January 2007


Issue 7:

Neglected Isolated Plantar Dislocation of Middle Cuneiform: A case report
BMC Musculoskeletal Disorders

ORIGINAL ARTICLE: Four cases of plantar dislocation of middle cuneiform have been reported in the english literature. All of them were fresh cases and treated with open reduction and internal fixation. We are reporting a case of neglected plantar dislocation of middle cuneiform which was treated with excision. In this case presentation, a farmer presented with a painful plantar dislocation of middle cuneiform bone after 9 months of injury. The bone was deformed and was excised by a plantar incision. It resulted in painless foot with no disability. 
 
  

[PDF] Read on….

Schwannomatosis involving peripheral nerves: a case report
Journal of Korean Medical Science

ORIGINAL ARTICLE: Schwannomatosis or neurilemmomatosis has been used to describe patients with multiple nonvestibular schwannomas with no other stigmata of neurofibromatosis type-2 (NF-2). In our case, schwannomatosis, multiple schwannomas were present in a 21-yr-old woman with no stigmata or family history of NF-1 or NF-2. She had no evidence of vestibular schwannoma or other intracranial tumors. Multiple peripheral tumors were found in the carotid space of the neck, and soft tissue of posterior shoulder, lower back, ankle and middle mediastinum. All of those tumors were completely limited to the right side of the body. All surgically removed tumor specimens in this patient proved to be schwannomas.  

[PDF] Read on . . .  

Foot rotational effects on radiographic measures of lower limb alignment
Canadian Journal of Surgery

ORIGINAL ARTICLE: Introduction: Surgical planning of high tibial osteotomy (HTO) typically requires the measurement of lower limb alignment from standing anteroposterior radiographs. Although every effort is made to maintain a standardized patient position, factors such as pain or anatomic constraints may necessitate acquiring the radiograph in a less than optimal patient position. One such constraint is natural rotation of the feet with respect to the tibia. The purpose of the present study was to investigate the magnitude of the effect of foot rotation on radiographic measures of lower limb alignment. Methods: We analyzed 19 lower limbs from radiographs obtained from 10 people who reported to an orthopedic injuries clinic. Each patient was radiographed in 3 positions: 15 degrees of internal foot rotation, no foot rotation and 15 degrees of external foot rotation. We measured and compared the mechanical axis angle (hip-knee-ankle) and the mechanical axis deviation from each position. Results: Compared with the position with no foot rotation, internal foot rotation resulted in less measured varus alignment and less mechanical axis deviation from the knee joint centre, whereas external foot rotation produced greater measured varus alignment and increased mechanical axis deviation from the knee joint centre. Conclusions: These results indicate that patient positioning is an important factor when measuring lower limb alignment from radiographs. As a result, special care must be taken when acquiring these radiographs for use in planning surgical procedures such as HTO.   

[PDF] Read on . . .

In people with diabetes, PVD and infected foot wounds are oral or intravenous antibiotics more effective?
British Medical Journal

The National Library of Health reports: The PRODIGY guideline on the management of diabetic foot disease distinguishes between non-limb and limb threatening infection and notes: “Non-limb threatening infections • Mild infections can usually be managed with oral antibiotics without hospital admission [Edmonds, 2006].” [1] A clinical review published in the BMJ on the diabetic foot states: A bacterial swab should be taken from the floor of the ulcer after the callus has been removed; culture of excised tissue may yield even more reliable information. Patients with superficial ulcers can be treated as outpatients and prescribed appropriate oral antibiotics until the ulcer has healed. The most likely organisms to infect a superficial ulcer are staphylococci, streptococci, and sometimes anaerobes. Thus, treatment is started with amoxicillin, flucloxacillin, and metronidazole and adjusted when the results of bacteriological culture are available. Choice and duration of antibiotic treatment require considerable expertise and laboratory guidance.     

Read on….

How can one platelet injection after tendon injury lead to a stronger tendon after 4 weeks?: Interplay between early regeneration and mechanical stimulation
Acta Orthopaedica

Original Article: Mechanical stimulation improves the repair of ruptured tendons. Injection of a platelet concentrate (platelet-rich plasma, PRP) can also improve repair in several animal models. In a rat Achilles tendon transection model, 1 postoperative injection resulted in increased strength after 4 weeks. Considering the short half-lives of factors released by platelets, this very late effect calls for an explanation.    

Read on….

Podiatry Related Abstracts this Week
Entrez Pub Med, Wiley Interscience, Ingenta Connect, Blackwell Synergy and more . . .

