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.
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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.
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.
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.
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.
Podiatry Related Abstracts this Week
Entrez Pub Med, Wiley Interscience, Ingenta Connect, Blackwell Synergy and more . . .
- Piperacillin-Tazobactam for Pseudomonas aeruginosa Infection: Clinical Implications of an extended- Infusion Dosing Strategy Clinical Infectious Diseases
- Clinical and Epidemiologic Characteristics Cannot Distinguish Community-Associated Methicillin- Resistant Staphylococcus aureus Infection from Methicillin-Susceptible S. aureus Infection: A Prospective InvestigationClinical Infectious Diseases
- An Outbreak in an Intensive Care Unit of a Strain of Methicillin-Resistant Staphylococcus aureus Sequence Type 239 Associated with an Increased Rate of Vascular Access DeviceRelated Bacteremia Clinical Infectious Diseases
- A Prospective Investigation of Outcomes after Hospital Discharge for Endemic, Community-Acquired Methicillin- Resistant and -Susceptible Staphylococcus aureus Skin InfectionClinical Infectious Diseases
- Reading the Tea Leaves or Deciphering DNA Microarrays: Are Certain Methicillin-Resistant Staphylococcus aureus Clones Adapted to Cause Specific Infections? Clinical Infectious Diseases
- Establishing Guidelines for Wounds Wound Repair and Regeneration
- A survey of approach to wound healing by secondary intention among British Society for Dermatological Surgery members British Journal of Dermatology
- Disseminated gonococcal infection presenting as vasculitis: a case report Journal of Clinical Pathology
- The effect of foot and ankle prosthetic components on braking and propulsive impulses during transtibial amputee gait Arch Phys Med Rehab
- Cosmetic reconstruction of distal finger absence with partial second toe transfer. British Journal of Plastic Surgery
- Are Ankle and Toe Brachial Indices (ABI-TBI) Obtained by a Pocket Doppler Interchangeable With Those Obtained by Standard Laboratory Equipment?JWOCN
- Tuberculosis of the Foot: A Rare Involvement in Osteoarticular Tuberculosis Journal of Clinical Rheumatology
- Foot Drop after Spinal Anesthesia in a Patient with a Low-Lying Cord:Case Reports Obstetric Anesthesia Digest
- The Contralateral Foot in Children With Unilateral Clubfoot: A Study of Pressures and Forces Involved in Gait Journal of Pediatric Orthopaedics
- The Diabetic Foot Diabetologia
- Troublesome Stress Fractures of the Foot and Ankle Sports Medicine and Arthroscopy Review
- Assessment of acute ankle sprain with os subfibularein children Journal of Pediatric Orthopaedics
- Functional reconstruction of Achilles tendon defects combined with overlaying skin defects using a free tensor fasciae latae flap British Journal of Plastic Surgery
- A Systematic Review on Ankle Injury and Ankle Sprain in Sports Sport Medicine
- Proximally placed alignment control strap for ankle varus deformity: a case report Arch Phy Med Rehab
- Evidence-based Approach to Treatment of Acute Traumatic Syndesmosis (High Ankle) Sprains Sports Medicine and Arthroscopy Review
- Needlestick Injuries to the Feet of Japanese Healthcare Workers: A Culture-Specific Exposure Risk Infection Control and Hospital Epidemiology
- The Unstable Posterior Heel Scar: Reconstruction Using the Reverse Sural Artery Adipofascial FlapAnnals of Plastic Surgery
The Foot Blog News this Week
The Foot Blog
- Leading Radiofrequency Manufacturer Introduces A New Product For Treating Heel Pain
- Childhood Obesity Linked To Foot Pain
- Developing Thought-Controlled Artificial Limbs: New Ideas From Penn Scientists
- A workout treat for the toes and feet
- Innocoll’s CollaRx cleared for phase 2 in the treatment of diabetic foot ulcers
- The rundown on foot injuries
- Safety fears over ‘wheelie shoes’
- Uganda: Keep Feet Clean to Avoid Odour
- Low-Dose Steroids Reduce Joint Damage From Rheumatoid Arthritis
- Medical Implants With An Antibiotic Coating
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.
© Podiatry Internet Communications (PICOMM)
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. 
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. 
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. 
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. 
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. 
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. 
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. “ 
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. 
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. 
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. 
All PICOMM publications will now offer RSS feeds for daily updates. You can learn more about RSS feeds here . . .
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. 
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). 
The bureau of labor statistics reports:
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?. 
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. 
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. 
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. 
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. 
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. 
