Podiatry Commons^™

The Effect Of Continuous Diffusion Of Oxygen Treatment On Cytokines, Perfusion, Bacterial Load, And Healing In Patients With Diabetic Foot Ulcers, Lawrence A. Lavery, Amanda L. Killeen, David Farrar, Yucel Akgul, Peter A. Crisologo, Matthew Malone, Kathryn E. Davis

School of Podiatric Medicine Publications

To evaluate continuous diffusion of oxygen therapy (CDO) on cytokines, perfusion, and bacterial load in diabetic foot ulcers we evaluated 23 patients for 3 weeks. Tissues biopsies were obtained at each visit to evaluate cytokines and quantitative bacterial cultures. Perfusion was measured with hyperspectral imaging and transcutaneous oxygen. We used paired T tests to compare continuous variables and independent T tests to compare healers and nonhealers. There was an increase from baseline to week 1 in TGF-β (P = .008), TNF-α (P = .014), VEGF (P = .008), PDGF (P = .087), and IGF-1 (P …

Lyopreserved Amniotic Membrane Is Cellularly And Clinically Similar To Cryopreserved Construct For Treating Foot Ulcers, Kathryn E. Davis, Amanda L. Killeen, David Farrar, Katherine M. Raspovic, Zachary D. Berriman-Rozen, Matthew Malone, Lawrence A. Lavery

School of Podiatric Medicine Publications

We compared cellular viability between cryopreserved and lyopreserved amniotic membranes and clinical outcomes of the lyopreserved construct in a prospective cohort study of 40 patients with neuropathic foot ulcers. Patients received weekly application of lyopreserved membrane for 12 weeks with standard weekly debridement and offloading. We evaluated the proportion of foot ulcers that closed, time to closure, closure trajectories, and infection during therapy. We used chi-square tests for dichotomous variables and independent t-tests for continuous variables with an alpha of α = .10. Cellular viability was equivalent between cryo- and lyopreserved amniotic tissues. Clinically, 48% of subjects' wounds closed in …

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 …

The Impact Of Diabetic Foot Ulcers And Unilateral Offloading Footwear On Gait In People With Diabetes, Erica Ling, Brian Lepow, He Zhou, Ana Enriquez, Ashley Mullen, Bijan Najafi

Faculty, Staff and Students Publications

BACKGROUND: Unilateral offloading footwear prescribed to patients with diabetic foot ulcers elevates one limb relative to the other, which may lead to limp and abnormal gait. This study investigated whether the unilateral foot ulcer and offloading combination negatively impacts gait function beyond diabetic peripheral neuropathy.

METHODS: Eighty-six participants were recruited in 3 groups: 12 with diabetic peripheral neuropathy and unilateral foot ulcers wearing offloading footwear (offloading group, age = 55.6 ± 9.5 years, BMI = 30.9 ± 4.5 kg/m

FINDINGS: The offloading group exhibited deteriorated gait function compared to the non-diabetic group (p < 0.005, Cohen's effect size d = 0.90-2.61). They also had decreased gait speed (p < 0.001, d = 1.79) and stride length (p < 0.001, d = 1.76), as well as increased gait cycle time (p < 0.001, d = 1.67) and limp (p < 0.050, d = 0.72-1.49) compared to the neuropathy group. The offloading group showed increased gait unsteadiness compared to the neuropathy group, but the difference did not reach statistical significance in our samples.

INTERPRETATION: This study demonstrated that while diabetic …

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.

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.

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.

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

Rowan-Virtua 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

Rowan-Virtua 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 …

Length Of Stay And Hospital Cost Comparison In Hind Foot And Ankle Surgery On Patients With Anxiety And Depression Versus Those Without Psychopathology Diagnoses., Christopher J. Betrus, Sham J. Persaud, Stephanie N. Campbell, Alan R. Catanzariti

School of Podiatric Medicine Publications

To evaluate if patients with depression and/or anxiety have more post-operative pain, necessitating more pain medication and requiring longer hospital stays, corresponding to increased costs following elective hind foot and/or ankle surgery.

Through comparing the LOS between our study group and our control group, a diagnosis of depression and/or anxiety did not seem to extend the length of time admitted to the hospital. We found, as expected, the average VAS pain score was increased in the study group, which has been previously seen in the available literature.

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.

Reconstruction Of Heel Soft Tissue Defects Using Sensate Medial Plantar Flap, Mihaela Pertea, Natalia Velenciuc, Oxana Grosu, Bogdan Veliceasa, Vladimir Poroch, Sorinel Lunca

Journal of Mind and Medical Sciences

Introduction. Reconstruction of heel soft tissue defects represents a true challenge for any surgeon due to the particularities of this anatomical region. The tissue used to reconstruct the heel area must be resistant, innervated, and adapted to take over the body weight. Innervated medial plantar fasciocutaneous flap is one of the best solutions to cover defects at the heel level.

Materials and Methods. We studied 5 patients, 4 males and one female, aged 42 to 67 years, who presented heel soft tissue defects of various etiologies. In all cases, the used reconstructive method was an insular innervated medial plantar fasciocutaneous …

A Review Of Mesenchymal Stem Cell Injections For Osteoarthritis, Ammar Qureshi, Jill Goodwin, Franklin D. Shuler, Timothy Wilson-Byrne, John J. Jasko, Charles Giangarra

Marshall Journal of Medicine

Mesenchymal stem cell (MSC) injections for osteoarthritis is reviewed.

Methods- PubMed search identifying articles in English from 2003-2018 that used intra- articular injection (IA), cartilage repair, cartilage regeneration, chondral injury, adipose stem cells, bone marrow stem cells, mesenchymal stem cells, or autologous stem cells.

Results – 388 patients receiving IA MSC injections are discussed with data obtained from 10 case reports or case series, 4 randomized clinical trials (RCT), 1 cohort study, and 3 case controlled therapeutic studies.

Conclusions – MSC injections may be an effective adjunct in the management of osteoarthritis and a variety of cartilage related pathologies.

Does The Start Of Dialysis Initiate A Period Of Increased Risk Of Ulceration Or Amputation?, Lawrence A. Lavery, David C. Lavery, Nathan A. Hunt, Javier La Fontaine, Ryan D. Lavery

School of Podiatric Medicine Publications

Background: Dialysis therapy is associated with an increased incidence of lower-extremity wounds and amputations. We compared the incidence of foot ulcers and amputations before and after the start of dialysis.

Methods: We evaluated 150 consecutive diabetic patients receiving dialysis and compared the incidence of foot complications 30 months before and after initiation of hemodialysis. We used claims data for diabetes, ulceration, and dialysis and abstracted medical records to verify diagnoses and dates of ulcers and amputations. We compared initial and cumulative ulcer/amputation incidence to account for multiple events in the same person over time. We used the same formula to …

Pressure Thresholds And Stiffness On The Plantar Surface Of The Human Foot, Thilina W. Weerasinghe, Ravindra S. Goonetilleke, Uwe Reischl

Public and Population Health Faculty Publications and Presentations

The objective was to develop a methodology to assess Pressure Discomfort Thresholds (PDT), Pressure Pain Thresholds (PPT), and tissue stiffness on the plantar surface of the foot. Ten male and ten female participants volunteered for the study. Foot landmarks were used to create a standardized grid-type template of 95 points. For each test point, PPT and PDT values were obtained, and stiffness was calculated for each of the twenty participants. Cluster analyses were performed to determine the regions of similarity for the three dependent variables, PPT, PDT and stiffness. Moran’s-I-index was used to determine the spatial auto correlations. The use …

Kinematic Repeatability Analyses Of Multi-Segment Foot Motion In University-Level Ballet Dancers, Sarah Carter, Nahoko Sato, Luke Hopper

ECU Posters

Background:

Dancers are susceptible to overuse foot and ankle injuries, however there is a lack biomechanical studies examining foot mechanics to explain the causality of these injuries. The purpose of this study was to determine the intra and inter-assessor repeatability of a modified Rizzoli Foot Model (RFM) for ballet dancers.

Methods: Six university-level ballet dancers performed the following trials in randomized order, natural stance, turnout plié and stance, and two dynamic trials; turnout rise and flex-point-flex movement. A twelve-camera motion capture system were used to track fourteen reflective markers and one triad on the following segments: shank, entire foot, hindfoot, …

Lower Leg And Foot Contributions To Turnout In University-Level Female Ballet Dancers: A Preliminary Investigation, Sarah Carter, Alan R. Bryant, Luke Hopper

ECU Posters

Functional turnout in ballet involves maximal external rotation through the lower limb kinetic chain. Hip external rotation, is considered the primary contributor of functional turnout. However, dancers will tend to increase their functional turnout angle through additional tibiofemoral external rotation and pronation of the foot/ankle complex. Hip external rotation measures in functional turnout has received extensive examination in dance science. However, the relationship between the ‘below the hip' assessments with functional turnout is poorly understood. We hypothesis that dancers with greater passive external tibiofemoral rotation (pTFR) and/or pronated stance will have a greater functional turnout angle.

Nineteen female university-level classical …

Characterization Of The Protective Role Of Regulatory T Cells In Experimental Periapical Lesions Development And Its Chemoattraction Manipulation As A Therapeutic Tool, Carolina Favaro Francisconi, Andreia Espindola Vieira, Cláudia Cristina Biguetti, Andrew J. Glowacki, Ana Paula Favaro Trombone, Ariadne Letra, Renato Menezes Silva, Charles S. Sfeir, Steven R. Little, Gustavo P. Garlet

School of Podiatric Medicine Publications

Introduction

The pathogenesis of periapical lesions is determined by the balance between host pro-inflammatory immune response and counteracting anti-inflammatory and reparative responses, which include regulatory T cells (Tregs) as potential immunoregulatory agents. In this study, we investigated (in a cause-and-effect manner) the involvement of CCL22-CCR4 axis in Tregs migration to the periapical area and the role of Tregs in the determination of outcomes in periapical lesions.