The Foot Blog News this Week
 
The Foot Blog

  

  1. Leading Radiofrequency Manufacturer Introduces A New Product For Treating Heel Pain
  2. Childhood Obesity Linked To Foot Pain
  3. Developing Thought-Controlled Artificial Limbs: New Ideas From Penn Scientists
  4. A workout treat for the toes and feet
  5. Innocoll’s CollaRx cleared for phase 2 in the treatment of diabetic foot ulcers
  6. The rundown on foot injuries
  7. Safety fears over ‘wheelie shoes’
  8. Uganda: Keep Feet Clean to Avoid Odour
  9. Low-Dose Steroids Reduce Joint Damage From Rheumatoid Arthritis
  10. Medical Implants With An Antibiotic Coating

   

Read on….

 

Podiatry Internet Journal:  What does Open-Access Mean?
Podiatry Internet Journal 

The Podiatry Internet Journal or PIJ is following the way of the internet: Open access means full access to journal articles free of charge without subscription. The internet now provides immense opportunities to write and publish medical articles. Most residencies now provide electronic access to articles for journal club. The Podiatry Internet Journal is the first open- access podiatry journal published for the internet, and we hope to set a precedent. On-line companies such as BioMed now provide over hundreds of open-access journals. This is mainly set up for institutions, however, they still charge a fee for setting up a journal for publication. The Podiatry Internet Journal does not charge fees for publication and is true to the open access format. The PIJ is also pleased to announce PDF format for all articles submitted in 2007. HTML format will still be available. PDF allows each article a ‘journal’ like quality and allows for easy printing and reading. PIJ continues to make strides to enhance free-online publishing for podiatry articles.    

Read on….

 

© Podiatry Internet Communications (PICOMM)

Issue 6:

Isolated dorsal midtarsal (Chopart) dislocation: a case report
Journal of Orthopaedic Surgery 

ORIGINAL ARTICLE: A case of isolated dorsal midtarsal (Chopart) dislocation resulting from blunt trauma is reported. The mechanism of injury, management, and long-term outcome are discussed. A 45-year-old inebriated man fell from a 4-m height and landed on his feet. He had immediate bilateral foot and back pain. Radiographs showed a burst fracture of the second lumbar vertebra, a left Pott’s fracture, and an isolated dorsal dislocation of the right midtarsal (Chopart) joint.   

[PDF] Read on….

Acute Ankle Sprain: An Update
American Family Physician

ORIGINAL ARTICLE: Dr.DOUGLAS IVINS, M.D., M.S.C.E., University of Oklahoma College of Medicine- Tulsa, Tulsa, Oklahoma, discusses Acute ankle injuries including diagnosis and treatments. This is an open-access article viewable on the American Family Physician website.  

Read on….

Postoperative Fever
Indian Journal of Critical Care Medicine

ORIGINAL ARTICLE: Postoperative fever is one of the most common problems seen in the postoperative ward. Most cases of fever immediately following surgery are self-limiting. The appearance of postoperative fever is notlimited to specific types of surgery. Fever can occur immediately after surgery and seen to be related directly to the operation or may occur sometime after the surgery as a result of an infection at the surgical site or infections that involve organs distant from the surgery. Therefore, during evaluating postoperative fever, it is important to recognize when a wait – and – see approach is appropriate, when further work-up is needed and when immediate action is indicated.   

Read on….

Community-acquired MRSA and pig-farming: A case presentation
Annals of Clinical Microbiology and Antimicrobials

ORIGINAL ARTICLE : A case report of MRSA cluster among family members of a pig-farmer, his co-workers and his pigs. Initially a young mother was seen with mastitis due to MRSA. Six months later her baby daughter was admitted to the hospital with pneumococcal otitis. After staying five days in hospital, the baby was found to be MRSA positive. At that point it was decided to look for a possible source, such as other family members and house- hold animals, including pigs on the farm, since those were reported as a possible source of MRSA earlier.     

Read on….

Treatment of Diabetic Foot Infections in the Era of MRSA
Pfizer Webcast

Dr’s. David Armstong and Warren Joseph discuss the treatment of diabetic foot infections and the role of MRSA. This is a 1 hour webcast or lecture online. The webcast is available until May 1st, 2007.     

Read on….

Podiatry Related Abstracts this Week
Entrez Pub Med, Wiley Interscience, Ingenta Connect, Blackwell Synergy and more . . .

