Podiatry Commons^™

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 …

Simulated Oral Environment Affects Zirconia Aging And Mechanical Strength, Danyal A. Siddiqui, Smriti G. Natarajan, Bhuvana L. Chandrashekar, Danieli C. Rodrigues

School of Podiatric Medicine Publications

Background: Zirconia is an emerging alternative to titanium for dental implant systems. However, zirconia surfaces can deteriorate under aqueous conditions, thereby compromising mechanical performance. The goal of this study was to assess the impact of biological exposure or aging simulating the oral cavity on the surface integrity and mechanical strength of surface-treated zirconia.

Methods: Partially yttria- or magnesia-stabilized zirconia specimens were polished, acid-etched, or sandblasted. Zirconia disks were exposed to mammalian cells or bacteria. Surface degradation via tetragonal-to-monoclinic phase transformation was assessed by Raman microscopy. Zirconia bars were subjected to accelerated aging by exposure to autoclave steam. Surface morphology was …

Bridging The Language Gap: Training Medical Students In Interpreter-Mediated Patient Interviews, Monica Agarwal Dpm

School of Podiatric Medicine Publications

No abstract provided.

Optimization Of Actuator Stiffness And Actuation Timing Of A Passive Ankle Exoskeleton: A Case Study Using A Musculoskeletal Modeling Approach, Jania Williams, Cody P. Anderson, Arash Mohammadzadeh Gonabad, Farahnaz Fallahtafti, Sara A. Myers, Hafizur Rahman

School of Podiatric Medicine Publications

Objective: A modeling and simulation tool, OpenSim, was used to determine the optimal relationship between actuator stiffness and actuation timing of a passive ankle exoskeleton for reducing metabolic costs during walking. We hypothesized that the absolute minimum in total metabolic cost would exist at an actuation timing of 15% of stance and at a spring stiffness of 7.5 kN/m. We also hypothesized that a local minimum in total metabolic cost would exist at an actuation timing of 50% of stance. Methods: Bilateral kinematics and kinetics data were collected on a healthy male walking overground wearing his regular tennis shoe. The …

Medial Artery Calcification As A Hidden Driver Of Osteomyelitis: The Impact Of Sad-Mac On Microvascular Perfusion And Antibiotic Delivery In The Diabetic Foot, Yasim Zafar, Paul Tran, Ofsman Quintana, Dustin Prins, Hooman Mir

School of Podiatric Medicine - Student Research

Purpose: To evaluate the association between small arterial disease with medial artery calcification (SAD-MAC) and increased risk of osteomyelitis in diabetic foot patients. This study explores how impaired microvascular perfusion contributes to ischemic ulcers, infection progression, and reduced antibiotic efficacy, leading to poor healing and higher amputation rates.

Methods: A retrospective review was conducted on nine diabetic patients with chronic kidney disease, hypertension, and peripheral vascular disease who presented with ischemic or gangrenous toes. Patients lacking radiographs or with non-diabetic ischemic etiologies were excluded. Radiographs were evaluated for small arterial disease with medial artery calcification (SAD-MAC) and graded using the …

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 …

Providencia Rettgeri As An Unusual Pathogen In Diabetic Foot Osteomyelitis: A Case Report And Literature Review, Stephanie N. Campbell, Madeleine Mehaffey, Nikita Gambhir, Amanda L. Killeen

School of Podiatric Medicine Publications

Providencia rettgeri is a Gram-negative bacterium, rarely reported as a cause of diabetic wound infections. Its frequent resistance to β-lactams and carbapenems limits treatment options, especially in immunocompromised patients. We present the case of a 59-year-old unhoused male living with diabetes, peripheral artery disease, and prior bilateral transmetatarsal amputations who presented with a University of Texas 3B diabetic foot ulcer. Magnetic resonance imaging showed osteomyelitis of metatarsals 2–4, and bone biopsy grew Providencia rettgeri and Proteus mirabilis. The patient declined further surgery and was treated with 6 weeks of cefepime and metronidazole, with outpatient wound care, achieving wound closure …

Slimmer’S Paralysis In The Era Of Glp-1 Therapy: A Review Of Recent Cases, Nidhin John, Amayrani Sanchez, Naomie Jean

School of Podiatric Medicine - Student Research

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) such as semaglutide and tirzepatide have transformed obesity management by producing substantial and sustained weight loss. However, rapid weight reduction has been increasingly associated with peroneal neuropathy, or “slimmer’s paralysis.” This review summarizes the pathophysiology, recent case reports, and clinical implications of this emerging complication. Slimmer’s paralysis arises indirectly through loss of protective adipose tissue around the fibular head and nutritional deficiencies, rather than direct neurotoxic effects of GLP-1 agents. Recognition is critical, as timely intervention with conservative or surgical management can restore function. Clinicians should maintain vigilance in patients undergoing rapid pharmacologic weight …

Enhancing Surgical Understanding Of Diabetic Foot Ulcer Classification Through Anatomage Integration: A Digital Approach To Wagner Grading, Nidhin John, Hooman Mir

School of Podiatric Medicine - Student Research

Background: Diabetic foot ulcers often lead to amputation, and accurate Wagner classification requires strong spatial understanding. Anatomage, a 3D digital anatomy tool, may improve this learning.

