Podiatry Commons^™

Review Of Orthoplastic Techniques For Lower Extremity Reconstruction: Part One, Benjamin Heddy, Brady Webb

Advances in Clinical Medical Research and Healthcare Delivery

Orthoplastic techniques are effective tools for limb salvage in the lower extremity. In order to apply proper techniques successfully, a surgeon must be aware of all the different types of flaps available. Proper pre-operative evaluation and patient selection are also important factors. The following review covers six papers that give surgeons a strong foundation in the anatomical basis and surgical technique of intrinsic muscle flaps and other fasciocutaneous or adipofascial flaps of the foot. These flaps, along with split thickness skin grafts, external fixation, and dermal regenerative templates, quickly close soft tissue deficits in the foot and ankle that often …

The Importance Of Stigma Theory For Clinical Decisions Related To Diabetic Foot Amputations, Rachael Garcia, Callie Bartkowiak, Alison Nesbitt Do

Clinical Research in Practice: The Journal of Team Hippocrates

The authors examine the unconsidered impact of social stigma theory on the shared clinical decision-making process for a patient with foot osteomyelitis and MRSA bacteremia facing the prospect of an amputation.

Joint Angle Variability Is Altered In Patients With Peripheral Artery Disease After Six Months Of Exercise Intervention, Farahnaz Fallahtafti, Zahra Salamifar, Mahdi Hassan, Hafizur Rahman, Iraklis Pipinos, Sara A. Myers

School of Podiatric Medicine

Supervised exercise therapy (SET) is a conservative non-operative treatment strategy for improving walking performance in patients with peripheral artery disease (PAD). Gait variability is altered in patients with PAD, but the effect of SET on gait variability is unknown. Forty-three claudicating patients with PAD underwent gait analysis before and immediately after a 6-month SET program. Nonlinear gait variability was assessed using sample entropy, and the largest Lyapunov exponent of the ankle, knee, and hip joint angle time series. Linear mean and variability of the range of motion time series for these three joint angles were also calculated. Two-factor repeated measure …

Surgical Treatment Of Multiple Deforming Xanthomas Of The Foot And Ankle With Complete Excision And Rotational Skin Flaps: A Case Report, Qanita Ali, Rachelle Randall, Lawrence M. Fallat

Articles

Xanthomas are cholesterol rich nodular dermal lesions characterized by lipid-laden macrophages that accumulate in skin and tendons.1 These lesions are frequently associated with hyperlipidemia disorders characterized by impaired cholesterol metabolism and accelerated atherosclerotic plaque development.2 Until recently, xanthomas were considered mere cosmetic lesions, however extensive evidence has shown that the presence of xanthomas signify increased cardiovascular risk and reduced average lifespan.3 Treatment centers around lipid lowering agents and rarely are these masses large enough to require surgical resection, thus there is very little literature discussing proper surgical excision.4, 5 We present a rare case of a 65 year old female …

A Case Series Of Three Patients With Rare Pantalar Dislocation, Marissa Mogavero, Andrew Robitaille, Lawrence M. Fallat

Articles

Total talar dislocations are rare, significant surgical challenges for foot and ankle surgeons. These dislocations can be very difficult to manually close-reduce, requiring immediate surgical intervention secondary to arterial impingement, pain and risk of skin necrosis attributable to skin tenting. In this case series, we report on three patients who presented to the emergency room following a traumatic ankle injury. Ankle radiographs and computed tomography (CT) scans were obtained, revealing pantalar dislocations. Closed reduction utilizing Charnley’s principles was attempted in the emergency room through manual accentuation of the deformity, traction and reduction. Closed reduction was unsuccessful in all three patients …

Tibiotalocalcaneal Fusion With Bulk Femoral Head Allograft In A Patient With A Rare, Trauma Induced, Rigid, Cavovarus Foot Deformity, Josh Carroll, Joseph Wolf, Lawrence M. Fallat

