Podiatry Commons^™

Navigating The Uncommon: Providencia Rettgeri In Diabetic Foot Ulcers, Nikita Gambhir, Heather V. Tran, Stephanie N. Campbell, Mihir Panchal

School of Podiatric Medicine Publications

A case study presents with a rare microorganism, Providencia rettgeri, as a pathogen identified in a non-healing diabetic foot ulcer with osteomyelitis. P. rettgeri remains an emerging pathogen with documented drug-resistant hospital associated infections. Given the rarity of this organism in such wounds and its intrinsic resistance to multiple antibiotics, this study aims to understand the pathogen’s role in diabetic foot infections and improve clinical management practices.

Providencia has been classified as Critical Priority 1 on World Health Organization’s global priority pathogen list for the need of new antibiotics, highlighting its international significance. P. rettgeri tends to grow in nosocomial …

Effect Of A Potent Nitrogenous Bisphosphonate On Cell Viability In Diabetic Conditions: An In Vitro Study On Human Fibroblasts And Pre-Osteoblasts, Denae Cantu, Bryan Liu, Deborah Rocha Seixas, Claudia Biguetti

School of Podiatric Medicine - Student Research

Introduction Zoledronate (Zol) is a nitrogenous bisphosphonate (nBP) used to treat osteoporosis, bone metastases, and Charcot foot. Despite its efficacy in preventing fractures, concerns exist about its side effects on mesenchyme-origin cells and impaired wound healing. We hypothesize that Zol may impair the responses of human fibroblasts (hF) and pre-osteoblasts (MC3T3), potentially compromising tissue healing in the lower extremities of patients with diabetes.

Methodology: MC3T3 cells and hF were cultured in 96-well plates at a density of 2.5 x 10³ cells for 48 and 72 hours, respectively. Cells were subjected to normal glucose, high glucose, and high oxidative stress conditions …

Return To Play Time After Achilles Tendon Rupture In Professional Soccer Players, Oyinkansola Mudasiru, Amanda Killeen

School of Podiatric Medicine - Student Research

Introduction: Achilles tendon ruptures are severe injuries that drastically affect the careers of athletes. These ruptures typically occur during matches, often due to dorsiflexion of the ankle during passes or when tackling. Professional athletes tend to have surgical repair quickly with the goal of returning to their sport as fast as possible.

Objective: To present a scoping review to identify the return to play (RTP) rates following Achilles tendon rupture and whether these athletes achieve functional outcomes comparable to their pre- operative conditions.

Methods: 2 databases were queried; Google Scholar and PubMed using the search terms "Achilles tendon rupture" AND …

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.

A Systematic Review Of Diabetic Foot Infections: Pathogenesis, Diagnosis, And Management Strategies, Sabyasachi Maity, Noah Leton, Narendra Nayak, Ameet Jha, Nikhilesh Anand, Kamala Thompson, Danielle Boothe, Alexandra Cromer, Yaliana Garcia, Aliyah Al-Islam

School of Medicine Publications

Background: Diabetic foot infection represents a significant complication of diabetes mellitus, contributing substantially to morbidity, mortality, and healthcare expenditure worldwide. Accurate diagnosis relies on a comprehensive assessment integrating clinical evaluation, imaging studies, and microbiological analysis. Management necessitates a multidisciplinary approach, encompassing surgical intervention, antimicrobial therapy, and advanced wound care strategies. Preventive measures are paramount in reducing the incidence and severity, emphasizing patient education, regular foot screenings, and early intervention.

Methods: The researchers performed a systematic review of literature using PUBMED MESH keywords. Additionally, the study was registered in the International Prospective Register of Systematic Reviews at the Center for Reviews …

Evaluating Hmgb1 As A Biomarker For Metabolic Dysregulation And Progression Of Diabetes In A Mexican American Cohort, Peter Elvin, Walid Fakhouri, Craig Hanis, Cláudia Cristina Biguetti

School of Podiatric Medicine - Student Research

Aim/Hypothesis: This study focuses on HMGB1 to evaluate its association with the development and progression of diabetes within a Mexican American cohort of non-diabetic (ND), pre-diabetic (Pre-D), and diabetic (D) individuals.

Methods: Data from a cohort of 40 individuals, standardized by age (61.76±11.77), BMI (32.52±7.02), and sex (58% male, 42% female) was analyzed. We assessed several immunological markers utilizing ELISA assays from buffy coats. After excluding out of range samples, the remaining 20 individuals displayed statistical significance in HMGB1. Pearson's correlation coefficient examined the relationship between HMGB1 levels and glycemic changes (HOMA-IR, HOMA-B, HOMA-IS², and HbA1c). Statistical significance …

Co-Localization Of Osteoclasts Differentiation Markers In An Implant Model In Diabetic Mice, Diego Adobbati, Deborah Rocha Seixas, Danieli Rodrigues, Claudia C. Biguetti

School of Podiatric Medicine - Student Research

Introduction and Hypothesis: Diabetes can impair implant osseointegration and impact implant functionality. While significant research has focused on osteogenesis during the osseointegration, little attention has been given to pre-osteoclast differentiation. We hypothesize that diabetes increases pre-osteoclast activity potentially leading to implant failure. This study aims to identify and localize osteoclast markers, specifically DC-STAMP (Dendritic Cell-Specific Transmembrane Protein) and NFATc2 (Nuclear Factor of Activated T-cells, cytoplasmic 2), in diabetic (D) and non-diabetic (ND) mice.

