms during adolescence, as it presents with pain at the Mid-hindfoot and with decreased range of motion at the [...] Read more.

Cubonavicular coalition is a rare type of tarsal coalition that can be described as osseous or nonosseous (fibrous, cartilaginous, or fibrocartilaginous). Typically, it manifests symptoms during adolescence, as it presents with pain at the Mid-hindfoot and with decreased range of motion at the midtarsal joints, hindfoot valgus deformity, or peroneal spasm. Here, we present a rare case of cubonavicular coalition in a middle-aged woman with atypical presentation and a review of the literature. We conclude that this abnormality should be taken into account in the differential diagnosis of mid-hindfoot pain, even in middle-aged adults. Full article

► Show Figures

Figure 1

196 KB

Open AccessArticle

Ankle Charcot Mimics: Tubercular Rheumatism to Complex Regional Pain Syndrome

by Ashu Rastogi, Uttam Saini and Edward Jude

J. Am. Podiatr. Med. Assoc. 2022, 112(6), 21122; https://doi.org/10.7547/21-122 - 1 Nov 2022

Cited by 1 | Viewed by 216

Abstract

Charcot Foot is often misdiagnosed because of its varied presentation that mimics other common disorders including tubercular rheumatism, complex regional pain syndrome or gout. We present a case of ankle swelling and discuss the differential diagnosis, radiological findings, and management. We also discuss [...] Read more.

Charcot Foot is often misdiagnosed because of its varied presentation that mimics other common disorders including tubercular rheumatism, complex regional pain syndrome or gout. We present a case of ankle swelling and discuss the differential diagnosis, radiological findings, and management. We also discuss the approach to diagnosis and provide differences in clinical presentations, magnetic resonance imaging,and bone scan findings for various differentials considered for Charcot foot. Full article

► Show Figures

Figure 1

1498 KB

Open AccessArticle

Comparison of the Effectiveness of Kinesiology Taping and Rigid Taping on Ankle Kinematics During Drop Landing in Individuals with Lateral Ankle Injury

by Suleyman Korkusuz, Rabia Tugba Kilic, Serdar Aritan, Nihat Ozgoren, Seyhan Sozay, Sibel Kibar and Hayri Baran Yosmaoglu

J. Am. Podiatr. Med. Assoc. 2022, 112(6), 21121; https://doi.org/10.7547/21-121 - 1 Nov 2022

Cited by 3 | Viewed by 224

Abstract

Background: Lateral ankle sprain is an injury that often occurs during sports or daily life activities. Athletic tape and kinesiology tape applications are among the external support treatment options especially for athletes to support the ankle and protect it from recurrent sprains. We [...] Read more.

Background: Lateral ankle sprain is an injury that often occurs during sports or daily life activities. Athletic tape and kinesiology tape applications are among the external support treatment options especially for athletes to support the ankle and protect it from recurrent sprains. We sought to compare the kinematic stabilization effects of different ankle taping applications on the ankle joint during drop landing in individuals with a history of unilateral lateral ankle injury. Methods: In this randomized controlled study, 30 volunteers with unilateral ankle injury were evaluated. The participants were asked to land on one leg on the involved side and the contralateral side from a 30-cm-high platform. The same practice was repeated after applying kinesiology tape and rigid tape to the injured foot. Kinematic analysis of the foot and ankle was performed by recording three-dimensional spatial position information at a speed of 240 frames per second using infrared cameras. Results: The highest inversion angles of the involved foot at initial contact and 150 msec after initial contact were higher than those of the uninvolved side (P = .03 and P = .04, respectively). There was no significant difference in ankle kinematic values in the involved foot among kinesiology taping, athletic taping, and no taping applications (P = .74). Conclusions: People with lateral ankle sprains show reduced inversion during landing. There were no significant differences among kinesiology taping, athletic taping, and no taping on the injured foot in terms of ankle kinematics. Care should be taken when using taping materials as protective measures for sports activities. Full article

► Show Figures

Figure 1

411 KB

Open AccessArticle

Case Report of a Diabetic Foot Infection Caused by Staphylococcus pseudintermedius, a Zoonotic Pathogen of Canine Origin

by Kimberly Bobbitt, Michelle L. Winder and Stephanie P. Kvas

J. Am. Podiatr. Med. Assoc. 2022, 112(6), 21114; https://doi.org/10.7547/21-114 - 1 Nov 2022

Cited by 3 | Viewed by 133

Abstract

Staphylococcus pseudintermedius is an emerging zoonotic pathogen that is very similar to human Staphylococcus pathogens, particularly multidrug-resistant Staphylococcus aureus. Recent reports have indicated that S pseudintermedius is easily transmitted between pets (mainly dogs) and owners because of these similarities. Although this pathogen [...] Read more.

