Podiatry Commons^™

Beyond Revascularization: Is Tibial Transverse Transport The Next Frontier In Diabetic Limb Salvage?, Karishma A. Sebastian, Nidhin John

School of Podiatric Medicine - Student Research

Poster Category:  Non-sponsored.

Level of Evidence: Level III

Introduction: Diabetic foot ulceration remains a major cause of lower-extremity amputation despite multidisciplinary wound care, debridement, infection control, offloading, and revascularization. Tibial transverse transport (TTT), based on the Ilizarov tension-stress principle, uses controlled transverse distraction of tibial cortex to promote angiogenesis and distal microcirculation in severe or recalcitrant diabetic foot ulcers (DFUs).

Aim: To systematically evaluate whether TTT improves wound healing, distal perfusion, ulcer recurrence, and limb salvage in severe or recalcitrant DFUs and define its potential role as an adjunctive salvage intervention.

Methods: A PRISMA-guided review of peer-reviewed literature through August …

Walking The Line How Social Forces Shape Diabetic Foot Outcomes In The Texas Rio Grande Valley, Amanda L. Killeen, Stephanie N. Campbell, Naomie Jean, Juan Lopez-Alvarenga, Xuan Wang, Cyaandi Dove, Caroline E. Fife

School of Podiatric Medicine Publications

• Diabetes in the Rio Grande Valley is widespread and severe. Nearly 1 in 3 adults is affected, with foot ulcers and amputations occurring at rates far above state and national averages.
• Social drivers of health (SDOH) strongly influence outcomes. Poverty, uninsurance, limited education, transportation barriers, and distance from specialty centers delay care and increase amputation risk.
• Living conditions amplify risk. Colonias, unincorporated settlements often lacking clean water, sewer systems, or reliable electricity, make diabetes management and preventive foot care especially challenging.
• Data-driven identification of high-risk populations is critical. Zip code–level SDOH data, integrated into electronic medical records, can serve as …

The Impact Of Minor Amputation On Occurrence Of Major Amputation In Patients With Diabetic Foot Ulcers, Nivan Wadhawan, Naohiro Shibuya, Daniel C. Jupiter

School of Podiatric Medicine Publications

Diabetic foot ulcers (DFU) may lead to lower extremity amputation (LEA). Although minor LEAs (at or distal to the ankle) can carry a higher risk of perioperative complications compared to major LEAs (proximal to the ankle), they can increase patient independence and quality of life. This study aims to elucidate the impact of minor LEA on the time between DFU occurrence and major LEA to help determine the safer and more efficacious LEA choice for a given clinical situation. Data from 4,199 DFU patients from the TriNetX research platform were utilized. Kaplan-Meier curves and Cox regression were conducted to evaluate …

Diabetes-Related Foot Complications And Socioeconomic Influences Among Hispanic Males In South Texas: A Scoping Review, Mariana J. Rodriguez, Demian Rodriguez, Amanda L. Killeen

School of Podiatric Medicine - Student Research

Introduction: Diabetes mellitus is the 7^th leading cause of death in the United States and is 6^th in the state of Texas. Counties from South Texas are primarily affected with higher rates of diabetes than both the state and national average. Diabetes mellitus is a complex and progressive disease which can affect multiple systems of the body, leading to serious complications if untreated, especially in the lower extremities. Uncontrolled diabetes is often associated with diabetic foot ulcers (DFU), foot infections, and lower extremity amputations (LEA). South Texas is a region predominantly populated by Hispanic Americans who are disproportionally …

Diabetes-Related Foot Complications And Socioeconomic Influences Among Hispanic Males In South Texas: A Scoping Review, Mariana J. Rodriguez, Demian Rodriguez, Amanda Killeen

School of Podiatric Medicine Publications

Introduction: Diabetes mellitus is the 7th leading cause of death in the U.S. and 6th in Texas. South Texas counties have higher diabetes rates than state and national averages. This complex, progressive disease affects multiple body systems and can lead to serious complications, especially in the lower extremities. Uncontrolled diabetes is often associated with diabetic foot ulcers (DFU), foot infections, and lower extremity amputations (LEA). South Texas, predominantly Hispanic American, is disproportionately affected. This demographic faces clinical barriers due to a lack of cultural understanding, highlighting the need for culturally sensitive healthcare workers such as promotoras. This study aimed to …

The Infected Diabetic Foot: Bacteraemia And Endocarditis Complicating Moderate And Severe Foot Infections, Mario C Reyes, Arthur N Tarricone, Mathew J Sideman, Michael C Siah, Bijan Najafi, Edgar J G Peters, Lawrence A Lavery

Center on Aging Staff Publications

To identify the incidence of blood stream infections (BSIs) and endocarditis in patients with diabetic foot infections (DFIs), risk factors and clinical outcomes. A post hoc analysis of 280 patients using pooled patient level data from three RTCs. Blood cultures were drawn at time of admission for DFI. Deep intraoperative cultures were obtained from infected foot wounds. Data from the 12-month follow-up were used to determine clinical outcomes. 77.1% (N = 216) had blood cultures of which 15.7% (n = 34) had BSI. One patient (3.3%) had endocarditis. Risk factors for BSI included Charcot Neuroarthropathy history (20.6% vs. 7.1%, p …

The Dialysis Foot- The Impact Of Presenting Estimated Glomerular Filtration Rate On Clinical Outcomes In Patients Hospitalized With Diabetic Foot Infections, Arthur Tarricone, Tyler L Coye, Allen Gee, Bijan Najafi, Michael C Siah, Lawrence A Lavery

Center on Aging Staff Publications

To evaluate the association between presenting estimated glomerular filtration rate (eGFR) and clinical outcomes in patients hospitalized with diabetic foot infections. This retrospective cohort study included 344 patients with moderate to severe diabetic foot infections. Patients were categorized into three groups based on presenting estimated eGFR: eGFR ≥60 (eGFR >60 mL/min), eGFR 30-60 (eGFR 30-60 mL/min) and eGFR < 30 (eGFR < 30 mL/min). Outcomes assessed included wound healing, time to heal, re-infection, amputation, mortality and re-hospitalization for infection. Compared with patients with eGFR < 30, patients with eGFR ≥60 had significantly lower rates of retinopathy, peripheral arterial disease and use of beta blockers or calcium channel blockers. Glycated haemoglobin levels were inversely related to eGFR, decreasing as eGFR severity increased. Haemoglobin levels were significantly lower, and inflammatory markers (ESR and CRP) were significantly higher in patients with eGFR < 30. There were no significant differences among eGFR groups in rates of wound healing, time to heal, re-infection or amputation. However, mortality increased with decreasing eGFR (1.9% in eGFR ≥60 vs. 3.2% in eGFR 30-60 vs. 8.1% in eGFR < 30; p = 0.04). Similarly, re-hospitalization for infection at a different site also increased with decreasing eGFR (20.5% in eGFR ≥60 vs. 28.1% in eGFR 30-60 vs. 48.4% in eGFR < 30; p <  0.01). In diabetic foot infections, presenting eGFR severity did not affect rates of wound healing, time to heal, re-infection or amputation. However, decreasing eGFR was associated with increased mortality and re-hospitalization for infection at a different site. In this study, presenting eGFR was not a predictive value for wound healing or time until healing, however was associated with rehospitalization and overall mortality this diabetic foot population.

Limbgod(Pat. Pending): Wearable Garment For Amputation Prevention, Naomi Choi Dpm, Mba, Phuc An Dinh Bs, Ms, Eric Lee Bs, Francois M. Lokenye Dpm

Posters

Approximately 1.6 million people in the U.S. have lower limb amputations, which is expected to double by 2050 (Wong et al.). Socio-economic factors: income, education, rural residency & race, impact amputation risk (Okesina et al.), with Black Americans 70% are more likely to undergo major lower limb amputations than white Americans, even after adjusting for care access & comorbidities (Feinglass et al., Holman et al., Regenbogen et al.). Within 5 years, up to 50% of first-time amputees require another amputation (Dilingham et al., Glaser et al.) & those with comorbidities face a 77% five-year mortality rate (Fortington et al.).

Train Foot: History Of The Migrant Worker, Stephanie N. Campbell, Heather V. Tran, Nikita V. Gambhir, Luis Caporusso

School of Podiatric Medicine Publications

Immigrant labor has a long history in the United States, comprised of millions of workers from various ethnic and cultural backgrounds supporting multiple industries from farm work to steel. As of 2019, 25.6% of total migrant workers employed in the Americas [1,2]. Crush injuries or “pinch points” are events when a body part is entangled within machinery or under or between an object [3]. After a series of crush related injuries of young (20s), male Latino patients across Texas to a level 1 trauma center, case review was performed for 2 patients for which follow up could be evaluated. The …

Prevention Of Transmetatarsal Amputation In A Diabetic Patient With A Chronic Foot Ulcer Including Osteomyelitis By Minimally Invasive Surgery Floating Lesser Metatarsal Osteotomies In Conjunction With Adipose Injectable Filler, Francois M. Lokenye Dpm, Orlexia Thomas Dpm, Lady Paula Dejesus Dpm, Facfas, Facpm, Dwsp

Posters

Problem: Diabetic foot ulcers (DFUs) complicated by osteomyelitis often result in transmetatarsal amputations, leading to significant morbidity.

Objective: To evaluate a minimally invasive surgical approach combining floating lesser metatarsal osteotomies with adipose injectable filler to prevent transmetatarsal amputation, enhance wound resolution, and improve foot biomechanics

The Infected Diabetic Foot: Incidence And Risk Factors For Dehiscence After Surgery For Diabetic Foot Infections, Lawrence A Lavery, Mario C Reyes, Bijan Najafi, Tyler L Coye, Jayer Chung, Michael C Siah, Arthur N Tarricone

Center on Aging Staff Publications

Our objective was to assess the incidence, risk factors and clinical outcomes of dehiscence after foot surgery in diabetic patients. We used pooled patient‐level data from two randomised clinical trials with 240 diabetic patients who required foot surgery for infections. Most patients (n = 180, 75.0%) had surgical wound closure. We defined dehisced surgical wounds (DSW) when the surgical site was not completely epithelialized with no drainage after sutures/staples were removed with a 2‐week validation of healing. We evaluated the time to heal, re‐infection, re‐ulceration, hospital admissions and amputations. Moderate and severe infection was based on criteria of the …

Management Of Group B Streptococcus Necrotizing Fasciitis Secondary To Puncture Wound In Diabetic Patient Using Xenograft* Therapy, Nikita V. Gambhir, Heather V. Tran, Stephanie N. Campbell

School of Podiatric Medicine Publications

Necrotizing soft tissue infection (NSTI) is a rapidly progressive skin and soft tissue infection that primarily affects deeper layers of adipose tissue, fascia and muscle. Once a patient becomes symptomatic, the disease typically progresses within hours. The standard treatment consists of broad-spectrum IV antibiotics, serial debridement and supportive care. However, long-term goals should include prevention of atherosclerotic disease, cardiovascular and cerebrovascular events, and ultimately, a reduction in mortality rates. Following debridement for NSTI, it is not uncommon for patients to require multiple surgeries and secondary wound healing given the extent of soft tissue loss.

Methicillin-Resistant Staphylococcus Aureus In Diabetic And Non-Diabetic Foot Infections, Lawrence A Lavery, Mario C Reyes, Mehmet Suludere, Bijan Najafi, Matthew Sideman, Michael C Siah, Arthur N Tarricone

Center on Aging Staff Publications

To identify the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection, reinfection and clinical outcomes. Four hundred forty-six patients that were admitted to the hospital with moderate or severe foot infections were retrospectively reviewed. Tissue and bone cultures were obtained from the index hospital admission. Conversion was defined as methicillin susceptible Staphylococcus aureus in the first culture and subsequently MRSA when there was a reinfection. The incidence of MRSA was 7.8% (n = 35), with no significant difference between soft tissue infections (7.7%) and osteomyelitis (8.0%). MRSA incidence was 9.4 times higher in non-diabetics (23.8% vs. 3.2%, p = < 0.01). The incidence of reinfection was 40.8% (n = 182). Conversion to MRSA was seen in 2.2% (n = 4) total, occurring in 5.4%. Non-diabetics were 20.1 times more likely to have MRSA reinfection than people with diabetes (28.6% vs. 1.9%, p <  0.001). MRSA patients had a higher proportion of healed wounds (82.4% vs. 69.3%, p = 0.02). There were no differences in other clinical outcomes in MRSA vs. other infections in reinfection (28.6% vs. 24.3%, p = 0.11), amputation (48.6% vs. 52.0%, p = 0.69) or hospitalization (28.6% vs. 42.6, p = 0.11). The incidence of MRSA for the first infection (7.8%), reinfection (6.0%) and conversion to MRSA (2.2%) was low. MRSA was 9.4 times more common in people without diabetes.

The Effect Of Limb Salvage Efforts In Different Age Groups: Relationships Between Major And Minor Amputations, Wenye Song, Javier La Fontaine, Naohiro Shibuya, John Prochaska, Daniel C. Jupiter

School of Podiatric Medicine Publications

“Limb salvage” efforts, such as performing minor amputations before infections spread proximally from the foot to decrease major lower extremity amputation, are an important part of healthcare today. It is unclear whether these efforts are preventing the number of major amputations and improving patients’ quality of life and the cost-effectiveness of the U.S. healthcare system. Rates of non-traumatic lower extremity amputation (NLEA) among patients with diabetes decreased in the early 2000s but rebounded in the 2010s. We analyzed the proportion of major amputations and differences in amputation rates between age groups in Texas. Patient data was extracted from the Texas …

Diabetes-Related Major And Minor Amputation Risk Increased During The Covid-19 Pandemic., Dominick J Casciato, Sara Yancovitz, John Thompson, Steven Anderson, Alex Bischoff, Shauna Ayres, Ian Barron

Heart and Vascular Articles

BACKGROUND: Along with significant case transmission, hospitalizations, and mortality experienced during the global severe acute respiratory syndrome coronavirus 2 pandemic, there existed a disruption in the delivery of health care across multiple specialties. We studied the effect of the pandemic on inpatients with diabetic foot problems in a Level I trauma center in central Ohio.

METHODS: A retrospective chart review of patients necessitating a consultation by the foot and ankle surgery service were reviewed from the first 8 months of 2020. A total of 270 patients met the inclusion criteria and were divided into prepandemic (n = 120) and pandemic …

Home-Based Electrical Stimulation To Accelerate Wound Healing-A Double-Blinded Randomized Control Trial, Alejandro Zulbaran-Rojas, Catherine Park, Nesreen El-Refaei, Brian Lepow, Bijan Najafi

Center on Aging Staff Publications

Background: Electrical stimulation (E-Stim) may offer a unique adjunctive treatment to heal complicated diabetic foot ulcers (DFU). Our primary goal is to examine the effectiveness of daily home-based E-Stim therapy to speed-up wound healing.

Methods: Patients with chronic DFUs and mild to severe peripheral arterial disease (PAD) were recruited and randomized to either control (CG) or intervention (IG) groups. The IG received 1-hour home-based E-Stim therapy on daily basis for 4 weeks (4W). E-Stim was delivered through electrical pads placed above the ankle joint using a bio-electric stimulation technology (BEST®) platform (Tennant Biomodulator® PRO). The CG was provided with an …

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.

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.