Journal of the American Podiatric Medical Association最新文献

{"title":"Heel Offloading Posterior Splint for Treatment of Heel Ulcerations.","authors":"Fahad Hussain, Robin Lenz","doi":"10.7547/22-131","DOIUrl":"10.7547/22-131","url":null,"abstract":"<p><p>Total contact casting is the gold standard for plantar foot ulcers but has been questioned in heel pressure ulcers. Current offloading of heel ulcers is typically removable offloading boots. We describe using a modified posterior splint to offload heel ulcers in nonweightbearing patients. The posterior splint is readily available and familiar to practitioners, with less of a learning curve than a total contact cast. As part of the dressing, the posterior splint is less likely to be removed and leads to increased compliance. We hypothesize that this can translate to improved healing of pressure ulcers at the heel.</p>","PeriodicalId":17241,"journal":{"name":"Journal of the American Podiatric Medical Association","volume":"114 6","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tissue Selective Ultrasonic Debridement with Cryopreserved Human Skin Allograft to Heal a Chronic Wound: A Case Report.","authors":"Fahad Hussain, Robin C Lenz","doi":"10.7547/22-180","DOIUrl":"10.7547/22-180","url":null,"abstract":"<p><p>Tissue selective ultrasonic debridement is a new method of debriding chronic wounds that prepares the wound for advanced tissue application. This article presents the case of an 89-year-old woman with a chronic nonhealing wound to her lateral distal leg. The wound had a significant amount of biofilm and fibrous slough. Conservative treatment consisting of debridement and multilayer compression was attempted for 4 weeks. After 4 weeks, the patient was taken to the operating room for tissue selective ultrasonic debridement with placement of cryopreserved human skin allograft. With local wound care and multiple applications of graft, the chronic wound fully epithelialized. This study highlights the use of tissue selective ultrasonic debridement combined with cryopreserved human skin allograft to successfully heal a chronic wound. To our knowledge, this method of operative debridement and application of graft has not been documented in the literature.</p>","PeriodicalId":17241,"journal":{"name":"Journal of the American Podiatric Medical Association","volume":"114 6","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Plate for Vertical Shear Fractures of the Medial Malleolus: A Biomechanical Study.","authors":"Yunus Emre Bektas, Ramadan Özmanevra, Hakan Cici, Samet Ciklacandir, Nihat Demirhan Demirkiran, Yalcin Isler, Onur Basci, Mehmet Erduran","doi":"10.7547/22-100","DOIUrl":"10.7547/22-100","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate and compare stiffness and load to failure values of a novel medial malleolus compression plate (MP) and a 3.5-mm one-third tubular plate (TP) in the treatment of vertical shear fractures of the medial malleolus.</p><p><strong>Methods: </strong>Fourteen identical synthetic third-generation composite polyurethane bone models of the right distal tibia were randomly separated into two groups. Fracture models were created with a custom-made osteotomy guide to provide the same fracture characteristics in every sample (AO/OTA type 44A2). Fractures were reduced, and a novel MP was applied to bone models in the MP group and a TP was applied in the TP group. All of the samples were evaluated biomechanically, and force/displacement and load to failure values were recorded.</p><p><strong>Results: </strong>The force required to create displacement in the MP group was twice of that in the TP group. There was a significant difference between the two groups in all of the amounts of displacement (P = .006, P = .005, P = .007 and P = .015 for 0.5, 1.0, 1.5, and 2.0 mm, respectively).</p><p><strong>Conclusions: </strong>In the treatment of vertical shear fractures of the medial malleolus, the strength of fixation with the novel MP is biomechanically higher than that with the one-third semi-TP.</p>","PeriodicalId":17241,"journal":{"name":"Journal of the American Podiatric Medical Association","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9873259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Antiphospholipid Syndrome Causing Critical Limb Ischemia and Ultimately Amputation in an Otherwise Healthy Young Female.","authors":"Katherine Lyons, Ronald Adelman, Vanessa Adelman, Britney Wenig","doi":"10.7547/23-096","DOIUrl":"10.7547/23-096","url":null,"abstract":"<p><p>This case report describes an otherwise healthy 43-year-old female who presented with severe pain, foot drop, and critical limb ischemia to her left foot caused by thrombosis of a peripheral artery secondary to antiphospholipid syndrome. Antiphospholipid syndrome is an autoimmune disease that frequently manifests as recurrent arterial and/or venous thrombotic events, ischemic strokes, and miscarriages. Antiphospholipid syndrome affecting primarily the arteries is less common as compared to venous thrombosis. Our patient underwent several vascular surgical interventions and anticoagulant treatment; despite this, she ultimately underwent a below-the-knee amputation due to worsening ischemia. The purpose of the current case report is to emphasize that antiphospholipid syndrome should be kept on the differential for arterial ischemic events such as critical limb ischemia without another known cause and should be managed with an interprofessional team approach.