Podiatry Commons^™

Smart Offloading Boot System For Remote Patient Monitoring: Toward Adherence Reinforcement And Proper Physical Activity Prescription For Diabetic Foot Ulcer Patients, Catherine Park, Ramkinker Mishra, Davide Vigano, Maurizio Macagno, Stefano Rossotti, Karen D'Huyvetter, Jason Garcia, David G Armstrong, Bijan Najafi

Center on Aging Staff Publications

Background: A critical factor in healing diabetic foot ulcers is patient adherence to offloading devices. We tested a smart offloading boot (SmartBoot) combined with a smartwatch app and cloud dashboard to remotely monitor patient adherence and activity. In addition, the impact of SmartBoot on balance, gait, and user experience was investigated.

Methods: Fourteen volunteers (31.6±8.7 years; 64% female) performed natural activities (eg, sitting, standing, walking) with and without the SmartBoot for approximately 30 minutes. All participants completed balance tests, 10-meter walking tests at slow, normal, and fast pace while wearing the SmartBoot, and a user experience questionnaire. The accuracy of …

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.

Digital Biomarkers Of Gait And Balance In Diabetic Foot, Measurable By Wearable Inertial Measurement Units: A Mini Review, Gu E. Kang, Angeloh Stout, Ke’Vaughn Waldon, Amanda L. Killeen, Peter A. Crisologo, Michael C. Siah, Daniel C. Jupiter, Bijan Najafi, Ashkan Vaziri, Lawrence A. Lavery

School of Podiatric Medicine Publications

People with diabetic foot frequently exhibit gait and balance dysfunction. Recent advances in wearable inertial measurement units (IMUs) enable to assess some of the gait and balance dysfunction associated with diabetic foot (i.e., digital biomarkers of gait and balance). However, there is no review to inform digital biomarkers of gait and balance dysfunction related to diabetic foot, measurable by wearable IMUs (e.g., what gait and balance parameters can wearable IMUs collect? Are the measurements repeatable?). Accordingly, we conducted a web-based, mini review using PubMed. Our search was limited to human subjects and English-written papers published in peer-reviewed journals. We identified …

Digital Biomarkers Of Gait And Balance In Diabetic Foot, Measurable By Wearable Inertial Measurement Units: A Mini Review, Gu Eon Kang, Angeloh Stout, Ke'vaughn Waldon, Seungmin Kang, Amanda L Killeen, Peter A Crisologo, Michael Siah, Daniel Jupiter, Bijan Najafi, Ashkan Vaziri, Lawrence A Lavery

Center on Aging Staff Publications

People with diabetic foot frequently exhibit gait and balance dysfunction. Recent advances in wearable inertial measurement units (IMUs) enable to assess some of the gait and balance dysfunction associated with diabetic foot (i.e., digital biomarkers of gait and balance). However, there is no review to inform digital biomarkers of gait and balance dysfunction related to diabetic foot, measurable by wearable IMUs (e.g., what gait and balance parameters can wearable IMUs collect? Are the measurements repeatable?). Accordingly, we conducted a web-based, mini review using PubMed. Our search was limited to human subjects and English-written papers published in peer-reviewed journals. We identified …

Middle Cuneiform Stress Fracture In A Postal Worker: A Case Report, Stephanie N. Campbell, Jacob M. Jones, Raul Aviles, Loren K. Spencer, John J. Anderson

School of Podiatric Medicine Publications

This report is to supplement the limited nature of isolated cuneiform fractures. Cuneiform fractures are identified as “low risk stress fracture” but with delayed diagnosis may cause prolonged treatment due to continued foot pain. Delayed diagnosis may be due to low sensitivity on radiographic exam and/or low suspicion clinically due to the rare involvement of isolated cuneiform fractures.

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

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 …

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 …

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 …

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

Posters

No abstract provided.

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 …

Filleted Toe Flap For Closure Of Neuropathic Wound With Osteomyelitis, Robert Boguski, Danniyal Shahid

Posters

No abstract provided.

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 …

Effect Of Sensory Neuropathy On The Predictive Value Of Inflammatory Biomarkers For Osteomyelitis In Diabetic And Nondiabetic Patients With Foot Infections, Easton Ryan, Junho Ahn, Dane K. Wukich, Javier La Fontaine, Andrew Crisologo, Matthew Malone, Orhan Oz, Lawrence A. Lavery

School of Podiatric Medicine Publications

Objective: To investigate the predictive value of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in persons with and without diabetes with osteomyelitis (OM).

Methods: We evaluated 455 patients in a retrospective cohort study of patients admitted to the hospital with diabetic foot OM (n = 177), diabetic foot soft-tissue infections (STIs) (n = 176), nondiabetic OM (n = 51), and nondiabetic STIs (n = 51). Infection diagnosis was determined through bone culture, histopathologic examination for OM, and/or imaging (magnetic resonance imaging/single-photon emission computed tomography) for STI. The optimal cutoff values of ESR and CRP in predicting OM were determined …

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 …

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 …

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.

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 Studies & Special Education 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 …

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 …

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.