Staphylococcus pseudintermedius is an emerging zoonotic pathogen that is very similar to human Staphylococcus pathogens, particularly multidrug-resistant Staphylococcus aureus. Recent reports have indicated that S pseudintermedius is easily transmitted between pets (mainly dogs) and owners because of these similarities. Although this pathogen has been associated with diabetic foot infections, it has not yet been described in the podiatric medical literature. In this case report, we present a diabetic foot infection in a 61-year-old man that was refractory to multiple rounds of antibiotic drug therapy. Deep wound cultures eventually grew S pseudintermedius, which was the first known case of this pathogen reported in our hospital system. Full article

► Show Figures

Figure 1

56 KB

Open AccessArticle

Decreasing Osteomyelitis Occurrence in Remaining Bone After Partially Resected Infected Bone

by Jeffrey C. Karr

J. Am. Podiatr. Med. Assoc. 2022, 112(6), 21038; https://doi.org/10.7547/21-038 - 1 Nov 2022

Viewed by 155

Abstract

Background: After partial bone resection for osteomyelitis there is a high rate of osteomyelitis occurrence in the remaining bone due to adherent bacterial biofilm, dysvascular infected spongiosum bone, and absence of a surgical technique that can prevent osteomyelitis developing in the remaining bone. [...] Read more.

Background: After partial bone resection for osteomyelitis there is a high rate of osteomyelitis occurrence in the remaining bone due to adherent bacterial biofilm, dysvascular infected spongiosum bone, and absence of a surgical technique that can prevent osteomyelitis developing in the remaining bone. Methods: Presented is a surgical procedure using a dicalcium phosphate bone void filler putty with antibiotics placed into the remaining bone to prevent the development of osteomyelitis, therefore preventing amputation. Results: This procedure has an osteomyelitis eradication rate of 94.8% and also decreases the rate of lower-extremity amputations. Conclusions: This procedure provides a single stage surgical technique for infected open bone defects decreasing the previously reported high osteomyelitis reoccurrence rate of 57.1% to 5.2%. Full article

199 KB

Open AccessArticle

Extracorporeal Shockwave Therapy Versus Graston Instrument-Assisted Soft-Tissue Mobilization in Chronic Plantar Heel Pain: A Randomized Controlled Trial

by Pelin Pisirici, Elif Tugce Cil, Dilber Karagozoglu Coskunsu, Ugur Saylı and Feryal Subasi

J. Am. Podiatr. Med. Assoc. 2022, 112(6), 21036; https://doi.org/10.7547/21-036 - 1 Nov 2022

Cited by 8 | Viewed by 255

Abstract

Background: Although there are studies showing that extracorporeal shockwave therapy (ESWT) and instrument-assisted soft-tissue mobilization methods are effective in chronic plantar heel pain (CPHP) treatment, there is a need for studies comparing these techniques. We compared the effectiveness of ESWT versus instrument-assisted soft-tissue [...] Read more.

Background: Although there are studies showing that extracorporeal shockwave therapy (ESWT) and instrument-assisted soft-tissue mobilization methods are effective in chronic plantar heel pain (CPHP) treatment, there is a need for studies comparing these techniques. We compared the effectiveness of ESWT versus instrument-assisted soft-tissue mobilization using Graston Technique (GT) instruments in addition to stretching exercises (SEs) in CPHP. Methods: Sixty-nine patients were randomly assigned to three groups: ESWT1SEs (group 1), GT1SEs (group 2), and SEs only (control group) (ratio, 1:1:1). The SEs, twice daily for 8 weeks, were standard for all. Group 1 received low-intensity ESWT; in group 2, GT was the selected method. Visual analog scales (for initial step and activity pain), the Foot Function Index (FFI), the 12-item Short-Form Health Survey (SF-12), and the Tampa Scale for Kinesiophobia were used pretreatment, posttreatment, and at 8-week and 6-month follow-up. Results: Visual analog scale and FFI scores improved posttreatment and during follow-up in all groups (P < .001). Although effect sizes were greater in groups 1 and 2 than in the control group in initial step pain posttreatment and at 8-week follow-up, group 2 had the highest effect size at 6 months. Mean SF-12 scores in groups 1 and 2 improved on the posttreatment assessment. Furthermore, group 2 showed significant improvements in FFI scores compared with the other groups at 6-month follow-up (F = 6.33; P = .003). Conclusions: Although ESWT1SEs and GT1SEs seem to have similar effects on initial step pain posttreatment and at 8-week follow-up, GT1SEs was found most effective for improving functional status at 6 months in the management of CPHP. Full article

► Show Figures

Figure 1

532 KB

Open AccessArticle

Podiatric Medical Resident Wellness: A Group Survey Study

by Patrick A. Deheer, William Wolfe, Joshua A. Nichols, Bethany J. Badell and Niral A. Patel

J. Am. Podiatr. Med. Assoc. 2022, 112(6), 21005; https://doi.org/10.7547/21-005 - 1 Nov 2022

Cited by 2 | Viewed by 168

Abstract

Background: Burnout and medical resident well-being has become an increasingly studied topic in medical degree (MD) and doctor of osteopathic medicine (DO) fields and specialties, which has led to systemic changes in postgraduate education and training. Although an important topic to address for [...] Read more.