</p>","PeriodicalId":17241,"journal":{"name":"Journal of the American Podiatric Medical Association","volume":"114 6","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Bicortical Headless Cannulated Screw Fixations, Tension Band Fixations, and Kirschner Wire Fixations of a Jones Fracture: A Biomechanical Study.","authors":"Onur Yilmaz, İbrahim Mutlu, Tolgahan Kuru, Ali Bilge, Berna Güngör, Hasan Kizilay, Hacı Olcar, Recai Özkılıç, H Yener Erken","doi":"10.7547/22-201","DOIUrl":"10.7547/22-201","url":null,"abstract":"<p><strong>Background: </strong>The aim of study was to biomechanically compare the fixation of Jones fracture using headless cannulated screw, tension band, and two Kirschner wires.</p><p><strong>Methods: </strong>A total of 60 fourth-generation, fifth metatarsal synthetic bone models were divided into three groups according to the fixation techniques. A vertical load, oriented from plantar to dorsal and lateral to medial, was applied to the metatarsal specimen that were potted with molding material. The stiffness and fatigue values were compared between the three fixation groups.</p><p><strong>Results: </strong>In the plantar to dorsal load test, the stiffness values were found to be significantly higher in Group 1 compared to the other groups (P = .034, P = .013). No significant difference was found in the analysis in terms of fatigue values in plantar to dorsal load testing (P = .348, P = .416). No significant difference was found between compression screw and tension band groups in lateral to medial loading test, in terms of stiffness and fatigue values (P = .096, P = .762). However, the stiffness values and fatigue values of these two groups were found to be statistically significantly higher than the Kirschner wire group (P = .003, P = .002, P = .016, P = .023).</p><p><strong>Conclusions: </strong>The result of this study showed that the bicortical fixation of headless compression screw provides a more stable fixation than other fixation methods, especially in plantar to dorsal loading.</p>","PeriodicalId":17241,"journal":{"name":"Journal of the American Podiatric Medical Association","volume":"114 6","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Serum HMGB-1 Level in Differentiating the Soft-Tissue Infection From Diabetic Foot Osteomyelitis.","authors":"Ibrahim Halil Rizvanoglu, Ümit Cinkir, Vuslat Bosnak, Nuri Orhan, Necla Benlier, Füsun Kokcu","doi":"10.7547/22-209","DOIUrl":"10.7547/22-209","url":null,"abstract":"<p><strong>Background: </strong>The incidence of diabetic foot infections is increasing due to the rising number of persons with diabetes and the prolonged life expectancy. It is vital to differentiate soft-tissue infection (STI) from diabetic foot osteomyelitis (DFO), as treatment modalities and durations vary widely, but this can be challenging. We aimed to assess the blood concentration levels of the high mobility group box 1 protein (HMGB-1) in STI and DFO compared to healthy subjects, and to investigate whether this protein could contribute to differentiating STI from DFO.</p><p><strong>Methods: </strong>Data from patients with suspected soft-tissue infection or diabetic foot osteomyelitis and healthy volunteers were prospectively recorded. Mean C-reactive protein, erythrocyte sedimentation rate, white blood cell, and HMGB-1 values in the groups were analyzed. Cut-off values of HMGB-1 between the three groups were also determined. A three-phase bone scintigraphy was accepted as the diagnostic method for differentiating STI and DFO.</p><p><strong>Results: </strong>A total of 92 volunteers, were included in the study. Group 1 comprised 28 healthy individuals who composed the control group. Group 2 comprised the 35 patients diagnosed with STI, and Group 3 comprised 29 patients diagnosed with DFO. The HMGB-1 was significantly higher in DFO. The sensitivity, specificity, and accuracy of HMGB-1 in differentiating between STI and DFO was 55%, 94%, and 77%, respectively.</p><p><strong>Conclusions: </strong>We concluded that measurement of the serum HMGB-1 level could be an adjunctive test in the differential diagnosis of diabetic foot infections.