Methodology: Twenty-four 16-week-old male 129 Sv mice (12 diabetic and 12 non-diabetic) underwent implantation with a 0.5x1.5 mm commercially pure titanium screw in the right maxillary bone. …

A Microtomographic And Histopathological Evaluation Of Dental Cements As Late-Stage Peri-Implant Complication In A Rat Model, Bhuvana Lakkasetter Chandrashekar, Cláudia Cristina Biguetti, Alexandra Arteaga, Andres J. Miramontes, Evelin Rios, Danieli C. Rodrigues

School of Podiatric Medicine Publications

Cement mediated peri-implantitis accounts for 1.9–75% of dental implant failures associated with peri-implant diseases. This study evaluated the biological impact of dental cements on osseointegrated implants using Lewis rats. Twenty-two rats were distributed into 6 groups: negative control (NC) soft diet (SD), and hard diet (HD); positive control SD and HD (n = 3); Implant + bio-ceramic Cement (BC) SD and HD which included contralateral Sham sites (n = 5). Titanium implants were placed on either side of the maxillae and allowed to heal for 14 days. Later, both sides of experimental groups underwent a re-entry surgery to simulate clinical …

The Effect Of Limb Salvage Efforts In Different Age Groups: Relationships Between Major And Minor Amputations, Wenye Song, Javier La Fontaine, Naohiro Shibuya, John Prochaska, Daniel C. Jupiter

School of Podiatric Medicine Publications

“Limb salvage” efforts, such as performing minor amputations before infections spread proximally from the foot to decrease major lower extremity amputation, are an important part of healthcare today. It is unclear whether these efforts are preventing the number of major amputations and improving patients’ quality of life and the cost-effectiveness of the U.S. healthcare system. Rates of non-traumatic lower extremity amputation (NLEA) among patients with diabetes decreased in the early 2000s but rebounded in the 2010s. We analyzed the proportion of major amputations and differences in amputation rates between age groups in Texas. Patient data was extracted from the Texas …

A Proposed Addition To The Modified Wells Criteria: Exploring Thrombosis In The E-World, Nidhin John, Amanda Kileen

School of Podiatric Medicine - Student Research

The advancement of technology and over-reliance on electronics have led to "e-thrombosis." This review investigates the link between prolonged sedentary behavior due to extensive electronic use and the risk of venous thromboembolism (VTE) and deep vein thrombosis (DVT). The term "e-thrombosis" was introduced in 2003 by Beasley et al., highlighting the risk of immobility associated with electronics. E-thrombosis is particularly relevant post-COVID-19, with increased remote working and online learning. This review evaluates recent studies to determine if e-thrombosis should be considered in updated screening tools like the Wells Score.

A systematic literature review was conducted using PubMed, Direct Science, and …

Case Report Of Surgical Management For Charcot Foot Medial Column Beaming With Stj Arthrodesis, Prachi Patel, Randy Semma

Posters

Medial column beaming is a surgical procedure that involves inserting a metallic beam to the medial column of the foot to treat the Charcot deformity of the foot.

A surgeon will use a large diameter screw to insert a beam into medial column which includes the first metatarsal, medial cuneiform, navicular and talus (fig 3) The beam shares the load of weightbearing with the foot's ligaments and joints, reducing the abnormal loss of structural integrity that can occur in Charcot arthropathy of the foot.

Subtalar joint fusion is often performed concurrently with medial column beaming to enhance the overall stability …

Sole Searching: The Mystery Of A Left Foot Mood Swing Unraveled, Kaitlin Sebranek, Randy Semma

Posters

About 0.2% of patients in the Diabetic population have Charcot Neuroarthropathy.

When the gold standard of offloading in a total contact cast fails for CN patients, surgical treatment can be considered to achieve a stable, plantigrade, and functional foot.

Due to the complexity of the condition, potential complications such as hardware breakage, nonunion, and infection can result over time.

Complications And Formation Of Sinus Tracts Due To Presence Of Lead From Foreign Bodies In Soft Tissue: A Case Report, Peter J. Godoy, Marshall G. Solomon

Posters

A cornerstone of lower extremity limb salvage is to avoid development of wound complications involved in soft tissue infections . Predicting probability of sinus tract development due to presence of lead in soft tissues from foreign bodies. In this particular case a bullet fragment from a previous gunshot wound was noted to be the catalyst disrupting multiple biologic processes and impairing the function of soft tissues to heal. Predicting a level of contamination in this particular case lead believed to cause oxidative stress and inflammation and prompt excisional removal can avoid sinus tract formations and complications. This study presents a …

The Curious Case Of Ainhum Dactolysis Spontanea, Jesse Miller, Michele Bertele-Semma, Randy Semma

Posters

46 yo African male, no major PMH.

Pt presents with severe pain in the right 5th toe.

Pt had used a corn remover at home treatment 2 years ago which they stated started the progression in the pain of the patient.

Pt states that the toe has progressively become more constricted and painful.

Pt states that they want their toe amputated to relieve the pain.

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 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 individual.

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.

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 …

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 non-union

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 …

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.