The Chopart amputation is a controversial amputation level and has been described as a relatively non-functional amputation due to the increased risk for stump deformity and subsequent complications. Recent literature has shown that a tibiotalocalcaneal arthrodesis can subjectively increase function in the Chopart amputation. We describe the use of a tibiotalocalcaneal arthrodesis in a 44-year-old diabetic male with a Chopart amputation for the purpose of limb and gait salvage. After 292 days and an uneventful postoperative course, the patient consented to gait analysis. The case allows us to objectively conclude that the tibiotalocalcaneal arthrodesis can quantitatively increase the functionality of the Chopart amputation and, in turn, expand its indication for use within the more functional populations.
Primary cutaneous cribriform tumor is a rare sweat gland neoplasm with a characteristic histologic architecture and typically benign clinical behavior. We present the first reported pediatric case in a 10-year-old female who developed a painful, firm nodular lesion on the lateral aspect of her right foot. Initially thought to be a verruca, the lesion was treated conservatively. However, the persistence of pain prompted a biopsy that revealed features consistent with a primary cutaneous cribriform tumor. Imaging showed no evidence of spread, and the lesion was excised with a conservative surgical approach.
Podiatry residents may benefit from addiction medicine rotations due to substantial overlap between podiatric needs and substance use disorders (SUDs), particularly in the hospital setting. In a semi-structured format, we describe the cases of two podiatry residents, perhaps the first ever documented, who rotated with an inpatient addiction medicine consult team at an urban, academic hospital. These two residents joined the addiction consult team in 2023 and 2024 and rated their confidence in twelve learning objectives via a five-point Likert scale before and after the rotation (2 weeks long). They also rated their attitude toward the value of addiction services. Post-rotation feedback from the module and ad hoc e-mail correspondence are included. Residents 1 and 2 joined the team and engaged well in orientating with the team, eventually providing near-independent addiction medicine consultations for primary inpatient teams. Pre/post data showed large increases in confidence in learning objectives (mean scores 2.1 to 4.9 for Resident 1, and mean scores 1.5 to 4.0 for Resident 2). They both reported positive experiences, and months later reflected on both pragmatic (e.g., available resources) and attitude-related (e.g., understanding the importance of substance use context for patients) educational gains. In summary, residents from surgical specialties like podiatry may benefit from inpatient addiction medicine exposure. It is unclear whether their rotation spots could be better utilized by those in other specialties, but SUDs are prevalent in a multitude of settings, arguing for broad dissemination of SUD treatment education.
Background: Diabetic foot ulcers (DFUs) and lower extremity amputations are major contributors to morbidity and mortality in individuals with diabetes. Among patients undergoing active cancer treatment, the risks are compounded by immunosuppression, peripheral neuropathy, and vascular complications. Even minor foot infections or wounds in these patients can necessitate the suspension of cancer therapy, with potentially lifethreatening consequences. This study evaluated the impaqt of integrating symptom-focused patient education with coordinated podiatric care to reduce DFUs and amputations in this highrisk population with concurrent cancer and diabetes. Methods: A five-year retrospective review was conducted at a National Cancer Institute (NCl)designated comprehensive cancer center as part of the Novel Limb Preservation Initiative. The cohort included patients with Type II diabetes undergoing treatment for prostate, breast, colorectal, lymphoma, leukemia, thyroid, or lung cancers. Patients were assigned targeted educational modules based on self-reported diabetic foot symptoms. Podiatric care was individualized according to each patient's signs and symptoms, including routine diabetic foot examinations and close, timely monitoring when indicated. Results: The intervention yielded a DFU incidence of 2. 8% and an amputation rate of 0. 43%, both lower than national benchmarks. Enhanced patient engagement through diabetic foot symptom-focused education and earlier detection of foot complications-including diabetic foot ssues that may appear minor to laypersons-contributed to these improved outcomes. Conclusion: Integrating diabetic foot symptom-focused education with proactive podiatric monitoring significantly reduced DFUs and amputations in this high-risk population. This model, developed under the Novel Limb Preservation Initiative, offers a scalable strategy for broader implementation, particularly in high-risk communities, including Hispanic, African American, low socioeconomic, and rural populations across the United States.