Methods: Thirty-six surgical trainees completed a pretest, explored digitally reconstructed Wagner grade 0–5 ulcers on Anatomage, and completed a posttest. Paired-sample analysis measured changes in accuracy, comprehension, and confidence.

Results: Classification accuracy improved from 61% to 89% (p < 0.05), with the greatest gains in higher Wagner grades. Participants reported clearer visualization of wound depth, bone involvement, and infection spread.

Conclusion: Anatomage enhances understanding and diagnostic precision of Wagner ulcer classification, supporting more effective limb-preservation education

Use Of Prophylaxis For Deep Venous Thrombosis And Pulmonary Embolism In Isolated Foot And Ankle Trauma, Regina Hansen, Alexander P. Rader, Naohiro Shibuya, Daniel C. Jupiter

School of Podiatric Medicine Publications

Background: Deep venous thrombosis (DVT) and pulmonary embolism (PE) are relatively rare after foot and ankle surgery, especially after trauma. Diagnosing DVT is difficult, and even when it is discovered it does not necessarily clinically manifest on, for example, duplex ultrasound. Thus, it is often recommended that prophylaxis use be assessed on a case-by-case basis based on risk profile rather than being uniformly given or not prescribed.

Methods: We searched the National Trauma Data Bank Trauma Quality Programs Participant Use File for patients experiencing foot and ankle trauma from 2013 to 2017. Patients were identified using the International Classification of …

Single Local Injection Of 3s-Hmgb1 Enhances Early Bone Healing And Titanium Implant Osseointegration In Type 2 Diabetic Mice, Bhuvana L. Chandrashekar, Alexandra Arteaga, Evelin Rios, Jimena Mora, Gustavo P. Garlet, Danieli Rodrigues, Cláudia Cristina Biguetti

School of Podiatric Medicine Publications

Diabetes significantly impairs bone healing via several mechanisms, including sustained inflammation, oxidative stress, and poor osteogenic responses. Fully reduced isoform of High Mobility Group Box 1 with three serine substitutions (3S-HMGB1) has shown regenerative properties while being resistant to oxidative degradation.

Objective: This study evaluated the therapeutic potential of a single local injection of 3S-HMGB1 in early osseointegration under diabetic conditions in mice.

Methodology: A total of 48 male 129/Sv mice (24 non-diabetic [ND], 24 diabetic [D]) received titanium implants following maxillary first molar extraction. ND and D mice (n:12) were injected with either saline (control) or 3S-HMGB1 (0.75 mg/kg) …

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 …

Soft Tissue Envelope Compromise Following Low-Side Motorcycle Accident: A Case Study And Literature Review, Steven A. Bolton, Ali Ahmad, Jonathan Rodriguez, Hooman Mir

School of Podiatric Medicine - Student Research

Purpose: This case report details a staged approach in managing a patient who presented to the ER with a displaced proximal second phalanx fracture, extensive soft tissue damage, and diffuse fracture blistering following a motorcycle crash. This case highlights that soft tissue damage may not always correlate with severe osseous injury.

Methodology: This case is a concurrent chart review of a 40-year-old who sustained a low side motorcycle injury resulting in a minimally displaced avulsion fracture of the medial 2nd toe proximal phalanx base with extensive soft tissue damage, fracture blisters, and lower extremity edema.

Procedures: Radiographic evaluation demonstrated no …

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 Association Between Glp-1 Receptor Agonist Use And Gastroparesis In Patients With Type 2 Diabetes Mellitus: A Scoping Review, Daniela Lizbeth Avilez, Amanda Killeen

School of Podiatric Medicine - Student Research

Poster Category:  Non-sponsored

Level of Evidence:  Level V

Introduction:  GLP-1 receptor agonists (GLP-1 RAs), widely used for glycemic control and weight management in Type 2 Diabetes Mellitus (T2DM), slow gastric motility.