Background: Burnout and medical resident well-being has become an increasingly studied topic in medical degree (MD) and doctor of osteopathic medicine (DO) fields and specialties, which has led to systemic changes in postgraduate education and training. Although an important topic to address for physicians of all experience levels and fields of practice, there is little research on this topic as it pertains specifically to the podiatric medical community. Methods: A wellness needs assessment was developed and distributed to podiatric medical residents via electronic survey to assess overall wellness levels of residents and to highlight several subdomains of well-being in the training programs of the podiatric medical profession. Results: A total of 121 residents completed the wellness needs assessment. Survey respondents indicated that they experienced high levels of professional burnout, with large numbers of them experiencing depression and anxiety. When analyzing the different subdomains of wellness, levels of intellectual and environmental wellness were high, and levels of financial and physical wellness were reported as low. In addition, free response answers were recorded in the survey regarding well-being initiatives that have been implemented in residency programs, and in many cases no such programs are reported to exist. Conclusions: Podiatric medical residents experience compromised well-being similar to their MD/DO counterparts. These exploratory survey group results are concerning and warrant further investigation as well as organizational introspection. Analyzing well-being and implementing changes that can support podiatric physicians at all levels of training could decrease the deleterious effects of burnout in all its forms. Full article

► Show Figures

Figure 1

742 KB

Open AccessArticle

Intraosseous Gouty Osteolytic Lesion in Calcaneus

by Tae-Young Kwon, Do-Yeon Kim and Kwang-Bok Lee

J. Am. Podiatr. Med. Assoc. 2022, 112(6), 20260; https://doi.org/10.7547/20-260 - 1 Nov 2022

Viewed by 155

Abstract

Tophaceous gout often occurs in soft tissues, and gouty invasion to the bone is rare. To date, only one case of isolated intraosseous gouty invasion to the calcaneus has been reported. We report here a rare case of an intraosseous calcaneal gouty cystic [...] Read more.

Tophaceous gout often occurs in soft tissues, and gouty invasion to the bone is rare. To date, only one case of isolated intraosseous gouty invasion to the calcaneus has been reported. We report here a rare case of an intraosseous calcaneal gouty cystic lesion treated with curettage and allogenous and autogenous bone graft. Satisfactory function and pain relief were obtained at 12-month follow-up, without any evidence of recurrent disease. Full article

► Show Figures

Figure 1

1650 KB

Open AccessArticle

Cure Rates of Control Interventions in Randomized Trials of Onychomycosis Treatments: A Systematic Review and Meta-Analysis

by Aditya K. Gupta, Maanasa Venkataraman, Emma M. Quinlan and Mary A. Bamimore

J. Am. Podiatr. Med. Assoc. 2022, 112(6), 20226; https://doi.org/10.7547/20-226 - 1 Nov 2022

Cited by 3 | Viewed by 2316

Abstract

Background: The efficacy of antifungals for onychomycosis has been determined in randomized controlled trials (RCTs); interestingly, their control arms have demonstrated some therapeutic effects. These controls constitute either placebos (inert pills) or vehicles (all but the antifungal component of the creams). We sought [...] Read more.

Background: The efficacy of antifungals for onychomycosis has been determined in randomized controlled trials (RCTs); interestingly, their control arms have demonstrated some therapeutic effects. These controls constitute either placebos (inert pills) or vehicles (all but the antifungal component of the creams). We sought to determine whether RCT controls exhibited statistically relevant efficacy rates (ie, beyond the placebo effect), whether oral and topical controls differed in their efficacies, and whether the efficacy rates of the controls correlated with those of the active comparator associated with that control. Methods: All RCTs of oral and topical monotherapies for dermatophyte toenail onychomycosis were identified through a systematic literature search. For the meta-analyses of cure rates, the double arcsine transformation was used. The N – 1 χ² test was used to determine whether the cure rates significantly differed between topical and oral controls. Correlation was investigated using Kendall rank correlation tests. Results: The pooled mycological, complete, and clinical cure rates of the control interventions (19 trials) were 9%, 1%, and 6%, respectively. The pooled efficacy rates for oral and topical controls were as follows: mycological cure rate, 7% and 12% (P = .0016); complete cure rate, 1% for both; and clinical cure rate, 4% and 8%, respectively (P = .0033). For oral RCTs, the respective cure rates of the active therapies were not correlated with controls. However, for topical RCTs, as the mycological and clinical cure rates of the active therapy increased, so did those of the topical vehicle associated with the active therapy in question, and vice versa. Conclusions: The topical vehicle cure rates were often higher than the oral placebo cure rates, likely due to the presence of nonantifungal chemicals (eg, moisturizers, urea) with antifungal and debriding properties, which are not present in oral controls. Full article