Background: Pilon fractures refer to distal tibial fractures that may involve extra-articular, partial articular, or complete intra-articular components, most commonly caused by high-energy trauma. The choice between early (<72 hours) and delayed (>7 days) surgical fixation significantly impacts clinical outcomes. This study aimed to compare the effects of early vs. delayed plate fixation on fracture healing time, functional outcomes, and complication rates. Materials and Methods: This retrospective study analyzed 80 patients who underwent surgical treatment for pilon fractures between 2018 and 2023. Patients were divided into two groups: Early surgery (<72 hours, n=40); Delayed surgery (>7 days, n=40). Additionally, patients were categorized based on the fixation method: Single plate fixation (n=40); Double plate fixation (n=40). Outcome Measures: Fracture healing time (weeks) - Defined as cortical continuity on radiographs; Functional outcomes (AOFAS score); Complication rates (infection, malunion, implant failure). Results: Shorter healing time was observed in the early surgery group (14.2 vs. 16.8 weeks, p<0.05). Better functional outcomes were recorded in the early surgery group (AOFAS score: 82.3±6.5 vs. 78.1±7.2, p<0.05). Lower infection rates were noted in the delayed surgery group (7.5% vs. 12.5%, p<0.05). Double plate fixation provided better mechanical stability but resulted in higher soft tissue complication rates. Single plate fixation preserved soft tissue integrity but had higher malunion and implant failure rates. Conclusion: Early surgery is associated with shorter healing time and better functional outcomes, but increased soft tissue complications require careful management. Delayed surgery offers a safer approach for soft tissue healing but may prolong functional recovery. While double plate fixation ensures greater stability, it may increase soft tissue morbidity, whereas single plate fixation reduces soft tissue complications but may compromise stability. A personalized surgical approach is recommended for optimal outcomes in pilon fracture management.
Background: The aim of this study was to investigate the effect of dry needling (DN) applied to the abductor hallucis (ABH) muscle on pain function and angle in patients with hallux valgus (HV). Methods: The study included 31 HV patients. Patients were randomly divided into two groups. The first group received toe-spread-out (TSO) exercise. The second group received three sessions of DN for myofascial trigger points in the ABH muscle in addition to TSO exercise. Visual analog scale (VAS) (rest, activity) and foot function index (FFI) (pain, disability, activity) were used for clinical evaluation. Hallux valgus angle (HVA) and intermetatarsal angle (HVA) were measured. The evaluations were performed at baseline and at the first and fourth weeks following treatment. Results: VAS-rest baseline-fourth week and baseline-first week changes were significantly superior in the TSO-plus-DN group compared to the TSO group (p = 0.023, p = 0.039, respectively). FFI-disability baseline-fourth week change was significantly superior in the TSO-plus-DN group compared to the TSO group (p = 0.040). HVA and IMA baseline-fourth week changes were significantly superior in the TSO-plus-DN group compared to the TSO group (p = 0.001, p = 0.045, respectively). Conclusions: According to our findings, the combination of DN for the ABH muscle with TSO exercise may be recommended for the treatment of patients with mild-to-moderate HV.
Background: Flatfoot is a condition brought on by trauma, persistent foot stress, obesity, and poor biomechanics. These factors result in the development of a flat foot, collapse of the foot arch, and malfunction of the posterior tibial tendon. This study aimed to assess the immediate effects of Kinesio Tape on static plantar foot pressure and force in young females with flexible flatfoot. Methods: A pilot study (pre-experimental study design) with a convenience sample of 20 female subjects from a university with flexible flatfoot (age = 20.1 ± 1.3 years, weight = 91.8 ± 14.4 kg, height = 162.2 ± 6.3 cm, BMI = 34.9 ± 5, foot posture index (FPI) = 8.8 ± 2.1) was selected. The TekScan MatScan® system was used to measure the static plantar forces and pressures, foot contact area, and the mediolateral displacement of COF over time while standing (Boston, MA, USA) before and immediately after the application of Kinesio Tape (KT). Results: While there were no statistically significant changes in the foot peak or total pressure, paired-sample t-tests showed a statistically significant reduction in foot contact area (p < 0.05) and a statistically significant increase in midfoot maximum force (p < 0.05) following the application of KT. Furthermore, after applying KT, there was a statistically significant decrease in the mediolateral COF velocity, indicating greater lateral displacement of COF (p < 0.05). Conclusions: The results of this study concluded that Kinesio Tape was a useful intervention method for immediately redistributing pressure and forces in young females with flexible flat feet.