 

The Foot Blog News this Week
The Foot Blog 

 

  1. Sneakers track your every move
  2. Fashion conscious must weigh high-heeled
  3. MRI Helps in Ankle Diagnosis
  4. FDA Recalls the RE-Flex VSP Prosthetic Foot
  5. How ‘DNA Parasites” Can Increase Spread of Antibiotic Resistence
  6. Poor Wound Care is Harming Patients
  7. Cartilage Discovery Offers Arthritis Hope
  8. Orthotics Not Effective for Plantar Fasciitis
  9. UK Hospital Abandons Option for Cash Pay
  10. Dr. Stephen Barret Unleashes a host of Responses in Podiatry Today Letters   

Read on….

 

Podiatry Internet Journal: Now Accepting Original Articles
Podiatry Internet Journal 

The Podiatry Internet Journal is now accepting original articles for publication. This is a free, open- access journal that allows quick and easy access to original material. A new feature includes “pre- presentation” of material before editing. This means that your article abstract and some basic information will be up on the site as soon as its submitted. Once the article completes our editing process, it will be available on-line in its entirety in full. Original material will be up on the site and available in a short period of time. Case presentations, new technology and instrumentation and other topics will be accepted.    

Read on….

 

© Podiatry Internet Communications (PICOMM)

Issue 5:

Blastomycosis with Osteomyelitis of the Foot: A case report
Canadian Medical Association Journal 

A case report presented in January 2006 in the CMAJ deserves highlighting. A case is described in which a 31 year old man from Canada presented with osteomyelitis of the 5th metatarsal base. The case was complicated by Staphylococcal, Streptococcal, and an unusual organism of Blastomycosis infection. A discussion of blastomycosis osteomyelitis is presented.   

Read on….

Preventing Diabetic Foot Ulcer Recurrence in High-Risk Patients
Diabetes Care

In this months issue of Diabetes Care, Drs. Lavry, et al present the latest results on the use of temperature monitoring as a self-assessment tool to evaluate the effectiveness of this device in reducing the incidence of foot ulcers. The study was a physician-blinded, randomized study of 15 months with 173 subjects with a previous history of diabetic foot ulcerations. Patients in the enhanced therapy group were compared to a standard foot examination group. Results revealed that the standard group was 4.37 and 4.71 times more likely to develop ulcers than patients in the enhanced therapy group. It was determined that ”Infrared temperature home monitoring, in serving as an “early warning sign,” appears to be a simple and useful adjunct in the prevention of diabetic foot ulcerations. “  

Read on….

Closed Treatment of Calcaneal Fractures
Doctors Guide Orthopaedics

In this months edition of Doctors Guide Orthopaedics and Orthopaedic Web Links (OWL) , Dr. Richard E. Buckley, MD discusses the closed treatment of calcaneal fractures. You can follow the on-line web cast similar to a class room lecture.  

Read on….

Pearls and Pitfalls of Open fractures
American Academy of Orthopedic Surgeons

A discussion of open fractures is presented by Dr. Douglas W. Lundy, MD in last months AAOS Bulletin. The discussion includes pearls and pitfalls concerning liability risks, prophylactic antibiotics, tetanus vaccination, timing of operative debridement, diagnosing an open fracture, low pressure irrigation, use of internal versus external fixation, compartment syndrome, the use of photographing the injury, classifying open fractures and when to use wound VAC and antibiotic beads.     

Read on….

Pigmented Villonodular Synovitis of the Ankle and MRI: A Case Report
University of Pennsylvania Orthopaedic Journal

This article, now available online, deserves another look.  An interesting case of Pigmented Villonodular Synovitis (PVNS) of the Ankle is presented. MRI review, histologic presentation and discussion is presented. Abtract: Although most common in the hip and knee joints, pigmented villonodular synovitis (PVNS) has also been reported to occur in the ankle. The distinctive appearance of PVNS on magnetic resonance imaging (MRI) has proven to be useful in both the diagnosis and treatment of this pathologic process. The following is the report of a case that illustrates the utility of MRI in determining the extent of soft tissue and osseous involvement of PVNS about the ankle. This information is especially helpful in planning subsequent surgical intervention.   

Read on….

Celecoxib Therapy Does Not Increase Cardiovascular Events
Medscape Medical News-Medscape Orthopaedics

January 5, 2007 — A 39-study meta-analysis including more than 41,000 patients that found no increased cardiovascular (CV) risk with celecoxib was published in the January 1 issue of The American Journal of Cardiology. As reported by heartwire at the American College of Cardiology (ACC) 2006 Scientific Sessions held on March 11-14, 2006, the analysis by William B. White, MD, of the University of Connecticut, in Farmington, and colleagues is the largest patient-level meta-analysis of celecoxib to date; however, the analysis did not include 2 studies of colon polyp prevention or a third trial of Alzheimer’s disease prevention with celecoxib that have fueled debate over the cardiovascular adverse effects of the drug.     