► Show Figures

Figure 1

743 KB

Open AccessArticle

A Comparison of Pathogens in Skin and Soft-Tissue Infections and Pedal Osteomyelitis in Puncture Wound Injuries Affecting the Foot

by David H. Truong, Javier La Fontaine, Matthew Malone, Dane K. Wukich, Kathryn E. Davis and Lawrence A. Lavery

J. Am. Podiatr. Med. Assoc. 2022, 112(6), 20206; https://doi.org/10.7547/20-206 - 1 Nov 2022

Cited by 4 | Viewed by 186

Abstract

Background: To compare pathogens involved in skin and soft-tissue infections (SSTIs) and pedal osteomyelitis (OM) in patients with and without diabetes with puncture wounds to the foot. Methods: We evaluated 113 consecutive patients between June 1, 2011, and March 31, 2019, with foot [...] Read more.

Background: To compare pathogens involved in skin and soft-tissue infections (SSTIs) and pedal osteomyelitis (OM) in patients with and without diabetes with puncture wounds to the foot. Methods: We evaluated 113 consecutive patients between June 1, 2011, and March 31, 2019, with foot infection (SSTIs and OM) from a puncture injury sustained to the foot. Eighty-three patients had diabetes and 30 did not. We evaluated the bacterial pathogens in patients with SSTIs and pedal OM. Results: Polymicrobial infections were more common in patients with diabetes mellitus (83.1% versus 53.3%; P = .001). The most common pathogen for SSTIs and OM in patients with diabetes was Staphylococcus aureus (SSTIs, 50.7%; OM, 32.3%), whereas in patients without diabetes it was Pseudomonas (25%) for SSTIs. Anaerobes (9.4%) and fungal infection (3.1%) were uncommon. Pseudomonas aeruginosa was identified in only 5.8% of people with diabetes. Conclusions: The most common bacterial pathogen in both SSTIs and pedal OM was S aureus in patients with diabetes. Pseudomonas species was the most common pathogen in people without diabetes with SSTIs. Full article

► Show Figures

Figure 1

478 KB

Open AccessArticle

Pseudoaneurysm of the Dorsalis Pedis Artery Following Open Reduction and Internal Fixation of a Second Metatarsal Fracture: A Case Study

by Stephanie P. Kvas and Scott F. Jorgensen

J. Am. Podiatr. Med. Assoc. 2022, 112(6), 20201; https://doi.org/10.7547/20-201 - 1 Nov 2022

Cited by 1 | Viewed by 153

Abstract

Pseudoaneurysms are created by a traumatic or iatrogenic perforation of an artery, resulting in accumulation of blood between the two outermost layers of a blood vessel, the tunica media and tunica adventitia. Pedal artery pseudoaneurysms are an extremely uncommon complication of foot and [...] Read more.

Pseudoaneurysms are created by a traumatic or iatrogenic perforation of an artery, resulting in accumulation of blood between the two outermost layers of a blood vessel, the tunica media and tunica adventitia. Pedal artery pseudoaneurysms are an extremely uncommon complication of foot and ankle surgery; therefore, few cases have been reported in the literature. Early diagnosis is important to ensure timely treatment of this condition. Once clinical suspicion has been established, urgent referral to the vascular surgery clinic for prompt surgical evaluation is required to prevent potentially harmful sequelae. We present the case of a 70-year-old woman who developed a pseudoaneurysm of the dorsalis pedis artery 33 days after undergoing open reduction and internal fixation of a second metatarsal fracture. Her treatment included urgent referral to the vascular surgery clinic with subsequent surgical repair of the pseudoaneurysm by means of ligation of the medial dorsal branch of the dorsalis pedis artery. At 10-month follow-up, she denied any pain, sensory deficits, or functional disability and had returned to all preinjury activities, with no recurrence of the pseudoaneurysm. Our case study demonstrates early diagnosis and successful treatment of a pseudoaneurysm of the dorsalis pedis artery that developed shorty after open reduction and internal fixation of a second metatarsal fracture. Full article

► Show Figures

Figure 1

146 KB

Open AccessArticle

More Specialties, Fewer Problems: Using Collaborative Competency Between Infectious Diseases, Podiatry, and Pathology to Improve the Care of Patients with Diabetic Foot Osteomyelitis

by Vimal V. Jhaveri, Christopher Sullivan, Ashley Ward, John M. Giurini, Adolf W. Karchmer, Isaac E. Stillman, Roger B. Davis, Jason A. Freed, Mary T. LaSalvia and Wendy Stead