Articles

Tibiotalocalcaneal (TTC) arthrodesis with bulk femoral head allograft is a commonly performed limb salvage procedure when dealing with complex deformity. However, little has been reported in patients who receive tibiotalocalcaneal arthrodesis with femoral head allografts for a rigid cavovarus foot type. The purpose of this case report was to examine the outcomes of a tibiotalocalcaneal arthrodesis with a femoral head allograft in a diabetic patient with a trauma induced rigid cavovarus deformity who had complete lateral dislocation of the talar body. The secondary purpose was to highlight the preservation of limb length in the surgical extremity when utilizing a tibiotalocalcaneal …

A Rare Benign Soft-Tissue Chondroma In The Plantar Foot: A Case Report, Ashley Mariano, Lawrence M. Fallat

Articles

Extraskeletal chondromas are rare, benign cartilaginous neoplasms that are usually found in adults and often present as a slow growing solitary mass. We present a case of a 78-year-old male who initially presented with a painful hyperkeratotic lesion to the plantar aspect of his right foot resembling a porokeratosis. He noted increased pain when bearing weight. Initial radiographs revealed no osseous pathology, bone spurs or foreign bodies that correlated with the area of pain. Due to failed conservative treatment that consisted of regular debridement, surgical excision of the lesion was performed which revealed a large underlying hard nodule. The nodular …

Podiatric Medicine And Surgery Journal Club, Tyler Coye, Courtney Foote, Aaren Harrington, Ryan Thurston, Eileen Farley, Gaurav Singh

Advances in Clinical Medical Research and Healthcare Delivery

The general purpose of this and future journal club columns is to facilitate the review of specific research studies and to discuss implications of each study for clinical practice as it relates to the lower extremity. Each column will be dedicated to a specific topic relevant to the treatment of a Foot and Ankle pathology. Each article chosen and reviewed will reflect the most recent advancements in Foot and Ankle Surgery and Medicine. We hope that you, the reader, find value and pleasure in the articles reviewed.

Perceived Instability, Pain, And Psychological Factors Predict Function And Disability In Individuals With Chronic Ankle Instability, Ashley M.B. Suttmiller, Julie M. Cavallario, Shelby E. Baez, Jessica C. Martinez, Ryan S. Mccann

Rehabilitation Sciences Faculty Publications

Context:

Chronic ankle instability (CAI) is associated with residual instability, pain, decreased function, and increased disablement. Injury-related fear has been associated with CAI, although its relationship to other impairments is unclear. The Fear-Avoidance Model is a theoretical framework hypothesizing a relationship between injury-related fear, chronic pain, pain catastrophizing, and disability. It has been useful in understanding fear's influence in other musculoskeletal conditions but has yet to be studied in those with CAI.

Objective:

To explore relationships between instability, pain catastrophizing, injury-related fear, pain, ankle function, and global disability in individuals with CAI.

Design:

Cross-Sectional Study

Setting:

Anonymous online survey

Patients …

The Influence Of Shoe And Cleat Type On Lower Extremity Muscle Activation In Youth Baseball Pitchers, Jacob R. Gdovin, Chip Wade, Lauren A. Luginsland, Charles C. Williams, Riley Galloway, John C. Garner

Human Movement Sciences Faculty Publications

Background: Baseball pitching is a dynamic movement where the lower extremities generate and sequentially transfer energy to the upper extremities to maximize ball velocity. The need for lower body muscular strength to produce adequate push-off and landing forces has been documented; however, the influence footwear and surface inclination has on muscle activation remains unknown.

Objectives: Determine how pitching in molded cleats and turf shoes from a pitching mound and flat ground affects stride-leg muscle activation in youth baseball pitchers while determining percent activation during each pitching phase.

Methods: Cross – sectional study analyzing mean muscle activity and percent activation of …

Limb Salvage Therapy In Septic Diabetic Foot Ulcer In Patients Unwilling To Undergo Amputation, Luke Hong

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising

Shojaiefard A, Khorgami Z, Larijani B. Septic diabetic foot is not necessarily an indication for amputation. J Foot Ankle Surg. 2008;47(5):419-423. https://doi.org/10.1053/j.jfas.2008.05.005

for a patient with a septic diabetic foot.

