Podiatry Commons^™

Peripheral Artery Disease Causes Consistent Gait Irregularities Regardless Of The Location Of Leg Claudication Pain, Hafizur Rahman, Todd Leutzinger, Mahdi Hassan, Molly Schieber, Panagiotis Koutakis, Matthew A. Fuglestad, Holly Despiegelaere, G. Matthew Longo, Philippe Malcolm, Jason M. Johanning

School of Podiatric Medicine Publications and Presentations

Highlights

• Peripheral artery disease (PAD) is a multi-level disease.

• PAD diffusely impairs the performance of leg muscles.

• PAD causes similar irregularities in gait biomechanics regardless of where claudication pain is located in the leg.

Abstract

Background

The most common symptom of peripheral artery disease (PAD) is intermittent claudication that involves the calf, thigh, and/or buttock muscles. How the specific location of this leg pain is related to altered gait, however, is unknown.

Objectives

We hypothesized that because the location of claudication symptoms uniquely affects different leg muscle groups in people with PAD, this would produce distinctive walking patterns.

Methods

A …

Bioengineered Skin For Diabetic Foot Ulcers: A Scoping Review, Nathaniel R. Primous, Peter Elvin, Kathleen V. Carter, Hagner L. Andrade, Javier La Fontaine, Naohiro Shibuya, Cláudia Cristina Biguetti

School of Podiatric Medicine Publications and Presentations

Diabetic foot ulcers (DFUs) pose a significant threat to individuals with diabetes mellitus (DM), such as lower limb amputation and severe morbidity. Bioengineered skin substitutes (BSS) are alternatives to traditional interventions for treating DFUs, but their efficacy compared to standard wound care (SWC) or other treatment types, such as allografts, remains unknown. A scoping review of human studies was conducted to identify current approaches in the treatment of DFUs using BSS as compared with other treatment options. Systematic searches in PubMed, Cochrane Library, and Web of Science were conducted to identify comparative studies that enrolled 10 or more patients and …

From Heel To Toe: Investigating Plantar Fasciitis Causes, Diagnosis, And Treatment Strategies, Breanna Littlejohn

Undergraduate Honors Theses

This presentation informs plantar fasciitis patients. The cause of plantar fasciitis is multifactorial but most cases result from overuse stress. The cause of plantar fasciitis is multifactorial but most cases result from overuse stress. The classic presentation is of sharp localized pain at the heel. In some cases, a heel spur may be found. This presentation explains how exercise can improve plantar fasciitis. Reviewing risk factors will help you identify and manage plantar fasciitis when undergoing treatment. Understanding plantar fasciitis is crucial as it is a common and painful condition affecting the bottom of the foot. This inflammation of the …

Effects Of The Injury Recovery Process On Neuromuscular Activation In An Uninjured Ankle, Mark Tankersley

CMC Senior Theses

This study was conducted to observe the effects of changed activity levels due to a major lower extremity injury on ankle function in the uninjured leg. Neuromuscular activation in the Gastric Medialis (GAS) and Tibialis Anterior (TA), the muscles primarily responsible for movement at the ankle, was assessed in 8 athletes at the Claremont Colleges while walking on a flat surface, stepping up a 15º incline, and stepping up a 27º incline. Athletes were split into two groups based on injury condition: a “recovered” group (n=4) who had suffered a major lower extremity injury in the last two years in …

Aged And Induced-Premature Ovarian Failure Mouse Models Affect Diestrus Profile And Ovarian Features, Ana Carolina Zucon Bacelar, Nataira Regina Momesso, Felipe Haddad Martim Pederro, Alaíde Gonçalves, Edilson Ervolino, Antonio Hernandes Chaves-Neto, Cláudia Cristina Biguetti, Mariza Akemi Matsumoto

School of Podiatric Medicine Publications and Presentations

Sex hormones exert a wide influence on several systems of the human body, especially in women, who undergo intense changes in the trans and postmenopausal periods. Different experimental models are used to mimic these conditions; however, the impact on hormonal profile may be different. This study aimed to analyze and compare vaginal cytology of different post-estropausal mice models, along with their microscopical ovarian features. Forty-six C57BL/6J female mice with the ages of 4, 6 and 18 months at the beginning of the experiment, weighing about 25–28 grams, constituted five groups: NC–(negative control) animals with no treatment, OVX-SHAM—sham ovariectomized, OVX–ovariectomized, VCD–medicated …

Empowering Foot Health: Harnessing The Adaptive Weighted Sub-Gradient Convolutional Neural Network For Diabetic Foot Ulcer Classification, Abdullah Alqahtani, Shtwai Alsubai, Mohamudha Parveen Rahamathulla, Abdu Gumaei, Mohemmed Sha, Yu-Dong Zhang, Muhammad Attique Khan

School of Podiatric Medicine Publications and Presentations

In recent times, DFU (diabetic foot ulcer) has become a universal health problem that affects many diabetes patients severely. DFU requires immediate proper treatment to avert amputation. Clinical examination of DFU is a tedious process and complex in nature. Concurrently, DL (deep learning) methodologies can show prominent outcomes in the classification of DFU because of their efficient learning capacity. Though traditional systems have tried using DL-based models to procure better performance, there is room for enhancement in accuracy. Therefore, the present study uses the AWSg-CNN (Adaptive Weighted Sub-gradient Convolutional Neural Network) method to classify DFU. A DFUC dataset is considered, …

Glycemic Markers And Insulin-Related Parameters In The Progression Of Diabetes And Lower Extremities Complications: A Pilot Study In Mexican Americans From Starr County, Peter Elvin, Garrett Edwards, Walid Fakhouri, Craig Hanis, Cláudia Cristina Biguetti

School of Podiatric Medicine Publications and Presentations

No abstract provided.

Water-Tight Arthrotomy Joint Closure Of Modified Intervastus Approach In Total Knee Arthroplasty, Muthana M. Sartawi, James M. Kohlmann, Karam R. Abdelsamie, Hafizur Rahman

School of Podiatric Medicine Publications and Presentations

Background: The joint closure technique used for total knee arthroplasty cases can have an impact on outcomes, especially when considering accelerated rehabilitation programs that follow surgery. In this study, we describe the details of the technical steps involved in performing the water-tight arthrotomy joint closure technique that we developed and use. Methods: A total of 536 patients (average age: 62 years, average body mass index: 34 kg/m2) with primary osteoarthritis of the knee underwent total knee arthroplasty using the modified intervastus approach between 2019 and 2021. We used the water-tight arthrotomy joint closure technique to close the knee arthrotomy incision. …

A Model Study To Evaluate Osseointegration And Fracture Healing Following Open Reduction And Internal Fixation (Orif) In Diabetic Lewis Rats, Alexandra Arteaga, Claudia Biguetti, Bhuvana Lakkasetter Chandrashekar, Jimena Mora, Adeena Qureshi, Evelin Rios, Javier La Fontaine, Danieli C. Rodrigues

School of Podiatric Medicine Publications and Presentations

There is a higher risk of implant osseointegration failure after open reduction and internal fixation (ORIF) in patients with diabetes due to increased inflammatory conditions, associated metallic corrosion and infection. While it is possible to avoid elective osseous surgery in patients with diabetes, it may not be the case in nonelective cases, such as ORIF ankle fractures. A total of 30 male Lewis rats (12-15 weeks old) were distributed into diabetic (D) and nondiabetic (ND) groups. Fracture healing and osseointegration were evaluated at 2-, 10-, and 21-day time points. Microtomographic and histological analysis depicted distinct differences in fracture healing …

Cohort Study Using A Survey To Evaluate The Effects Of Sleep On Hba1c Levels And Foot Pathology In Patients Seen In The Podiatry Clinic, Carmen Johnson, Eric Li, Jihan Toma, Marshall G. Solomon

Posters

We investigate the impacts of sleep issues on patients in the podiatry clinic by comparing HbA1c, sleep, and foot pathology. Diabetic foot pathology of peripheral arterial disease, peripheral neuropathy, lower extremity ulcerations, and a history of lower extremity amputation all increase the patient's risk of future amputation. Once a patient has an amputation of the lower extremity the five-year mortality rates are 40-70%. So, limb salvage not only improves the quality of life, but also increases the life expectancy for patients. Through a survey and chart review, we are investigating possible impacts of sleep issues on diabetic patients seen in …

Revisional Arthrodesis Of Tarsometatarsal (Lisfranc) Complex Injury Secondary To Non-Union, Lei Wilson, Randy Semma

Posters

The tarsometatarsal joint and its components provide structural support for the foot. Notably the Lisfranc ligament is a fundamental stabilizer for the midfoot. Injuries to this component are complex and can be debilitating. These injuries require surgical intervention when significant displacement resulting in instability is involved.

Following success of several previous repairs of Lisfranc fractures and dislocations, a treatment algorithm has been proposed. This case report demonstrates the success of the algorithm which has allowed the surgeon to perform reduction and repair in a reproducible, step-wise manner with minimal difficulty to ensure successional revisional arthrodesis of a nonunion

Septic First Metatarsophalangeal Joint Arthrodesis With Alternative Mini-Rail Fixation, Brenna Barker, Morgan Gascoyne, Randy Semma

Posters

For non-infection cases, first metatarsal phalangeal joint arthrodesis is a definitive procedure for painful, arthritic joints.

Standard fixation methods include screws, plates, staples, or a combination of the three.

For complex septic joint cases, an alternative method of fixation is needed to reduce the risk of infection retention.

Case Report Of Bullous Diabeticorum: A Self-Limiting Condition With Potentially Devastating Consequences, Taylor Allison, Randy Semma

Posters

Bullous diabeticorum (BD) is a skin manifestation of patients with diabetes mellitus with an incidence of about 0.16% per year (Larsen et al) although the condition is believed to be widely underdiagnosed. The blistering disease favors acral regions of the body including the feet. There are no accepted diagnostic tests, and histopathology results are often inconclusive which makes BD a clinical diagnosis of exclusion. It is often self-limiting and resolves in a few weeks without residual sequelae. However, it may present with a secondary bacterial infection which can put patients at risk for soft tissue infections and osteomyelitis requiring more …

Failed Medial Column Fusion Due To Subtalar Joint Instability, Travis Rich, Randy Semma, Michele Bertelle-Semma

Posters

• CNA is a destructive complication affecting the bone and joint structure, most often in diabetics w/ longstanding peripheral neuropathy.
• High incidence of major amputation associated with Charcot foot

Utilization Of Negative Pressure Wound Therapy And Split Thickness Skin Grafts In The Context Of Complex Skin Closure Via Secondary Intention: A Protocol Approach, Jihan Toma, Eric Li, Randy Semma, Michele L. Bertelle-Semma, Asif Khan

Posters

Patients with complex, chronic foot wounds or ulcerations are at risk for major amputations. In this quality improvement (QI) initiative, we present an implemented protocol for patients with foot ulcerations and attempt to heal them using a combination of wound vac therapy and split thickness skin grafting. These patients have a history of either diabetes and/or neuropathy that makes wound healing more difficult than an otherwise healthy individua

Diabetic Limb Salvage: Chopart Amputation, Jesse Miller, Randy Semma

Posters

Diabetic limb salvage is the act of saving a limb, even with decreased function after infection.

It is the difficult choice of the surgeon/patient to decide to proceed with salvage versus amputation proximally.

Impact Of Immunological And Inflammatory Mediators In The Progression Of Type Ii Diabetes: A Pilot Study From A Mexican American Population In The Rio Grande Valley, Peter Elvin, Garrett Edwards, Walid Fakhouri, Craig Hanis, Cláudia Cristina Biguetti

School of Podiatric Medicine Publications and Presentations

No abstract provided.

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 …

New Year's Resolution, Graham A. Hamilton

School of Podiatric Medicine Publications and Presentations

No abstract provided.

Current Concepts Of Treatment For Foot And Ankle Arthritis, Nehal Modha, Warren Windram

East Florida Research Day 2023

Foot and ankle arthritis is a prevalent and debilitating musculoskeletal condition that significantly impairs the quality of life for millions of individuals worldwide. This scientific abstract provides an overview of the current concepts of treatment for foot and ankle arthritis, highlighting the multifaceted approach employed by healthcare professionals to alleviate pain, improve function, and enhance the overall well-being of affected patients.

This comprehensive review outlines the key elements of contemporary foot and ankle arthritis management. First, it discusses the importance of early diagnosis and classification of the condition, emphasizing the role of advanced imaging modalities and clinical assessments in establishing …

Plantar Plate Injury: Current Treatment Options, Nehal Modha, Warren Windram

East Florida Research Day 2023

Plantar plate injuries have gained recognition as a common cause of forefoot pain and instability. This review aims to comprehensively analyze the present landscape of treatment options available for addressing plantar plate injuries.

A comprehensive literature review was completed by the authors using Google Scholar, Pubmed, Cochrane Review, and Science Direct using a combination of phrases related to the title of this article that discussed various treatment modalities for plantar plate injuries. The review encompassed both non-surgical and surgical interventions, assessing their efficacy, outcomes, and potential complications.

Conservative approaches, such as rest, taping, orthotic devices, and physical therapy, have been …

Optimal Fixation Requirements For Lapidus Bunionectomies: A Comprehensive Review And Analysis, Nehal Modha, Diego Peralta, Warren Windram

East Florida Research Day 2023

The Lapidus bunionectomy procedure, aimed at correcting hallux valgus deformities, involves realignment of the first metatarsal-cuneiform joint and often necessitates fixation to ensure proper alignment and stability during the healing process. A comprehensive literature review was completed by the authors using Google Scholar, Pubmed, Cochrane Review, and Science Direct using a combination of phrases related to the title of this article to determine the optimal fixation requirements for successful outcomes in Lapidus bunionectomies.

A systematic search of electronic databases that reported on fixation techniques, outcomes, and complications associated with Lapidus bunionectomies. Analysis of these studies revealed a wide range of …

The Location And Incidence Of Neuromas As Related To Metatarsal Juxtaposition On Radiographs: A Prospective Review Of Consecutively Enrolled Patients, Giacat Pham, Taylor Bergstrom, Liz Connolly, Jihae Kim, Spencer Stringham, Josh Joseph, Kaitlin Thompson, Hisham Ashry

East Florida Research Day 2023

INTRODUCTION: Neuromas are commonly diagnosed at the third interspace, and are known as morton’s neuromas. It is not a true neuroma, but rather degeneration of myelinated nerve fiber with associated histopathological changes of the interdigital nerve within the foot. This condition is a degenerative process rather than neoplastic. The purpose of this study is to determine whether or not third interspace neuromas truly are the most common location for a neuroma when compared to other interspaces of the foot.

MATERIAL AND METHODS: A retrospective review of the medical records of 100 patients diagnosed with interspace neuromas from private practices …

Current Treatment Options For Avn (Freiberg's Infraction) Of The Second Metatarsophalangeal Joint, Nehal Modha, Fahad Rahman, Warren Windram

East Florida Research Day 2023

Avascular necrosis (AVN) of the second metatarsal is a debilitating condition characterized by the loss of blood supply to the bone, leading to cellular death and potential collapse of the affected metatarsal head. This study presents a comprehensive review of contemporary literature to elucidate the spectrum of treatment options available for managing AVN of the second metatarsal.

A systematic search of reputable medical databases yielded a total of 38 pertinent studies detailing various treatment modalities for AVN of the second metatarsal. The review encompassed surgical and non-surgical approaches, evaluating their efficacy, long-term outcomes, and complications.

Non-surgical interventions, such as protected …

Mis Calcaneal Fracture Repair: A Literature Review, Nehal Modha, Roshni Patel, Warren Windram

East Florida Research Day 2023

Minimally invasive surgery (MIS) has gained prominence as a viable approach for the management of calcaneal fractures, offering the potential for reduced soft tissue trauma, enhanced visualization, and expedited recovery. This literature review aims to comprehensively analyze the existing body of research on MIS techniques employed in the repair of calcaneal fractures.

A comprehensive literature review was completed by the authors using Google Scholar, Pubmed, Cochrane Review, and Science Direct using a combination of phrases related to the title of this article that focused on MIS interventions for calcaneal fractures. The review encompassed studies from the last decade, evaluating surgical …

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 Publications and Presentations

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 …

Covid-19 And Incidence Of Necrotizing Fasciitis: A Case Study, Tehreem Sajjad, Carmen Johnson, Janet Baatile-Ajrouche

Posters

COVID-19 manifests as a flu-like respiratory infection affecting multiple organ systems. Symptoms range from mild viral illness to severe acute respiratory infection. There is no definitive relationship between COVID-19 and cellulitis, inflammatory myositis, vasculitis, or necrotizing fasciitis. It is interesting to note that angiotensin-converting enzyme 2 (Receptor for SARS-CoV-2) is present on endothelial cells in multiple organs, including dermal blood vessels and arterial smooth muscle cells. There are several theories that have formed to explain the relationship between COVID-19 and a necrotizing fasciitis infection. This study presents one unique case of an unvaccinated COVID+ patient and the necrotizing fasciitis infection …

Case Study: Injectable Bone Cement In Treatment Of Orif Calcaneal Fractures, Michael Flores, Siraj Panchbhaiya

Posters

No abstract provided.