J. Am. Podiatr. Med. Assoc. 2022, 112(6), 20178; https://doi.org/10.7547/20-178 - 1 Nov 2022

Cited by 6 | Viewed by 139

Abstract

Background: Diabetic foot osteomyelitis is a common infection where treatment involves multiple services, including infectious diseases, podiatry, and pathology. Despite its ubiquity in the hospital, consensus on much of its management is lacking. Methods: Representatives from infectious diseases, podiatry, and pathology interested in [...] Read more.

Background: Diabetic foot osteomyelitis is a common infection where treatment involves multiple services, including infectious diseases, podiatry, and pathology. Despite its ubiquity in the hospital, consensus on much of its management is lacking. Methods: Representatives from infectious diseases, podiatry, and pathology interested in quality improvement developed multidisciplinary institutional recommendations culminating in an educational intervention describing optimal diagnostic and therapeutic approaches to diabetic foot osteomyelitis (DFO). Knowledge acquisition was assessed by preintervention and postintervention surveys. Inpatients with forefoot DFO were retrospectively reviewed before and after intervention to assess frequency of recommended diagnostic and therapeutic maneuvers, including appropriate definition of surgical bone margins, definitive histopathology reports, and unnecessary intravenous antibiotics or prolonged antibiotic courses. Results: A postintervention survey revealed significant improvements in knowledge of antibiotic treatment duration and the role of oral antibiotics in managing DFO. There were 104 consecutive patients in the preintervention cohort (April 1, 2018, to April 1, 2019) and 32 patients in the postintervention cohort (November 5, 2019, to March 1, 2020), the latter truncated by changes in hospital practice during the coronavirus disease 2019 pandemic. Noncategorizable or equivocal disease reports decreased from before intervention to after intervention (27.0% versus 3.3%, respectively; P = .006). We observed nonsignificant improvement in correct bone margin definition (74.0% versus 87.5%; P = .11), unnecessary peripherally inserted central catheter line placement (18.3% versus 9.4%; P = .23), and unnecessary prolonged antibiotics (21.9% versus 5.0%; P = .10). In addition, by working as an interdisciplinary group, many solvable misunderstandings were identified, and processes were adjusted to improve the quality of care provided to these patients. Conclusions: This quality improvement initiative regarding management of DFO led to improved provider knowledge and collaborative competency between these three departments, improvements in definitive pathology reports, and nonsignificant improvement in several other clinical endpoints. Creating collaborative competency may be an effective local strategy to improve knowledge of diabetic foot infection and may generalize to other common multidisciplinary conditions. Full article

► Show Figures

Figure 1

81 KB

Open AccessArticle

Incidence and Recovery of Acute Kidney Injury in Diabetic and Nondiabetic Patients with Foot Infections

by Easton C. Ryan, Peter Andrew Crisologo, Orhan K. Oz, Javier La Fontaine, Dane K. Wukich, Matthew Malone and Lawrence A. Lavery

J. Am. Podiatr. Med. Assoc. 2022, 112(6), 20167; https://doi.org/10.7547/20-167 - 1 Nov 2022

Cited by 3 | Viewed by 231

Abstract

Background: The aim of this study was to evaluate the incidence and recovery of acute kidney injury (AKI) in patients admitted to the hospital with and without diabetes mellitus (DM) with foot infections. Methods: We retrospectively reviewed 294 patients with DM and 88 [...] Read more.

Background: The aim of this study was to evaluate the incidence and recovery of acute kidney injury (AKI) in patients admitted to the hospital with and without diabetes mellitus (DM) with foot infections. Methods: We retrospectively reviewed 294 patients with DM and 88 without DM admitted to the hospital with foot infections. The Kidney Disease: Improving Global Outcomes guidelines were used to define AKI. Recovery was divided into three categories: full, partial, and no recovery within 90 days of the index AKI. Results: The AKI incidence was 3.0 times higher in patients with DM (DM 48.5% versus no DM 23.9%; 95% confidence interval [CI], 1.74–5.19; P < .01). Acute kidney injury incidence was similar at each stage in people with and without DM (stage 1, DM 58.1% versus no DM 47.6%; stage 2, DM 23.3% versus no DM 33.3%, and stage 3, DM 18.6% versus no DM 19.1%). Twenty-nine patients with diabetes had a second AKI event and four had a third event. In patients without DM, one patient had a second AKI. Cumulative AKI incidence was 4.7 times higher in people with DM (DM 60.9% versus no DM 25.0%; 95% CI, 2.72–8.03; P < .01). Patients with diabetes progressed to chronic kidney disease or in chronic kidney disease stage 39.4% of the time. Patients without diabetes progressed 16.7% of the time, but this trend was not significant (P = .07). Complete recovery was 3.8 times more likely in patients without diabetes (95% CI, 1.26–11.16; P = .02). Conclusions: Acute kidney injury incidence is higher in patients with diabetes, and complete recovery after an AKI is less likely compared to patients without diabetes. Full article