Methods

Periapical lesions were induced in C57Bl/6 (WT) and CCR4KO mice (pulp exposure and bacterial inoculation), and treated with anti-GITR to inhibit Tregs function or alternatively with CCL22-releasing, PLGA particles to induce site-specific migration …

A Pilot Study Investigating The Utilization Of Crest Pads For Treatment Of Toe Callus And Ulceration (Presentation), Monica L. Melo Dnp, Rn, Acns-Bc, Cwocn, Cfcn, James Mccullough Md, Tricia S. Bernecker Phd, Msn, Rn, Acns-Bc, John J. Hong Md, Jane Scott Trumbauer

Patient Care Services / Nursing

No abstract provided.

Intramembranous Bone Healing Process Subsequent To Tooth Extraction In Mice: Micro-Computed Tomography, Histomorphometric And Molecular Characterization, Andreia Espindola Vieira, Carlos Eduardo Repeke, Samuel De Barros Ferreira Junior, Priscila Maria Colavite, Cláudia Cristina Biguetti, Rodrigo Cardoso Oliveira, Gerson Francisco Assis, Rumio Taga, Ana Paula Favaro Trombone, Gustavo P. Garlet

School of Podiatric Medicine Publications

Bone tissue has a significant potential for healing, which involves a significant the interplay between bone and immune cells. While fracture healing represents a useful model to investigate endochondral bone healing, intramembranous bone healing models are yet to be developed and characterized. In this study, a micro-computed tomography, histomorphometric and molecular (RealTimePCRarray) characterization of post tooth-extraction alveolar bone healing was performed on C57Bl/6 WT mice. After the initial clot dominance (0 h), the development of a provisional immature granulation tissue is evident (7 d), characterized by marked cell proliferation, angiogenesis and inflammatory cells infiltration; associated with peaks of growth factors …

Blood, Brain And Now Bone – Learning More About An Often Overlooked Pathogen, Linda Lesky, Julianne Camba, Sarah De Los Santos, Alexander Fortenko, Talal Alzahrani

GW Research Days 2015

INTRODUCTION:

Arcanobacterium haemolyticum (previously Corynebacterium haemolyticum), a facultative anaerobe, Gram positive rod was first isolated from United States servicemen and indigenous populations of the South Pacific in 1946. Early reported cases detailed A. haemolyticum as a causative pathogen for exudative pharyngitis (most commonly in adolescents) and cutaneous infections. Osteomyelitis caused by A. haemolyticum has been described in less than five cases in the literature. Here, we describe our experience in diagnosing patient with osteomyelitis caused by A. haemolyticum.

CASE REPORT:

A 30-year-old man with a history of peripheral neuropathy, diabetic foot ulcers, methicillin-resistant S. aureus osteomyelitis and amputation of the …

Analysis Of Multiple Cytokine Polymorphisms In Individuals With Untreated Deep Carious Lesions Reveals Il1b (Rs1143643) As A Susceptibility Factor For Periapical Lesions Development, Alisa Dill, Ariadne Letra, Letıcia Chaves De Souza, Mamatha Yadlapati, Cláudia Cristina Biguetti, Gustavo P. Garlet, Alexandre R. Vieira, Renato Menezes Silva

School of Podiatric Medicine Publications

Introduction

It has been proposed that individual genetic predisposition may contribute to persistent apical periodontitis. Cytokines are associated with levels of inflammation and are involved in caries, pulpal, and periapical tissue destruction. We hypothesized that polymorphisms in cytokine genes may contribute to an individual’s increased susceptibility to apical tissue destruction in response to deep carious lesions.

Methods

Subjects with deep carious lesions, with or without periapical lesions (≥ 3 mm) were recruited at the University of Pittsburgh and the University of Texas at Houston. Genomic DNA samples of 316 patients were sorted into 2 groups: 136 cases with deep carious …

Simultaneous Analysis Of T Helper Subsets (Th1, Th2, Th9, Th17, Th22, Tfh, Tr1 And Tregs) Markers Expression In Periapical Lesions Reveals Multiple Cytokine Clusters Accountable For Lesions Activity And Inactivity Status, Ana Claudia Araujo-Pires, Carolina Favaro Francisconi, Cláudia Cristina Biguetti, Franco Cavalla, Andreza Maria Fabio Aranha, Ariadne Letra, Ana Paula Favaro Trombone, Marcelo Faveri, Renato Menezes Silva, Gustavo P. Garlet

School of Podiatric Medicine Publications

Previous studies demonstrate that the balance between pro- and anti-inflammatory mediators determines the stable or progressive nature of periapical granulomas by modulating the balance of the osteoclastogenic factor RANKL and its antagonist OPG. However, the cytokine networks operating in the development of periapical lesions are quite more complex than what the simple pro- versus anti-inflammatory mediators' paradigm suggests. Here we simultaneously investigated the patterns of Th1, Th2, Th9, Th17, Th22, Thf, Tr1 and Tregs cytokines/markers expression in human periapical granulomas.

Methods:

The expression of TNF-α, IFN-γ, IL-17A, IL23, IL21, IL-33, IL-10, IL-4, IL-9, IL-22, FOXp3 markers (via RealTimePCR array) was …

Elderly Foot Care, Helen Chu

International Conference: Overcoming Challenges in Active Ageing

No abstract provided.