</p>","PeriodicalId":17241,"journal":{"name":"Journal of the American Podiatric Medical Association","volume":"114 6","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of Obtaining Patient-Reported Outcome Measures in a High-Volume Multidisciplinary Surgical Limb Salvage Center.","authors":"Adaah A Sayyed, Rebecca Yamamoto, Christopher Choi, Jina Lee, Jayson N Atves, John S Steinberg, David H Song, Christopher E Attinger, Kenneth L Fan, Karen K Evans","doi":"10.7547/22-064","DOIUrl":"10.7547/22-064","url":null,"abstract":"<p><strong>Background: </strong>Completion of patient-reported outcome measures (PROMs) is labor-intensive but paramount in improving patient-centered care, allowing for advancement of techniques and scrutinization of outcomes. We report the feasibility of PROM collection and reporting for patients seen in a high-volume, multidisciplinary, tertiary limb salvage center to determine pain and functionality outcomes.</p><p><strong>Methods: </strong>The center received grant funding resources for large-scale PROM collection. Patients completed either tablet or paper surveys. Functionality and pain PROMs included 1) Neuro-QoL Lower Extremity Function-Mobility, 2) Numerical Rating Scale, 3) Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity, and 4) PROMIS Pain Interference. Research assistants attended clinic daily to administer surveys. Patients were categorized into the following groups: amputation, flap reconstruction, other surgical management, and nonsurgical management.</p><p><strong>Results: </strong>Five hundred sets of each survey were administered to 420 patients across 2 months, with 16% of patients (n = 80) completing multiple sets at separate visits. The completion rate among eligible patients was 90% or greater for each PROM. Of the respondents, 133 (31.7%) were seen for previous amputation, 32 (7.6%) for local or free flap reconstruction, 68 (16.2%) for other surgical management (eg, debridement, arthroplasty), and 295 (70.2%) for nonsurgical management (eg, lymphedema, hidradenitis).</p><p><strong>Conclusions: </strong>We report that integration of PROM collection in a high-volume limb salvage center is feasible. These metrics allow measurement of the impact and effectiveness of salvage or amputation surgeries from patients' perspectives, providing quantification of satisfaction and aspects of health-related quality of life, improved patient advocacy, and an evidence-based approach to surgical management.</p>","PeriodicalId":17241,"journal":{"name":"Journal of the American Podiatric Medical Association","volume":"114 5","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antifungal Activity of Efinaconazole Compared with Fluconazole, Itraconazole, and Terbinafine Against Terbinafine- and Itraconazole-Resistant/Susceptible Clinical Isolates of Dermatophytes, Candida, and Molds.","authors":"Ahmed Gamal, Mohammed Elshaer, Lisa Long, Thomas S McCormick, Boni Elewski, Mahmoud A Ghannoum","doi":"10.7547/22-132","DOIUrl":"10.7547/22-132","url":null,"abstract":"<p><strong>Background: </strong>Recently, an increasing number of resistant-to-terbinafine dermatophytosis cases have been reported. Thus, identifying an alternative antifungal agent that possesses broad-spectrum activity, including against resistant strains, is needed.</p><p><strong>Methods: </strong>We compared the antifungal activity of efinaconazole with that of fluconazole, itraconazole, and terbinafine against clinical isolates of dermatophytes, Candida, and molds using in vitro assays. Minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) of each antifungal agent were quantified and compared. Susceptible and resistant clinical isolates of Trichophyton mentagrophytes (n = 16), Trichophyton rubrum (n = 43), Trichophyton tonsurans (n = 18), Trichophyton violaceum (n = 4), Candida albicans (n = 55), Candida auris (n = 30), Fusarium spp, Scedosporium spp, and Scopulariopsis spp (n = 15 for each) were tested.</p><p><strong>Results: </strong>Efinaconazole was the most active antifungal agent tested against dermatophytes, with MIC50 and MIC90 (concentrations that inhibited 50% and 90% of strains tested, respectively) values of 0.002 and 0.03 µg/mL, respectively. Fluconazole, itraconazole, and terbinafine showed MIC50 and MIC90 values of 1 and 8 µg/mL, 0.03 and 0.25 µg/mL, and 0.03 and 16 µg/mL, respectively. Against Candida isolates, efinaconazole MIC50 and MIC90 values were 0.016 and 0.25 µg/mL, respectively, whereas fluconazole, itraconazole, and terbinafine had MIC50 and MIC90 values of 1 and 16 µg/mL, 0.25 and 0.5 µg/mL, and 2 and 8 µg/mL, respectively. Against various mold species, efinaconazole MIC values ranged from 0.016 to 2 µg/mL versus 0.5 to greater than 64 µg/mL for the comparators.</p><p><strong>Conclusions: </strong>Efinaconazole showed superior potent activity against a broad panel of susceptible and resistant dermatophyte, Candida, and mold isolates.