Allogenic Fibular Bone Graft Reconstruction With Complete Regeneration Of The Lateral Malleolus After En Bloc Resection Of A Distal Fibular Aneurysmal Bone Cyst: A Case Report, Kalli E. Mortenson, Lawrence M. Fallat

Articles

Aneurysmal bone cysts are expansile lytic lesions that most commonly affect the metaphysis of long tubular bones. These lesions are locally aggressive and predominately occur within the first two decades of life. Currently the most widely used surgical treatment involves intralesional curettage of the affected bone. However, there have been several reports of high recurrence rates with this technique. We present a case of a 12 year old female who presented with an aneurysmal bone cyst of the lateral malleolus of the right ankle. The patient underwent multiple surgeries and ultimately had complete surgical resection of the cystic lesion and …

The Phoenix Sign: Is It Due To Vasodilation? Blinded Prospective Comparing The Effects Of Papaverine To Lidocaine Without Epinephrine, Julia Aguirre

Symposium of Student Scholars

A neurological phenomenon has been observed clinically that when after a small amount of 1% lidocaine (usually less than .5cc’s) has been infiltrated adjacent to the Common Fibular (Peroneal) nerve under sonographic guidance, in patients with drop foot, or significantly weakened motor potentials of the lower extremity dorsiflexors (Extensor Hallucis Longus (EHL), Tibialis Anterior (TA), and Extensor Digitorum Longus (EDL)), the patient will regain partial or full dorsiflexion temporarily during the effect of this nerve block. This has been named the Phoenix Sign, in reference to ancient Greek folklore, as the non-functioning nerve (like the bird) becomes functional due to …

The Epidemiology, Evaluation, And Assessment Of Lateral Ankle Sprains In Athletes, G. Javier Cavazos Jr., Lawrence B. Harkless

School of Medicine Publications and Presentations

Approximately 30,000 ankle injuries occur every day in the United States. With the incidence estimated at more than 3 million a year and at a rate of 2.15/1,000 in the U.S. alone, medical specialists and other healthcare providers caring for the foot and ankle must take notice. Despite the millions of ankle injuries sustained annually, the true incidence may be underestimated, as fewer than half of individuals with ankle sprains seek medical attention from healthcare professionals. The economic burden associated with the evaluation, diagnosis, and treatment is close to $4 billion annually. Ankle sprains account for half of all sports …

Minimally Invasive Surgery For Septic Arthritis Of The First Metatarsophalangeal Joint: An Uncommon Approach Utilizing Small Joint Arthroscopy, Michael Thomas, Hinal Patel, Jeffrey Belancio

Stratford Campus Research Day

Small joint arthroscopy can be utilized for septic arthritis, synovitis, osteochondral lesions, arthritis, and various other pathologies. However, information regarding arthroscopy of the first metatarsophalangeal joint (MTPJ) is limited in the literature. This case report discusses the use of arthroscopy for septic arthritis of the 1st MTPJ.

Lumbopelvic Stability And Trunk Muscle Contractility Of Individuals With Chronic Ankle Instability, Ryan S. Mccann, Kelly Johnson, Ashley M.B. Suttmiller

Rehabilitation Sciences Faculty Publications

BACKGROUND: Chronic ankle instability (CAI) results in hip neuromuscular impairments that can perpetuate dysfunction through reduced lumbopelvic stability and subsequent malpositioning of the lower body during functional movement. Lumbopelvic stability might be further impaired through changes in trunk muscular contractility. However, lumbopelvic stability and trunk muscle morphology have not been compared between individuals with and without CAI.

PURPOSE: To compare lumbopelvic stability and trunk muscle contractility between individuals with and without chronic ankle instability (CAI) and determine if lumbopelvic stability and trunk muscle contractility are associated with self-reported function.

STUDY DESIGN: Case-control study.

METHODS: Ten individuals with CAI, 10 …

A Comparison Of Neuropathy Quality Of Life Tools: Norfolk Qol-Dn, Pn-Qol-97, And Neuroqol-28, Jennifer Joy Brown, Sheri R. Colberg, Shana Pribesh, Kimberly G. Baskette, Aaron I. Vinik

Human Movement Sciences Faculty Publications

Aims To explore the effectiveness of the Norfolk QOL-DN (QOL-DN), PN-QOL-97, and NeuroQOL-28 as tools for early detection of diabetic peripheral neuropathy in overweight, obese, and inactive (OOI), prediabetes (PD), and type 2 diabetes (T2D) individuals.