494 KB

Open AccessArticle

Are Static Foot Posture Measures Related to Static and Dynamic Plantar Pressure Parameters?

by Muge Kirmizi, Yesim Salik Sengul, Gamze Yalcinkaya and Salih Angin

J. Am. Podiatr. Med. Assoc. 2022, 112(6), 20129; https://doi.org/10.7547/20-129 - 1 Nov 2022

Cited by 2 | Viewed by 219

Abstract

Background: A few studies have investigated the relationship between foot posture measures and plantar pressure parameters, but no study has investigated the correlation of foot posture measures with all primary parameters consisting of contact area (CA), maximum force (MF), and peak pressure (PP). [...] Read more.

Background: A few studies have investigated the relationship between foot posture measures and plantar pressure parameters, but no study has investigated the correlation of foot posture measures with all primary parameters consisting of contact area (CA), maximum force (MF), and peak pressure (PP). We aimed to determine the relationship of the Foot Posture Index-6 (FPI-6) and navicular drop (ND) with plantar pressure parameters during static standing and preferred walking. Methods: Seventy people were included. Navicular drop and the FPI-6 were used to assess foot posture. Plantar pressure parameters including CA, MF, and PP were recorded by a pressure-sensitive mat during barefoot standing and barefoot walking at preferred speed. All assessments were repeated three times and averaged. Pearson correlation coefficients below 0.300 were accepted as negligible and higher ones were interpreted. Results: Navicular drop was moderately correlated with dynamic CA under the midfoot and second metatarsal; also, the FPI-6 was moderately correlated with dynamic CA under the midfoot (0.500 < r < 0.700). The other interpreted correlations were poor (0.300 < r < 0.500). Both measures were correlated with dynamic CA under the second and third metatarsals; dynamic CA and MF under the midfoot; and static CA, MF, and PP under the first metatarsal and hallux (P < .01). Navicular drop was also correlated with dynamic MF under the first metatarsal and dynamic CA under the fourth metatarsal (P < .01). Furthermore, ND was correlated with static CA and PP under the second metatarsal and static PP under the fifth metatarsal (P < .01). The FPI-6 was also correlated with dynamic MF and PP under the hallux (P < .01). Conclusions: The correlations between foot posture measures and plantar pressure variables are poor to moderate. The measures may be useful in the clinical assessment of medial forefoot problems related to prolonged standing and midfoot complaints related to high force during walking. Furthermore, the FPI-6 may provide valuable data regarding hallux complaints related to the high loads during walking. Full article

► Show Figures

Figure 1

1093 KB

Open AccessArticle

Short-Term Clinical Outcomes Following Total Ankle Arthroplasty Without Concomitant Osteotomy in Ankles with Severe Preoperative Varus Deformity: Comparison to Ankles with Preoperative Neutral Alignment

by Takahiro Yamashita, Kanto Nagai, Noriyuki Kanzaki, Tetsuya Yamamoto, Kazuyuki Ibaraki, Daisuke Araki, Yuichi Hoshino, Takehiko Matsushita and Ryosuke Kuroda

J. Am. Podiatr. Med. Assoc. 2022, 112(6), 20116; https://doi.org/10.7547/20-116 - 1 Nov 2022

Cited by 4 | Viewed by 120

Abstract

Background: It remains controversial whether satisfactory outcomes can be obtained following total ankle arthroplasty (TAA) without osteotomy in patients with severe varus ankle deformities. This study aimed to examine outcomes following TAA without concomitant osteotomies in patients with severe varus ankle alignment by [...] Read more.