</p>","PeriodicalId":17241,"journal":{"name":"Journal of the American Podiatric Medical Association","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9643145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Internet Health Resources for Diabetic Foot Search: The Content, Quality, and Readability of Information on Web Sites.","authors":"Mehmet Burtaç Eren, Feyza Yildiz Aytekin","doi":"10.7547/21-155","DOIUrl":"10.7547/21-155","url":null,"abstract":"<p><strong>Background: </strong>As the incidence of diabetes mellitus increases, the incidence of diabetic foot also increases. This situation, which may lead to devastating complications and progress to limb loss for patients, exposes patients and their social environments to a big crisis. Thus, patients may seek secondary opinions from online sources about information they initially obtained from health institutions. We aimed to evaluate the information content related to diabetic foot on the Internet that is probably used by patients for Internet searching.</p><p><strong>Methods: </strong>After software optimization and reset, related queries with the keyword diabetic foot were determined on Google Trends. Selected keywords were searched in three search engines, and the results were examined. Web sites were classified into five subcategories (nongovernmental health institution, governmental institution, academic, blog, and university) and evaluated with an information content scale (ICS) based on the literature, Journal of the American Medical Association benchmark criteria, the Flesch-Kincaid readability test, and presence of the Health On the Net Foundation Code of Conduct certificate. The search engines, keywords, and Web site subcategories were investigated with the evaluation criteria.</p><p><strong>Results: </strong>In terms of finding Web sites eligible for assessment, the Google search engine listed more eligible Web sites than did Bing and Yahoo. Concerning the ICS, there was no significant difference between search engines for total scores (P > .05). Concerning ICS diagnosis and evaluation and ICS total score, academic Web sites scored significantly higher than other subcategories.</p><p><strong>Conclusions: </strong>Results that can be obtained with an Internet search for diabetic foot depend on the proper keyword selection, Web site type, and search engine to help patients reach more appropriate content.</p>","PeriodicalId":17241,"journal":{"name":"Journal of the American Podiatric Medical Association","volume":"114 5","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-Screw Fixation in Isolated Medial Malleolar Fractures.","authors":"Cem Zeki Esenyel, Tugcan Demir, Halil Karaca, İsmail Kalkar","doi":"10.7547/23-135","DOIUrl":"https://doi.org/10.7547/23-135","url":null,"abstract":"<p><strong>Background: </strong>Isolated medial malleolar fractures are observed less often than are lateral malleolar fractures, bimalleolar fractures, and trimalleolar fractures. The aim of treatment is to provide anatomical reduction, protect this reduction until the fracture heals, and to regain normal ankle function. The aim of our study was to evaluate the clinical and radiological outcomes of patients with isolated medial malleolus fracture treated with cross-screw fixation.</p><p><strong>Methods: </strong>The study included 13 patients: 9 males with a mean age of 37.1 years (range, 25-64 years) and 4 females with a mean age of 40.2 years (range, 24-62 years) who were treated with the cross-screw fixation method for an isolated medial malleolar fracture. The fracture union status was evaluated on the 3-month postoperative radiographs, and the functional outcomes with the American Orthopaedic Foot and Ankle Scale (AOFAS) ankle score.</p><p><strong>Results: </strong>The mean AOFAS score was 82 at 3 months postoperatively, evaluated as an excellent outcome in 2 patients, good in 9, and fair in 2. At the 24th month postoperatively, the mean AOFAS score was determined to be 92.2, evaluated as excellent in 11 patients and good in 2. On palpation of the medial malleolus, the mean VAS pain score was 2 (range, 1-3.8) at 3 months postoperatively, and a mean of 0.6 (range, 0.2-3) at 24 months.</p><p><strong>Conclusions: </strong>Cross-screw fixation can be preferred for the fixation of isolated medial malleolar fractures as it causes less soft-tissue damage because it can be performed percutaneously, and the screw head has a low profile, thereby eliminating the need for a Kirschner wire to be applied together with the screw to prevent rotational deformity.</p>","PeriodicalId":17241,"journal":{"name":"Journal of the American Podiatric Medical Association","volume":"114 5","pages":""},"PeriodicalIF":0.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}