Methods Thirty-four adults were divided by A1C [(10 OOI, 13 PD, and 11 T2D] and the sural nerves were tested bilaterally via NC-Stat DPN Check, conducting a sural nerve conduction study (NCS). Participants were individually timed, filling out questionnaires (QOL-DN, NeuroQOL-28, and PN-QOL-97) at a self-selected pace. Data were analyzed and compared to NCS findings to determine the best instrument for early neuropathy detection, …

The Implementation Of Diabetic Foot Care Into Primary Care, Shelby D. Strong

Evidence-Based Practice Project Reports

Diabetes mellitus (DM) is one of the most common metabolic diseases worldwide. It can lead to complications in many parts of the body and can increase overall risk of dying prematurely (World Health Organization (WHO), 2016). Diabetic peripheral neuropathy (DPN) in the feet is one of the most frequent complications of DM (Wang et al., 2017). Other lower extremity complications which can occur as a result of diabetic foot complication (DFC) includes peripheral artery disease (PAD), infection, ulcer and amputation. One of the obstacles for preventing (DFC) is the lack of examinations of the feet in clinical practice (Feitosa et …

Bullet Hole Sinus Tarsi: Functional And Radiographic Outcomes Following A Self-Inflicted Gunshot Wound To The Talus With Vascular Injury, Eric P. Krznaric Dpm, John R. Greaves Dpm, Jason C. Spector Dpm, Alan A. Macgill Dpm, Christopher Ochner

Podiatry

No abstract provided.

Staged Management Of High-Energy Complex Tibial Pilon Fractures, Gan Golshteyn Dpm, Gina Nguyen Dpm, Bradley Roth Do, Marie Williams Dpm

Podiatry

No abstract provided.

A Unique Schwannoma Of The Distal Hallux: A Case Study, Rebecca D. Stack Dpm, Brett Sachs Dpm Facfas, Dustin Kruse Dpm, Paul A. Stone Dpm, Facfas

Podiatry

No abstract provided.

Effect Of Venous Thromboembolic Prophylaxis On Surgical Incision Healing, Rebecca Stack Dpm, Brett Sachs Dpm Facfas, Dustin Kruse Dpm, Paul A. Stone Dpm, Facfas

Podiatry

No abstract provided.

Isolated Forefoot Juvenile Xanthogranuloma: Unique Case Study And Treatment In A Pediatric Patient, Brian Derner Dpm, Kristine Hoffman, Amy Storfa Md, Dustin Kruse Dpm, Paul A. Stone Dpm, Facfas

Podiatry

Juvenile xanthogranulomas (JXG) are a benign histiocytic cell proliferative disorder in early childhood. They most commonly present within the first two years of life with papular or nodular changes to the skin on the head, neck or upper trunk. Xanthogranulomas are mostly self-limiting, can be singular or multiple, and rarely can infer a systemic disease process1. The purpose of this study was to publish a unique finding of an extra-tendinous solitary mass in an otherwise healthy 17-year old, with surgical and medical treatment after diagnosis.

Program Evaluation In Women's Health Integration For Podiatric Residents, Nilin M. Rao Dpm, Carol A. Stamm Md, Elizabeth Ihler Md, Dustin Kruse Dpm, Paul A. Stone Dpm, Facfas

Podiatry

As the podiatric profession strives for professional and financial parity with allopathic and osteopathic colleagues, podiatric medical education has been transformed at both undergraduate and graduate levels to more closely align in important ways. The purpose of this program evaluation is to share the benefits of including a women’s health rotation into the required graduate medical training curriculum, share the initial experience of the first resident cohort receiving this training, and provide ideas to other programs that may be interested in providing similar program implementation for their residents.