Background: It remains controversial whether satisfactory outcomes can be obtained following total ankle arthroplasty (TAA) without osteotomy in patients with severe varus ankle deformities. This study aimed to examine outcomes following TAA without concomitant osteotomies in patients with severe varus ankle alignment by comparing them with those in patients with neutral alignment. Methods: Fifty-one patients (53 ankles; mean age, 71.4 ± 5.6 years) who underwent TAA using the TNK ankle prosthesis were examined (mean follow-up, 36.8 ± 17.8 months). Patients were allocated into groups according to the preoperative talar tilt (TT) angle: the neutral group (preoperative TT angle < 10°; n = 37) and the varus group (preoperative TT angle ≥ 10°; n = 16). Outcome measures, including the Japanese Society for Surgery of the Foot scale, Self- Administered Foot Evaluation Questionnaire, ankle range of motion, and radiographic parameters, were assessed before surgery and at the final follow-up. Results: Significant improvements were observed in clinical and radiographic outcomes in both groups after surgery. Postoperative Japanese Society for Surgery of the Foot scale and subscale scores of pain and shoes in the Self-Administered Foot Evaluation Questionnaire were not significantly different between the groups, whereas subscale scores of function, social, and health were greater in the varus group than in the neutral group at the final follow-up. Radiographic parameters, including TT angle and tibial axismedial malleolus (TMM) angle, improved postoperatively and were not significantly different between the neutral (mean TT angle, 0.5 ± 0.7°; mean TMM angle, 16.0 ± 4.6°) and varus (meanTT angle, 0.4 ± 0.7°; meanTMM angle, 17.0 ± 5.3°) groups at the final follow- up. To achieve neutral alignment, adjunctive procedures were required more often in the varus group. Conclusions: Outcomes of TAA using the TNK ankle prosthesis were favorable in patients with severe varus ankle and in those with neutral ankle without concomitant osteotomy. Satisfactory outcomes could be achieved in patients with severe varus ankle alignment after TAA without concomitant osteotomy. Full article

► Show Figures

Figure 1

185 KB

Open AccessArticle

The Prevalence of Biphalangealism for Each Toe in the Turkish Population: An Epidemiologic Study

by Tunca Cingoz, Yunus Emre Ozdemir, Mustafa Sungur, Mehmet Sahin, Dilara Usta, Birce Buturak Kucuk and Kerim Sariyilmaz

J. Am. Podiatr. Med. Assoc. 2022, 112(6), 20065; https://doi.org/10.7547/20-065 - 1 Nov 2022

Viewed by 245

Abstract

Background: Biphalangealism has been evaluated in many studies and has been shown as a common variant. Its frequency varies according to the populations. This epidemiological study aimed to determine the prevalence of biphalangealism for each toe in the Turkish population and compare it [...] Read more.

Background: Biphalangealism has been evaluated in many studies and has been shown as a common variant. Its frequency varies according to the populations. This epidemiological study aimed to determine the prevalence of biphalangealism for each toe in the Turkish population and compare it with other populations. Methods: The local hospital radiological database was searched for all consecutive foot radiographs, obtained between 2014 and 2018. Anteroposterior (AP) and oblique radiographs obtained to evaluate trauma or foot pathologies were included. Two-phalangeal toes according to radiographical views were defined as biphalangeal and other three-phalangeal toes were defined as normal. Results: A total of 2,881 radiographs of 2,710 adult patients met the incusion criteria. There were 1,558 (57.5%) female and 1,152 (42.5%) male patients. The cases were unilateral in 2,539 patients and bilateral in 171 patients. The overall prevalence of biphalangeal third toe was 0.29%, fourth toe was 1.29%, and fifth toe was 23.3%. Conclusions: The presence of pedal biphalangealism is a common variant and its frequency varies according to the populations. The exact cause is still unclear. Further studies are required to assess the clinical impact of biphalangealism. Full article

► Show Figures

Figure 1

234 KB

Open AccessArticle

Isokinetic Analysis of Flexible Flatfoot: Is It a Weakness of Proprioception and Muscle Strength?

by Osman Nuri Ozyalvac, Canan Gonen Aydin, Evren Akpinar, Avni Ilhan Bayhan and Timur Yildirim

J. Am. Podiatr. Med. Assoc. 2022, 112(6), 20045; https://doi.org/10.7547/20-045 - 1 Nov 2022

Cited by 4 | Viewed by 153

Abstract

Background: Although flexible flatfoot (FF) in children is a foot deformity that is frequently encountered in daily orthopedics practice, its etiology is still controversial. The aim of this study was to determine whether there is a weakness in muscle strength and proprioception in [...] Read more.

Background: Although flexible flatfoot (FF) in children is a foot deformity that is frequently encountered in daily orthopedics practice, its etiology is still controversial. The aim of this study was to determine whether there is a weakness in muscle strength and proprioception in patients with FF. Methods: The study group consisted of 16 cases with FF, and the control group consisted of 25 volunteers with normal feet. An isokinetic dynamometer was used to assess muscle strength and proprioception of movement directions of plantarflexion, dorsiflexion, eversion (EV), and inversion (INV) in both groups. Results: There was no statistically significant difference between the groups in strength of plantarflexion and dorsiflexion muscles, whereas in the control group, proprioception of all four movement directions and strengths of the EV and INV muscles were found to be statistically significantly higher (P < .05). Conclusions: There is weakness in EV and INV muscle strength and proprioception disorder in patients with FF. We recommend conducting further studies that validate muscle weakness and proprioception disorders with different study designs and evaluate the effectiveness of improving muscle strength and proprioception weakness in FF. Full article