Background: Despite the frequent occurrence of ankle injuries, there is no consensus among orthopedic surgeons regarding the diagnosis and treatment of syndesmotic injuries. This study evaluates the clinical and radiological outcomes of three-cortex syndesmotic fixation in Weber type B/C lateral malleolus fractures (with or without medial malleolus involvement) associated with syndesmotic injury. Material and Method: This study analyzed thirty-six (36) patients with Weber type B/C lateral malleolus fractures treated between 2011 and 2022. All underwent open reduction and fixation with plates and screws for malleolar fractures, along with a 3.5 mm cortical syndesmosis fixation using three cortical engagements. Preoperative and postoperative radiological findings and final functional ankle assessments were reviewed. Intraclass correlation coefficients (ICC) were used to assess inter- and intra-observer agreement for tibiofibular clear space (TFCS), tibiofibular overlap (TFO), medial clear space (MCS), and anterior tibiofibular ratio (ATFR) measurements. The functional status of the ankle has been assessed using the American Orthopedic Foot and Ankle Society (AOFAS) scale. Results: The mean age of the patients was 50.56 ± 16.23 years, and the mean follow-up duration was 20.89 ± 24.93 months. Postoperative AOFAS scores averaged 91.08 ± 9.90. The inter-observer agreement for preoperative assessments was excellent across all parameters (ICC > 0.9). However, in the postoperative period, inter-observer agreement for ATFR measurement was poor (ICC < 0.5), while agreement for all other parameters remained excellent (ICC > 0.9). Intra-observer comparisons of preoperative (pre-op) and postoperative (post-op) measurements were poor across all parameters (ICC < 0.5); this can be attributed to the success of reduction, reflecting the positive directional change on all parameters. After an average follow-up of 20 months, four radiological parameters showed significant differences, indicating enhanced stability and reduced diastasis. Conclusions: Three-cortex syndesmotic screw fixation in Weber type B/C lateral malleolus fractures with syndesmotic injuries yielded excellent mid-term radiological and functional outcomes.
This article discusses the treatment course of an aggressive diabetic foot infection (DFI) complicated by the emergence of pyoderma gangrenosum (PG). A 67-year-old man with long-standing diabetes presented with a nonhealing DFI that prompted antibiotic treatment and surgical debridement. However, the coexistence of DFI and PG may create a conflict in the treatment approach, as treating one condition may exacerbate the other. The patient responded positively to systemic corticosteroids and infliximab, and, despite conflicting recommendations on debridement, surgical intervention proved necessary. This report advocates for early PG diagnosis using the Delphi model and stresses the need for ongoing research regarding surgical debridement in these complex scenarios.
Venothromboembolic (VTE) events are considered rare complications following foot and ankle surgery. Most instances of VTE following surgical procedures occur in particularly high-risk patient populations; therefore, VTE prophylactic anticoagulation is initiated based on risk/benefit stratification for each individual patient undergoing foot and ankle surgery. We present a case report on a 40-year-old male who underwent isolated Lisfranc ligament repair and subsequently developed an acute saddle pulmonary embolism and deep vein thrombosis 1 month postoperatively. The patient was on prophylactic Lovenox, yet still developed a life-threatening complication. The patient was found to be on a selective estrogen receptor modulator for the off-label treatment of male infertility. This medication, surgical intervention, and a period of non-weight bearing are believed to be contributory to the patient's relatively increased hypercoagulable state. This case depicts a rare complication of foot and ankle surgery and highlights the importance of VTE prophylaxis during the postoperative period.