Reports of “gastroparesis” in GLP-1 RA users raise the question whether this reflects reversible pharmacologic effects or true diabetic autonomic neuropathy. This distinction matters for podiatric physicians, as gastroparesis indicates systemic autonomic dysfunction that parallels peripheral neuropathy, impaired wound healing, and heightened foot ulcer risk. Most prior studies rely on symptoms rather than validated gastric emptying (GE) measures.

Aim:  To evaluate the association between GLP-1 RA use and gastroparesis …

Screw Diameter And Healing Outcomes In Jones Fractures: A Scoping Review, Merlin Sajeev, Jessica Sima, Srilalitha Lanka, Amanda Killeen

School of Podiatric Medicine - Student Research

Introduction: Jones fractures occur at the metaphyseal–diaphyseal junction of the fifth metatarsal and are prone to delayed or nonunion due to limited perfusion and high mechanical stress. Intramedullary (IM) screw fixation is the standard operative treatment, yielding higher union rates than conservative management. There is no clear consensus on the influence of screw size on healing outcomes.

Aim: To examine the impact of IM screw diameter on union rates in Jones fracture fixation.

Methods: A literature search was conducted using Google Scholar and PubMed with the search term: “"Screw" AND "Diameter" AND "Union" AND "Jones Fractures"”. Articles published between 2015 …

Evaluating Trending Topics Published In The Journal Of Foot And Ankle Surgery, Sarah Weisbrodt, Asad Mustafa, Demian Rodriguez, Naohiro Shibuya

School of Podiatric Medicine - Student Research

Introduction: As the field of podiatry advances, it is valuable to identify the areas of research that receive the greatest focus. Evaluating popular topics published in podiatric medicine and surgery peer-reviewed journals helps us consider current trends in procedures, surgeon preferences, and current interest in our profession.

Aim: To evaluate current trends in podiatric medicine and surgery through compiling topics published in the Journal of Foot and Ankle Surgery (JFAS) and their frequency.

Methods: JFAS was selected for our analysis as it has the highest impact factor out of the indexed journals in our profession. We used Scopus to identify …

Tissue-Like Fracture Toughness And Stress–Relaxation Ability In Pva-Agar-Based Hydrogels For Biomedical Applications, Ismael Lamas Jr., Bhuvana L. Chandrashekar, Cláudia C. Biguetti, Mohammad R. Islam

Mechanical Engineering Faculty Publications

Soft tissues exhibit remarkable stretchability, fracture toughness, and stress–relaxation ability. They possess a large water content to support cellular processes. Mimicking such a combination of mechanical and physical properties in hydrogels is important for tissue engineering applications but remains challenging. This work aims to develop a hydrogel that can combine excellent mechanical properties with cellular viability. The research focused on polyvinyl alcohol (PVA)/agar double-network (DN) hydrogels, fabricated by thermal gelation and freeze–thawing methods. Their mechanical properties were characterized through tension, compression, fracture, and stress–relaxation tests, and their cellular viability was measured through cytotoxicity tests. The results show that the PVA/agar …

Actin Up And Factor’D In: ​ A Pediatric Spindle Cell Lesion Case Presentation, Michael Higham, Stephanie Campbell, Naomie Jean, Amanda Killeen

School of Podiatric Medicine Publications

Introduction: Solitary spindle cell nodules on the foot in pediatric patients are rare and diagnostically challenging. Dermatofibroma (benign fibrous histiocytoma), a common adult dermal lesion, is infrequently observed in children under 18.

The spectrum of pediatric spindle cell tumors includes reactive entities like nodular fasciitis and dermatomyofibroma, benign neoplasms such as myofibroma, and malignant tumors including spindle cell rhabdomyosarcoma, fibrosarcoma, and dermatofibrosarcoma protuberans (DFSP). Accurate differential diagnosis is essential, as DFSP requires wide excision or Mohs surgery to reduce recurrence risk.

Methods (Case Presentation): An 11-year-old boy presented with a one-year history of a non-healing lesion on the heel, initially …

Effect Of Gait Retraining In Minimalist Footwear Or Barefoot On Running Footstrike And Cadence: A Systematic Review, John Desrochers, Alexis Chow, David Rubin, Altamash Raja

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Gait retraining programs take a structured approach to altering a runner's gait, often with the goal of decreasing footstrike angle and increasing cadence, as these outcomes have been correlated to a reduced rate of injury and optimal performance. Minimalist footwear, or running barefoot entirely, has been explored as a tool for gait adjustment in runners, largely due to the increased feedback from ground forces experienced by the runner. This systematic review aims to decipher the effect of gait retraining with minimalist footwear or barefoot running on footstrike angle and cadence. The comparison group included runners that underwent gait retraining in …