► Show Figures

Figure 1

278 KB

Open AccessArticle

Effects of Walking Speeds and Durations on Peak Plantar Pressures

by Fu-Lien Wu, Chi-Wen Lung, Wendy Tzyy-Jiuan Wang, Jeannette Elliott, Sanjiv Jain and Yih-Kuen Jan

J. Am. Podiatr. Med. Assoc. 2022, 112(6), 20043; https://doi.org/10.7547/20-043 - 1 Nov 2022

Cited by 5 | Viewed by 194

Abstract

Background: Walking at various speeds and durations may result in different peak plantar pressure (PPP). However, there is no study comparing the effect of walking speeds and durations on PPP. The purpose of this study was to explore whether different walking speeds and [...] Read more.

Background: Walking at various speeds and durations may result in different peak plantar pressure (PPP). However, there is no study comparing the effect of walking speeds and durations on PPP. The purpose of this study was to explore whether different walking speeds and durations significantly change PPP and establish a normal response in healthy people. Methods: An in-shoe plantar pressure system was used to measure PPP under the first toe, first metatarsal, second metatarsal, and heel regions in 12 healthy, young people. All participants performed six walking trials at three speeds (3, 6, and 9 km/h) and for two durations (10 and 20 min). The 3 × 2 two-way analysis of variance was used to examine the main effects of speeds and durations and their interaction. Results: The results showed that walking speeds significantly affected PPP and that walking duration did not. No interaction between the walking speed and duration was observed. Peak plantar pressure values under the first toe and the first metatarsal head were significantly higher (P < .05) at 9 km/h (509.1 ± 314.2 kPa and 591.4 ± 302.4 kPa, respectively) than at 3 km/h (275.4 ± 168.7 kPa and 369.4 ± 205.4 kPa, respectively) after 10-min walking. Conclusions: People at risk for foot ulcers may use slow and brisk walking for exercise to reduce PPP, thus reducing risk for foot ulcers. Our study demonstrated that slow running at 9 km/h significantly increases PPP. Full article

► Show Figures

Figure 1

544 KB

Open AccessArticle

How Reliable Are Digital Radiographs for Evaluating Intra-articular Displacement in Ankle Epiphyseal Fractures: Can Computed Tomography Be Eliminated?

by Ali Turgut, Anıl Koca, Melikşah Uzakgider, Ümit Altundağ, Mehmet Can Gezer and Onder Kalenderer

J. Am. Podiatr. Med. Assoc. 2022, 112(6), 20002; https://doi.org/10.7547/20-002 - 1 Nov 2022

Cited by 2 | Viewed by 125

Abstract

Background: The amount of intra-articular displacement of the fracture is the main issue when deciding the treatment method between conservative or surgical means in intra-articular fractures. In this study, we aimed to determine the intraobserver and interobserver reliability of measuring intra-articular displacement and [...] Read more.

Background: The amount of intra-articular displacement of the fracture is the main issue when deciding the treatment method between conservative or surgical means in intra-articular fractures. In this study, we aimed to determine the intraobserver and interobserver reliability of measuring intra-articular displacement and to compare the digital radiographic and computed tomographic (CT) evaluations in distal tibia intra-articular epiphyseal fractures. Methods: Thirty-seven patients with digital radiography and CT scans were included in the study. Four sets were prepared with these images. Two of four sets were prepared as ankle radiographs, and the other two sets were prepared with CT scan views. Five observers were asked to measure the intra-articular displacement of the fractures in millimeters and also to make a decision between displacement amounts over or under 2 mm. Intraclass correlation coefficient scores were calculated for evaluation of intraobserver reliability, and Fleiss kappa values were calculated for interobserver reliability evaluations. A value greater than 0.75 was accepted as excellent agreement; 0.75 to 0.40 as intermediate to good agreement; and below 0.40 as poor agreement. Results: There were 15 Salter-Harris type 3, 13 Salter-Harris type 4, seven triplanar, and two Tillaux-Chaput fractures. Both intraobserver and interobserver reliabilities were slightly higher for CT scan evaluations. Amounts of displacement were found to be measured higher after CT scan evaluations other than radiographs. After the measurement of joint displacements on CT scans, it was observed that the measurements found below 2 mm on the digital radiograph measurement changed to greater than or equal to 2 mm in 16.4% of the patients. Conclusions: This study confirmed that digital radiographs cannot replace CT scans for the measurement of intra-articular displacement in ankle epiphyseal fractures. Full article

► Show Figures

Figure 1

Journal Menu

Journal Browser

J. Am. Podiatr. Med. Assoc., Volume 112, Issue 6 (11 2022) – 23 articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI