Podiatry Commons^™

Rearfoot Realignment As A Prophylactic Strategy For Recurrent Lateral Column Ulcers In Diabetic Foot: A Case-Based Hypothesis, Christopher I. Anjorin Ms Dpmc, Ali-Abdul Kareem Dpm

School of Podiatric Medicine - Student Research

Lateral column ulcerations remain a persistent and complex challenge in diabetic foot management. Although procedures such as tailor’s bunionectomy may provide localized pressure relief, they often fail to address the underlying biomechanical contributors, most notably rearfoot deformities such as calcaneal varus or pes cavovarus frequently observed in diabetic patients. These structural abnormalities shift the weight‑bearing axis laterally, increasing ground reaction forces along the fifth metatarsal and predisposing individuals with diabetic peripheral neuropathy and impaired proprioception to recurrent ulceration. This case explores the hypothesis that prophylactic rearfoot realignment may offer superior long‑term outcomes by correcting the mechanical etiology of lateral column …

Comparative Analysis Of M1 And M2 Macrophage Distribution And Localization In Chronic Wounds Of Metabolically Healthy And Diabetic Hosts Using A C57bl/6 Mouse Model, Bryan Liu, Ramiro Cisneros, Nathaniel Primous, Estephania Garcia, Bhuvana Lakkasetter Chandrashekar, Claudia Biguetti

School of Podiatric Medicine - Student Research

Introduction/Purpose: Type 2 diabetes and obesity are major risk factors for delayed wound healing in chronic foot ulcers. This study investigated whether a high-fat diet induces diabetes-like metabolic dysfunction in mice and characterized associated morphological changes and macrophage polarization during wound healing. Macrophages exist as pro-inflammatory M1 and anti-inflammatory M2 phenotypes that regulate tissue repair.

Methods: Ten male C57BL/6J mice (8 weeks old) were divided into high-fat diet (HFD) and regular diet (RD) (IACUC Protocol 22-33) groups.  After 12 weeks, body weight and intraperitoneal glucose tolerance test were measured to confirm metabolic phenotypes, after which a 6mm dorsal excision wound …

Expression Of 5-Lo In Chronic Wounds In A Preclinical Murine Model Of Obesity And Type 2 Diabetes, Joshua Wu, Ramiro Cisneros, Nathaniel Primous, Estephania Garcia, Bhuvana Lakkasetter, Claudia Biguetti

School of Podiatric Medicine - Student Research

Introduction: Diabetes is associated with impaired wound healing and a high incidence of chronic, non-healing ulcers, largely driven by persistent low-grade inflammation. Leukotriene B4 (LTB4), a product of the 5-lipoxygenase (5-LO) pathway, has emerged as a key mediator of this chronic inflammatory state. Hence, this study investigated the role of the 5-LO pathway in cutaneous wound healing under normoglycemic and diabetic conditions using a murine model.

Methods: Twelve 8-week-old male C57BL/6J mice were fed with high-fat diet (HFD; 60% kcal fat) or low-fat diet (LFD; 10% kcal fat) for 12 weeks (IACUC 22-33). Body weight (BW) and fasting blood glucose …

Bone Healing During A Dysregulated Inflammatory Phase: Comparative Skeletal Features In 5-Lipoxygenase Knockout And Wild Type Mice, Marco Hernandez, Nidhin John, Bhuvana L. Chandrashekar, Mariza A. Matsumoto, Naohiro Shibuya, Claudia Biguetti

School of Podiatric Medicine - Student Research

Background: High-risk patients, such as those with diabetic neuropathy, often experience prolonged and dysregulated inflammation during bone healing. The 5-lipoxygenase (5LO) pathway is a key mediator of inflammation and bone resorption and may influence these outcomes. Therefore, understanding the skeletal features associated with 5LO genetic deletion may help identify therapeutic opportunities to improve healing in high-risk patients.

Objective: To determine how genetic deletion of 5LO affects skeletal structure and macrophage phenotypes, with the goal of identifying therapeutic targets to improve bone healing in high-risk patients.

Materials and Methods: A total of 10, adult (3 months old), 129/SvEv male mice were …

Il-17a Immune Signature Across Stratified Stages Of Type 2 Diabetes​, Brittney C. White, Antonio Hernandes Chaves-Neto, Peter Elvin, Javier La Fontaine, Eric L. Brown, Walid Fakhouri, Craig Hanis, Claudia Biguetti

School of Podiatric Medicine - Student Research

Purpose: This study investigated whether IL-17A, a pro-inflammatory cytokine associated with Th17 cell activity, reflects distinct stages of type 2 diabetes progression.

Methods: Forty-two obese individuals (average age: 60.4 ± 10.3 years; 55% male; BMI: 31.3 ± 4.9) from Starr County, Texas, were matched for gender and BMI and stratified into five metabolic groups based on fasting blood glucose, 2-hour oral glucose tolerance test, and HbA1c levels. Groups included diabetes-free, isolated impaired glucose tolerance, combined glucose impairment, diabetes without complications, and diabetes with lower extremity complications. IL-17A protein levels were quantified from buffy coat samples using ELISA. After excluding …

Adipose Injectable Filler With Use Of Meshed Dermal Matrix And Porcine Urinary Bladder Matrix For The Management Of A Complex Achilles Wound, Francois M. Lokenye Dpm, Orlexia Thomas Dpm, Mariam Kamil Bs, Lady Paula Dejesus Dpm, Facfas, Facpm, Dwsp

Posters

Chronic Achilles wounds present a significant clinical challenge due to limited vascularity, high mechanical stress, and the complex anatomy of the posterior lower leg.

Regenerative medicine offers a promising alternative to traditional wound management through the use of advanced biologic materials.

This case highlights a novel approach utilizing a combination of adipose-derived injectable filler, acellular dermal matrix, and porcine urinary bladder matrix to enhance tissue regeneration, provide structural support, and promote wound healing.

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

Early Tissue Changes Linked To Diabetes: Insights From A Preclinical Model, Bryan Liu, Ramiro Cisneros, Estephania Garcia, Jimena Mora, Sumedha Guha, Evelin Rios, Krishna Prajapati, Danieli Rodrigues, Bhuvana Lakkasetter Chandrashekar, Claudia Biguetti

School of Podiatric Medicine - Student Research

Introduction and Hypothesis: The aim of this study is to compare soft tissue morphology and fibrosis pathology of different organs between diabetic and non-diabetic rats. Type 2 diabetes causes soft tissue remodeling in organ systems including heart, kidney, spleen, and pancreas. Fibrotic remodeling is a common pathological mechanism seen in diabetes-related organ dysfunction. By understanding fibrotic pathology in rats, it serves as a foundation to develop lower limb models applicable to podiatry. These systemic changes caused by diabetes may also play a role in lower limb changes such as diabetic ulcers and delayed wound healing.

Methodology: Male Lewis rats (6 …

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 …

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.

Towards A Remote Patient Monitoring Platform For Comprehensive Risk Evaluations For People With Diabetic Foot Ulcers, Gozde Cay, M G Finco, Jason Garcia, Jill L Mcnitt-Gray, David G Armstrong, Bijan Najafi

Center on Aging Staff Publications

Diabetic foot ulcers (DFUs) significantly affect the lives of patients and increase the risk of hospital stays and amputation. We suggest a remote monitoring platform for better DFU care. This system uses digital health metrics (scaled from 0 to 10, where higher scores indicate a greater risk of slow healing) to provide a comprehensive overview through a visual interface. The platform features smart offloading devices that capture behavioral metrics such as offloading adherence, daily steps, and cadence. Coupled with remotely measurable frailty and phenotypic metrics, it offers an in-depth patient profile. Additional demographic data, characteristics of the wound, and clinical …

Use Of A Borate-Based Bioactive Glass Martix On Infected, Exposed Hardware, Stephanie N. Campbell, Cyaandi V. Dove, Connor Krolikowski

School of Podiatric Medicine Publications

Hardware exposure is a challenging complication following foot and ankle surgery due to the high risk of infection, biofilm formation, and delayed healing. In two consecutive cases, the bioactive glass matrix combined with particulate micromatrix successfully eradicated the wound infection and biofilm, resulting in full granulation of the wound and successful wound closure. Here we present a novel bioactive glass matrix that successfully managed exposed hardware in an infected foot, providing a promising treatment strategy for managing these complications and preventing further morbidity.

Energy Expenditure In Partial-Foot Amputees With Diabetes: A Scoping Review, Nicholas Obias, Madeleine G. Mehaffey, Amanda Killeen

School of Podiatric Medicine - Student Research

Objective: The energy cost of walking in amputees is often cited in modern scientific literature and clinical rationales for determining amputation levels. However, many referenced papers do not study diabetic populations with partial foot amputations (PFAs) – relatively widespread conditions in podiatric patient populations. Commonly cited papers include Waters (1976), which is significantly dated, Goktepe (2010), which studies traumatic PFAs in a military academy, and Jeans (2011), which studies traumatic PFAs in pediatric populations. These papers do not study diabetic populations and PFAs specifically. We hoped to find a study population more reflective of diabetic patients with PFAs.

Methods: …

Therapeutic Effects Of Fully Reduced Hmgb1 On Fibroblasts And Pre-Osteoblasts Cultured Under Diabetic Conditions, Alfonso Reyes, Bhuvana Lakkasetter Chandrashekar, Peter Elvin, Danieli Rodrigues, Javier La Fontaine, Claudia Biguetti

School of Podiatric Medicine - Student Research

Background: Recent studies have shown that fully reduced High Mobility Group Box-1 (FR-HMGB1) can improve wound healing under normoglycemic conditions, but it has not been tested for diabetic conditions. This study aimed to assess the regenerative potential of FR-HMGB1 under high glucose levels in vitro.

Methods: Migration of human fibroblasts (HF) was tested using a scratch assay in control conditions, and in the presence of FR-HMGB1 (1.0 µg/mL and 10 µg/mL), both in non-diabetic (ND) and diabetic (D) conditions (60mM of glucose added to the culture media). HF cells were tested after 18 hours of scratching and stained with …

Energy Cost Of Walking In Diabetic Partial-Foot Amputees As Related To Amputation Level, Nicholas Obias, Javier La Fontaine, Javier Cavazos, Luis Venegas, Hafizur Rahman

School of Podiatric Medicine - Student Research

This review will explore how the energy cost of walking changes with different levels of partial-foot amputation in diabetic patients. Patient populations with advanced stages of diabetes and associated complications have a high incidence of distal lower extremity amputation. Diabetes associated conditions and altered foot function in post-amputation patients affect gait biomechanics and energy expenditure in gait. We will review studies utilizing advanced biomechanical tools to quantify and compare energy expenditure (defined as cardiac function and oxygen consumption) in established post-operative partial-foot amputees at various levels (post-operative day >90*) to controls. Dr. Rahman and his team aim to provide further …

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.

Meta-Analysis: Outcomes Of Surgical And Medical Management Of Diabetic Foot Osteomyelitis, David H. Truong, Roger Bedimo, Matthew Malone, Dane K. Wukich, Orhan Oz, Amanda L. Killeen, Lawrence A. Lavery

School of Podiatric Medicine Publications

Background

The aim of this study was to evaluate clinical outcomes in the published literature on medical and surgical management of diabetic foot osteomyelitis (DFO).

Methods

A PubMed and Google Scholar search of articles relating to DFO was performed over the dates of January 1931 to January 2020. Articles that involved Charcot arthropathy, case reports, small case series, review articles, commentaries, nonhuman studies, and non-English articles were excluded. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to rate the bias of each study. A meta-analysis was performed using random-effects and inverse variance methods. The search yielded 1192 …

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 …