Read on….

Update:  Using RSS Feeds
PICOMM, The Foot Blog

All PICOMM publications will now offer RSS feeds for daily updates. You can learn more about RSS feeds here . . .

Read on….

 

© Podiatry Internet Communications (PICOMM)

Issue 4:

Fracture of the Os Trigonum: A Case Report
Journal of Othopaedic Surgery 

Doctors Kose, et al from the Haydarpasa Numune Training and Research Hospital, Second Clinic of Orthopaedics and Traumatology in Istanbul, Turkey describe a case of os trigonum fracture involving the posterior lateral process of the Talus.  The os trigonum is a common accessory bone of the foot that usually ossifies and fuses with the talus between the ages of 8-11 as a secondary ossification center.  If the os remains unfused it is termed os trigonum.  In this case report, a 32 year old female presents after ankle injury from falling down a stairs.  She developed pain, swelling and pain on hyperplantaflexion.  Diagnosis, MRI/radiographic correlation and treatment is discussed.  

Read on….

Safe Zone for the Placement of Medial Malleolar Screws
Journal of Bone & Joint Surgery

In this months Journal of Bone and Joint Surgery, a study was undertaken on 10 cadaveric specimens.  The study was designed to identify possible screw abutement of medial malleolar screws in ankle fracture fixation, especially concerning abutement of screw heads causing posterior tibial tendon irritation.  3 zones were tested (Zone 1 is the anterior colliculus; Zone 2, the intercollicular groove; and Zone 3, the posterior colliculus).

It was found that Zone 1 & 2 were safe in respect to soft tissue irritation, however, all specimens showed tendon abutement in zone 3 with posterior tibial tendon injury to 5 specimens. 

Read on….

Podiatry-Our Occupational Outlook
U.S. Department of Labor

The bureau of labor statistics reports:

1. Despite increasing demand for podiatric care, job openings for podiatrists are expected to be limited because the occupation is small and most podiatrists remain in it until they retire.
2.  Opportunities for newly trained podiatrists will be better in group medical practices, clinics, and health networks than in traditional, solo practices. 3.  Podiatrists need a State license that requires the completion of at least 90 hours of undergraduate study; a 4-year post-graduate program at a college of podiatric medicine; and, in most States, a postdoctoral residency program lasting at least 2 years. Podiatrists enjoy very high earnings. Some interesting points are made in this bureau outlook concerning our employment trends, job outlook and average earnings.
  

Read on….

MRSA and the new Superbug CA-MRSA
Medical News Today

Drs. The Canadian Medical Association Journal issued a public health warning concerning clones of antibiotic-resistant MRSA infections or superbugs.  Until now, MRSA has normally been associated with hospital acquired infections.  However, a new strain of MRSA termed CA-MRSA (Community Associated MRSA) is emerging outside the hospital environment such as locker rooms and childcare centers.  The pathogen combines virulence and resistance and an ability to disseminate at large.  This new strain is now infecting even healthy individuals.  Last year, a number of professional athletes, wrestlers and football players were infected with MRSA.  There is also a good article in Podiatry Today discussing CA-MRSA and HA-MRSA.     

Read on….

Stretching and Plantar Fasciitis
Journal of Bone & Joint Surgery

A recent study in the Journal of Bone and Joint Surgery reports on the effects of Achilles versus isolated plantar fascial stretching in the treatment of plantar fasciitis.  A study recently found new evidence that simple stretching can help relieve heel pain in roughly 2 million Americans.   

Read on….

Podiatry Today eNews
Podiatry Today Volume 5, Issue 1

Doctor Vranes of San Antonio, Texas discusses keys to success after starting the Podiatry Group of South Texas (TPG).  Secrets to treating ankle fractures are presented by Drs. Damieon Brown, DPM, Lawrence DiDomenico, DPM, FACFAS, and Michael VanPelt, DPM.  Continuing Education: How To Address Pediatric Intoeing is presented by Edwin Harris, DPM.  An interesting Point-Counterpoint discussion with Dr. John S. Steinberg, DPM and Warren S. Joseph, DPM: Probe To Bone: Is It The Best Test For Osteomyelitis?.     

Read on….

Update:  Podiatry Internet Journal 

PICOMM has presented and notifed the APMA to the Podiatry Internet Journal and is notifying residency directors of this exciting online project.  Our goal is to introduce this online project to as many residency programs and private practioners who wish to participate.  We already have some distinguished residency programs on board who will begin submission of case material this year.!