Atypical Spindle Cell Lipomatous Tumor Under The Sesamoids In The Foot: A Case Report, Nilin M. Rao Dpm, Hani H. Saeed Dpm, Md, Facfas, Dustin Kruse Dpm, Bryan Raymond Dpm, Paul A. Stone Dpm, Facfas

Podiatry

Atypical spindle cell lipomatous (ASCL) tumors have a distinct histological and clinical presentation, rarely presenting in the foot. With the sub-sesamoidal location of this neoplasm found in our case report being an unusual location for atypical spindle cell lipomatous tumors to present, the purpose of our case report was to present the clinical presentation, histology/pathology, method of resection and outcome of our patient on follow-up to provide a framework for other surgeons on how to approach these neoplasms in the future.

Flexor Tenotomy For The Treatment Of Hallux Ulcers, Nathalia Esmeral, Val E. Haddon, Chase G. Dahl, Erin Lewis, David Khakshoor

Podiatry

Aims: To assess and evaluate the relationship between flexor tenotomies in a clinical setting and the time course for healing neuropathic, diabetic and structural deformity hallux ulcers.

Methods: This retrospective study analyzes the medical files of 1,471 patients treated for digital foot ulcers by flexor tenotomies between September 2011 and January 2019. For the intent of this particular research, focus was preserved towards the effect of flexor tenotomy on healing time to address hallux ulcers. A total of 97 patients between the ages of 41 and 86 years old underwent flexor tenotomy for the treatment of hallux ulcers with a …

Operative Intervention Does Not Change Pain Perception In Patients With Diabetic Foot Ulcers, Olivia V. Waldman, Stephanie P. Hao, Jeff R. Houck, Nicolette J. Lee, Judith F. Baumhauer, Irvin Oh

Faculty Publications - College of Physical Therapy

Researchers investigated pain perception in patients with diabetic foot ulcers (DFUs) by analyzing pre- and postoperative physical function (PF), pain interference (PI), and depression domains of the Patient-Reported Outcome Measurement Information System (PROMIS). They hypothesized that 1) because of painful diabetic peripheral neuropathy (DPN), a majority of patients with DFUs would have high PROMIS PI scores unchanged by operative intervention, and 2) the initially assessed PI, PF, and depression levels would be correlated with final outcomes. Seventy-five percent of patients with DFUs reported pain, most likely because of painful DPN. Those who reported high PI and low PF were likely …

Mri Findings After A Subchondroplasty Procedure Of The Ankle: A Case Report, Michael E. Calderone, Mansi Patel, Matthew K. Brant

Stratford Campus Research Day

Osteoarthritis (OA) of the ankle is a common disease and it is estimated that almost 1% of the world’s adult population have a painful ankle. Often in patients who fail conservative treatment, the use of an MRI is deemed necessary to identify pathologies. Bone marrow lesions (BMLs) seen on MRI have been recognized as a source of the ankle pain. Majority of the BMLs fluctuate in size over time and are seen as hyperintense lesions on MRI.We present MRI findings of a patient following arthroscopy with subchondroplasty.

Traumatic Compartment Syndrome Of The Foot: A Case Report, Mansi Patel, Asim Qureshi, Matthew K. Brant

Stratford Campus Research Day

Compartment syndrome of the foot is a rare but limb threatening condition that is often difficult to diagnose. It is usually caused by traumatic injuries and the diagnosis requires a high clinical suspicion and timely management. Clinically, patients will present with an acute traumatic event followed by physical exam findings of non-palpable pulses, paralysis, pallor, pain out of proportion, and paresthesias. The foot contains nine compartments, which should be assessed independently for elevated pressures. The diagnostic threshold for each compartment is 30 mmHg. Pressures above this threshold require emergent fasciotomy to preserve the anatomical structures and thus the function of …

Development And Exploration Of A Z-Shaped Foot And Ankle Internal Fixation Plate, Rhaz Shaghaghi Paul, Ian Hames, Sean Rich

Williams Honors College, Honors Research Projects

This paper will detail the design process of developing a Z-shaped foot and ankle internal fixation plating system. Group 6: Plates for the Sole was made up of 5 team members, who worked together to accommodate their client’s request to complete a biomechanical analysis of a Z-Plate design and a construct a prototype. The Z-Plate’s purpose is to provide podiatrists with a new solution that can fit nicely on the small, irregular bones of the foot, while also remaining strong enough to withstand the forces and torques of the foot.