The term "foot drop" is defined as the loss of active dorsiflexion at the tibiotalar joint. Surgical procedures such as tendon transfer may be considered in patients who have had foot drop for more than a year. The most commonly reported tendon transfer in the treatment of drop foot is the tibialis posterior tendon. In cases where the tibialis posterior tendon is non-functional, transfer of one of the non-standard tendons such as FHL tendon to the dorsum of the foot is performed. In the presented case, the surgical technique of endoscopic transfer of the FHL tendon was illustrated. The patient's AOFAS score was 50 points preoperatively and 78 points at the sixth postoperative month. The active dorsiflexion angle of the foot was increased to 0 degree from -30 degree.
Background: Diabetic foot ulcers (DFUs) and lower-extremity amputations (LEAs) complicating diabetes mellitus are significant contributors to morbidity, mortality, and disease burden. There is insufficient evidence, however, linking podiatric care to mortality and healthcare resource use. There is, concurrently, inadequate access to podiatric care, particularly in Asia. This study evaluated the clinical and healthcare use outcomes of patients with DFUs who received podiatric care. Methods: A longitudinal study involving patients in Diabetic Foot in Primary and Tertiary (DEFINITE) Care followed over a period of 2 years reviewed the effectiveness of podiatric care with regard to 1-year outcomes using multiple logistic and zero-inflated negative binomial regressions, adjusting for covariates. Clinical outcomes were minor and major LEA, mortality, and LEA-free survival rates; healthcare use outcomes were the number of admissions, number of visits to clinics and emergency departments, and length of stay. Results: Eligible patients (n = 2798 [65.5%]) completed at least 12 months of follow-up. Comparisons were made with patients without access to podiatric care. The overall mean ± SD patient age was 65.7 ± 12.7 years. Most patients receiving podiatric follow-up were of Malay or Indian ethnicities and had poor diabetic control and chronic kidney disease. There were more admissions (p < 0.01) and visits to the emergency department (p < 0.01) and hospital outpatient clinics (p < 0.01), but a shorter length of stay (incidence rate ratio, 0.833; p < 0.01), without any reported differences regarding visits to public primary care clinics (p = 0.68). There were more minor LEAs (p < 0.01) but fewer deaths (p < 0.01) and greater LEA-free survival (odds ratio, 1.26; p = 0.02). Conclusions: Podiatric care improved clinical outcomes for patients with DFU, particularly in terms of LEA-free survival, with a positive impact on healthcare utilization. This is a crucial contribution to the limited evidence on podiatric care in diabetic limb salvage in Asian populations.
Background: Caregivers often seek medical assistance when their child experiences podiatric medical ailments. Podiatric medical diseases such as ingrown toenails, callosities, warts, metatarsus varus, and hallux valgus frequently occur in children and adolescents. However, treatment, prevention, and rehabilitation are often based on empirical experiences; thus, as a first endeavor, clinical and epidemiologic mapping of podiatric medical diseases in children is warranted. We describe the prevalence of common foot conditions-callosities, ingrown toenails, hallux valgus, metatarsus varus, and warts-among Danish schoolchildren aged 6 to 16 years. Methods: In this cross-sectional study, we evaluated foot conditions in children in first (aged 6-8 years), fifth (aged 10-12 years), and ninth (aged 14-16 years) grades. The clinical status of the feet was examined by teams of two podiatric physicians each. Specifically, we evaluated deformities of the foot, foot pathologies, and their anatomical localization. Results: Of 501 children (1002 extremities) evaluated, 417 had one or more of the investigated foot deformities or pathologies. We found 266 various foot pathologies among Danish schoolchildren. Metatarsus varus (53%) and callosities (46%) were the most frequently occurring foot conditions. The prevalence of foot pathologies of ingrown toenails and warts was 14% and 12%, respectively. The prevalence of ingrown toenails, metatarsus varus, and hallux valgus increased with age. Conclusions: This study found that foot pathologies such as warts and ingrown toenails and conditions such as metatarsus varus and callosities are common in Danish primary school students. These findings of high prevalences of foot pathologies and conditions motivate future research projects to clarify how this affects general health and subsequently the relation to pain, health challenges, socioeconomics, and quality of life.