Read on….

 

© Podiatry Internet Communications (PICOMM)

Issue 3:

Haglund’s Correction with Removal Retrocalcaneal Spur and Transverse Achilles Tenoplasty:  2 Case Reports
Podiatry Internet Journal 

Two case presentations are described using a transverse incision technique for Achilles tendon repair. This approach differs from the vertical incisional approach of tendon repair that is most often described in the literature. These two cases represent the most severe type of retrocalcaneal exostosis. The transverse incisional approach allows adequate exposure and removal of bone. Both cases utilize soft tissue anchor sutures to plicate the tendon directly to raw bone with secure and strong fixation of the tendon attachment. An in-depth discussion is outlined discussing the anatomy of the posterior calcaneus and the Achilles tendon attachment into the posterior calcaneal tubercle. The vertical and transverse tenoplasty are compared and discussed. A literary review of Achilles attachment supporting this technique is introduced. Mid-line, vertical incisions continue to have their place in tendon pathology that may require removal of mid-tendon pathology. However, in the absence of such pathology, this technique is an alternative to mid-line transection of the tendon.  

Read on….

The Use of Phenytoin Ointment in the Preparation of Diabetic Foot Ulcers
Dermatology Online Journal

A recent report suggests that 10% Phenytoin Ointment is beneficial with the use of split thickness skin grafts to promote closure of large, diabetic ulcers.  Split-thickness skin graft is a simple reconstructive technique used to close large wounds. Phenytoin is known to promote healing mainly by increasing granulation tissue formation. The effectiveness of topical phenytoin in wound-bed preparation (WBP) for split thickness skin grafting has been examined in 16 patients with large diabetic foot ulcers. All patients were treated with standard wound bed preparation including debridement of necrotic tissue. Topical phenytoin (10 % w/w ointment) was applied for 2-8 weeks prior to performance of autografting. Clinical and histologic evaluations were performed. The graft survival was 100 percent In twelve patients, 80-90 percent in three patients take and 60 percent in one patient. Neither local nor systemic side effects were observed. The authors conclude that phenytoin ointment is a safe and efficacious treatment to enhance the survival of split-thickness skin grafts in large chronic diabetic ulcers. 

Read on….

Subungual Verruca or Benign Squamous Papilloma under the Toenail: A Case Report
Podiatry Internet Journal

Benign squamous verrucae is from HPV or human papillomavirus origin.  It is commonly called verrucae vulgaris or common wart.  Although not as common as plantar warts, a case is presented describing subungual squamous papilloma.  Differential diagnosis and treatment is discussed.  

Read on….

Application of Botox for Pedal Hyperhidrosis
Podiatry Management

Drs. Mostafa Niknafs, DPM and Mohsen Khoshneviszadeh, DPM report in a December 2006 article in Podiatry Management :  Pedal hyperhydrosis, or excessive sweating of the feet, is a medical condition caused by over-active sweat glands.  Current treatment options for hyperhydrosis include application of topical drying agenst, anti-cholinergic drugs, iontophoresis, and surgical denervation/sympathectomy.  The effects of botulinum toxin type A or Botox on sweat glands has opened a new door for treatment of hyperhydrosis.     

Read on….

Vohwinkel Syndrome
Dermatology Online Journal

 A case A recent report in DOJ describes keratoderma hereditaria mutilans in three siblings.  Vohwinkel syndrome or keratoderma hereditaria mutilans is a rare diffuse, honeycombed, palmoplantar keratosis usually accompanied by pseudoainhum near the distal interphalangeal creases. The syndrome is reported in three siblings (two brothers and one sister) out of five, who had been having this problem since early childhood.   This is a unique disease of nonepidermolytic palmoplantar keratosis (PPK) also described in an earlier article entitled Keratotic Lesions of the Foot.   

Read on….

Announcement:  Podiatry Internet Journal gets its Official Start in January 2007 with 2 original articles

The Podiatry Internet Journal is pleased to announce the beginning of our online project in January 2007.  Formerly, the Podiatry Online Journal, we now have a very distinguished board panel in place.    This is a completely non-profit project aimed at improving case presentation and interest over the internet.  We will accept original articles from residency programs including externs and interns, private practitioners and institutions starting Jan. 1.  Once of our goals this year will be to introduce this service to every residency program in the country.  We hope to post quality articles and case studies that we hope you will find interesting.  If you have residency contacts, please let them know about this exciting project for 2007!

Read on….

Sincerely yours, 

Signature
Al Kline DPM

© Podiatry Internet Communications (PICOMM)

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