Hallux fractures, particularly those involving the proximal phalanx, can lead to significant functional impairments if not promptly managed. This report introduces a novel, minimally invasive technique for hallux fracture fixation using hypodermic needles. This technique is specifically designed for resource-limited settings such as disasters or emergencies. A 30-year-old female sustained an open proximal phalanx fracture of the left hallux with interphalangeal joint dislocation following a motor vehicle accident. Under local anesthesia in the emergency service settings, fracture reduction and stabilization were achieved using two hypodermic needles. A 21-gauge needle was inserted intramedullary through the medial aspect of the hallux to stabilize the fracture, while an 18-gauge needle was placed distally to secure alignment. Postoperative radiographs confirmed proper alignment, and the needles were removed after four weeks. The patient achieved pain-free ambulation with a full range of motion within six months, with no complications noted. This technique offers a cost-effective, rapid, and practical alternative to traditional methods, eliminating the need for fluoroscopy or specialized surgical tools. It is particularly valuable in emergency and resource-constrained environments, providing favorable clinical and radiological outcomes. This approach demonstrates significant potential for managing hallux fractures in challenging settings and warrants further validation in broader orthopedic practice.
Background/Objectives: This cross-sectional study examined factors associated with diabetic foot complications and identified areas for targeted interventions. Methods: Participants were selected from Dubai Health Authority (DHA) primary health care centers (PHCCs) and divided into two groups: those with diabetic foot complications (DFC) and those without (non-DFC). Data were collected through demographic surveys and a structured questionnaire assessing knowledge, attitudes, and practices (KAP) related to foot care. Results: A significant age disparity was observed within the study population, with 70.6% of individuals in the DFC group being over 60 years. In contrast, only 41.8% of the non-DFC group fell within the same age range, underscoring the potential role of age as a critical risk factor. Analysis of KAP towards diabetic foot care did not reveal any notable differences when stratified by sex, employment status, or overall educational attainment. However, a higher proportion of individuals within the DFC group reported having received no formal education. Furthermore, participation in foot care education programmes was significantly correlated with enhanced knowledge (p < 0.001) and improved practices (p = 0.013). Overall, individuals within the DFC group exhibited significantly poorer self-care practices regarding foot health (p < 0.001). Conclusions: This finding indicates a pressing need for targeted educational interventions aimed at improving outcomes and reducing complications among patients with diabetes.
Background: We sought to compare the results of the Heifetz and Winograd methods, used in the surgical treatment of ingrown toenails, and their efficacy in different age groups. Methods: A total of 160 toes of 143 patients surgically treated with the diagnosis of toes growing into the skin between 1 June 2012, and 31 July 2019 were evaluated retrospectively. The age, sex, involved foot, involved toe, and relevant Heifetz stages of the patients were assessed. The patients underwent either the Winograd or Heifetz surgical treatment method. The groups were further divided by age (<18 years and ≥18 years) and were re-evaluated in terms of recurrence. Results: No statistically significant difference was detected between the groups in terms of age, sex, side, early infection, and recurrence rates. However, when the groups were divided according to age, a significantly lower recurrence rate was found in patients younger than 18 years who underwent the Heifetz method compared with patients 18 years and older who underwent the Winograd method. Conclusions: Aligned with the literature, these two surgical methods may be regarded as considerably successful, easily applied, and safe, with fewer complications in ingrown toenail cases. Although it is appropriate to select a surgical treatment method depending on the experience of the surgeon, we believe that the Heifetz method should be given priority due to better outcomes in terms of recurrence in patients younger than 18 years.
BACKGROUND:Diabetes-related foot complications are among the most common complications in individuals with type 2 diabetes mellitus. The prevention of foot problems that are at risk of developing because of type 2 diabetes mellitus should be addressed within the framework of preventive approaches prior to treatment. The aim of this study was to evaluate protective sensation in people with type 2 diabetes mellitus who have not been diagnosed with early diabetes-related foot complications and to investigate the effects of protective sensation on peripheral muscle strength, balance, and functional capacity. METHODS:This study included 42 volunteer patients (56.71 ± 7.59 years) who were followed up with a diagnosis of type 2 diabetes mellitus and met the inclusion criteria. Individuals were evaluated prospectively and via face-to-face interviews. Light-touch, vibration, and discrimination sense was evaluated to determine protective sensation. Peripheral muscle strength (quadriceps femoris, biceps brachii, and hand grip) was measured and a 6 min walking test for functional capacity and balance evaluation were performed. Spearman correlation analysis was conducted using SPSS Statistics 21.0 for data analysis. RESULTS:At least one of the components of protective sensation was moderately correlated with peripheral muscle strength, functional capacity, and balance scores. Reduced protective sensation was also observed in individuals with type 2 diabetes mellitus without neuropathy. CONCLUSIONS:In type 2 diabetes mellitus patients, decreases in light-touch, vibration, and discrimination sense are moderately associated with parameters of peripheral muscle strength, functional capacity, and balance. In patients with type 2 diabetes mellitus, early foot sole sensory examination may prevent the development of neuropathy and support clinicians in early diagnosis.
Heel pain is a very common foot condition. Mechanical factors are the most common cause of heel pain. The main causes of heel pain include plantar fasciitis, heel spurs, Achilles tendinopathy, heel neuritis, and heel bursitis. This case study aimed to manage pain in a patient with heel pain accompanied by pronounced pes planus. A 42-year-old woman presented with heel pain and pes planus. The pain was present in the normal standing position and at rest. After examination, a spur, plantar fasciitis, and Morton's neuroma were diagnosed. The patient, who had not responded to medical and rehabilitative treatments, was evaluated using the visual analog scale and the 36-Item Short Form Survey quality of life questionnaire to assess pain during rest and walking using a newly developed combined exercise method. Significant improvements were observed in the final measurements. This study contributes significantly to our knowledge of the best physiotherapy treatments for patients with heel pain associated with spurs and plantar fasciitis.
Objectives: Flat feet is a very common deformity in children. Often, radiologic evaluation for children with flat feet is made. Although the measurement reliability of some angles in flat feet has been evaluated in the literature, none of them have been performed in the age range of 3-7 years, when the deformity is most common. Our aim is to evaluate the interobserver and intraobserver reliability of the 7 angles that are used for assessing flat feet. Methods: Radiologic angles were measured by four independent observers (two specialists and two residents) in two separate sessions on the foot radiographs of 50 children aged 3-7 years with clinically diagnosed flat feet in the appropriate position and intra-class correlation coefficient was evaluated. Thus, interobserver and intraobserver reliability was measured. Results: High reliability values were found in the AP talus - 1st metatarsal (APT1MT) angle and calcaneus inclination (Cl) angle, while the reliability was moderate in the other angles. Intraobserver reliability values tended to be higher than interobserver values, which is consistent with other studies. Conclusions: It is useful to keep in mind that the measurement reliability is moderate except for APT1MT and CI when angles are measured in this specific age group. No positive effect of experience on measurement reliability was found in our study.
BACKGROUND:Podiatrists are crucial for managing lower limb pathologies, and effective appointment scheduling is vital for allocating adequate consultation time based on patient conditions. While occasional late patient arrivals may not significantly impact services, frequent lateness can disrupt patient flow and quality of care. This study explored the impact of patient lateness on podiatry practices worldwide, where no countries of origin were excluded. This study assessed current strategies to manage patient lateness, evaluated their effectiveness and reported recommendations for improvement. METHODS:An international cross-sectional online survey was conducted between January and March 2024. RESULTS:The survey, which garnered 201 responses from podiatrists, revealed that over 90% of podiatrists experienced disruptions in their clinic workflow due to late patients. Common reasons for lateness included traffic issues and difficulties with parking. SMS reminders emerged as the most effective tool for reducing tardiness. Over half (59.3%) of podiatrists implemented a 10-minute grace period before rescheduling late appointments, which effectively reduced lateness by 50%. However, some podiatrists refrained from rescheduling to avoid worsening patients' conditions or dealing with complaints. Additionally, many podiatrists reported a lack of managerial support in handling late patients. CONCLUSION:The frequency of late arrivals in podiatry is similar to other health professions and negatively impacts clinic workflow and staff morale. Enhanced managerial support is needed to better manage late patients, allowing podiatrists to concentrate on their clinical responsibilities.
