Issue 11:
Tuberculosis of the Foot: A case report
Podiatry Internet Journal
ORIGINAL ARTICLE: A case report discusses the presentation, diagnosis and treatment of a 22 year old male who presents with extra-pulmonary tuberculosis of the foot. Extra-pulmonary tuberculosis is extremely rare and accounts for less than 10% of osteoarticular tuberculosis. Radiographic and MRI correlations are introduced.
Subungual Osteochondroma or Exostosis Cartilaginea of the Hallux: A Case Report of Recurrent Bone Tumor One Year After Removal
Podiatry Internet Journal
ORIGINAL ARTICLE: Osteochondroma is the most common benign bone tumor of the foot. A case is presented of a teenage girl who returns after one year excision with recurrent bone tumor. We discuss etiology of this tumor and the diagnosis and treatment options. After initial excision, a revisional surgery was performed one year later that included more aggressive curettage of the recurrent osteochondroma with allogenic bone grafting using InterGro® DBM Plus.
Spontaneous Fracture of the Tibial Sesamoid: A case report
Podiatry Internet Journal
ORIGINAL ARTICLE: A female, while walking in an airport, experiences discomfort and pain under the first metatarsal head while wearing a high-heel shoe. Clinical investigation reveals a spontaneous fracture of the tibial sesamoid. The patient also has associated hallux valgus. Conservative treatment and surgical options are presented and discussed. The patient, after failed conservative treatment, had the sesamoid removed and a simple bunionectomy performed. It appears that a centrally placed tibial sesamoid with associated hallux valgus can cause a spontaneous fracture of the tibial sesamoid under the right circumstances.
Phlegmasia Cerulea Dolens: A case report
The New England Journal of Medicine
Original Article: An 85-year-old woman with newly diagnosed metastatic non–small-cell lung cancer was admitted for pain control. Two days after admission, bluish discoloration of the left great toe was noted. Doppler ultrasonography revealed a left femoropopliteal deep-vein thrombosis. Anticoagulation with heparin was initiated, but there was progressive swelling and cyanosis of the leg.
Flexor accessorius longus: A rare variation of the deep extrinsic digital flexors of the leg and its phylogenetic significance
Indiana Journal of Plastic Surgery
Original Article: Anomalies of the calf muscles are rare. One such anomalous muscle, known as the Muscle Flexor accessorius longus (also named accessorius ad accessorium, accessorius secondus, accessory flexor digitorum longus or pronator pedis) is of morphological significance. When present, this originates in the deep fascia of the tibia or fibula and inserts in the foot either into the flexor digitorum accessorius or into the tendons of the flexor digitorum longus. In this report we present a discussion of the morphological significance and phylogenetic history of one such muscle observed. In this case report we describe an anomalous calf muscle which extends from the popliteal region, runs along the posterior compartment of the leg, reaches the sole and is inserted to the flexor digitorum longus muscle. This kind of muscle variations are considered to be the higher origin of the flexor digitorum accessorius muscle of the sole. Here we discuss the phylogenetic history of this muscle as this muscle variant is present in some primitive mammals, absent in apes and in this particular case appeared as one of the muscles of the flexor compartment of the leg.
Podiatry Related Abstracts this Week
Entrez Pub Med, Wiley Interscience, Ingenta Connect, Blackwell Synergy and more . . .
- Parosteal lipoma associated with an underlying osteochondroma arising from the hallux Skeletal Radiology
- The effectiveness of wedge shoes in patients with insufficient vestibular compensation Auris Nasus Larynx
- Foot injuries in the sports populationCurrent Opinion in Orthopedics. 18 (2):97-101, March 2007. Farber, Daniel C
- The pes cavovarus foot: update on current advances Current Opinion in Orthopedics. 18(2):118-123, March 2007. Sizensky, Joseph A
- Fractures of the ankle and foot in the diabetic population Current Opinion in Orthopedics. 18(2):128-132, March 2007. Arangio, George A
The Foot Blog News this Week
The Foot Blog
Issue 6:
- Foot Pain Ruining Your Golf Swing?
- No More Orthopaedic Shoes? Orthopedists weigh- in on Flat Feet
- Traumatic Decision: To Amputate Or Salvage A Limb?
- Damage Control Orthopaedics: Patient Stabilization, Early Mobilization
- FDA Fast Tracks Medical Device Designed For U.S. Military
- FDA Accepts Two Supplemental New Drug Applications To Expand The U.S. Labeling For JANUVIA
- Serious Proliferation Of Multiresistant Staphylococcus In Intensive Care Units
Podiatry Internet Journal: Distinguished Contributions
Podiatry Management Letters
This marks the end of our 2nd month of the Podiatry Internet Journal. The journal now has 10 original articles published. Article highlights have been donated from the Department of Orthopedics at St. Stephen’s Hospital, Tiz Hazari, India and the Kaiser Permanente Foundation Department of Podiatric Surgery in Ohio. We hope to add more articles in the coming year from other distinguished programs.
© Podiatry Internet Communications (PICOMM)
ORIGINAL ARTICLE: Eumycetoma is a localized, chronic fungal infection of skin and subcutaneous tissues. It is characterized by tumefaction, abscess formation, draining sinuses, and sclerotia (grains) within the abscesses and fistulae. Treatment of eumycetoma is a challenge. Relapse rates are high even when a combination of surgical and medical approaches is utilized. Here we report a case of eumycetoma due to Exophiala jeanselmei arising on the foot of a man from Trinidad, West Indies. 
ORIGINAL ARTICLE: A 2005 article written in the American Family Physician deserves another look. Good article desribing diabetic neuropathy and its relation to various clinical disorders. Abstract: Diabetic neuropathy is a debilitating disorder that occurs in nearly 50 percent of patients with diabetes. It is a late finding in type 1 diabetes but can be an early finding in type 2 diabetes. The primary types of diabetic neuropathy are sensorimotor and autonomic. Patients may present with only one type of diabetic neuropathy or may develop combinations of neuropathies (e.g., distal symmetric polyneuropathy and autonomic neuropathy). Distal symmetric polyneuropathy is the most common form of diabetic neuropathy. Diabetic neuropathy also can cause motor deficits, silent cardiac ischemia, orthostatic hypotension, vasomotor instability, hyperhidrosis, gastroparesis, bladder dysfunction, and sexual dysfunction. Strict glycemic control and good daily foot care are key to preventing complications of diabetic neuropathy. (Am Fam Physician 2005;71:2123-8, 2129-30) 
ORIGINAL ARTICLE: The high glucose levels typically occurring among adults with type 2 diabetes contribute to blood vessel injury and complications such as blindness, kidney failure, heart disease, and stroke. Higher physical activity levels are associated with improved glycemic control, as measured by hemoglobin A1C. A 1 percent absolute increase in A1C is associated with an 18 percent increased risk for heart disease or stroke. Among Canadians with type 2 diabetes, we postulate that declines in walking associated with colder temperatures and inclement weather may contribute to annual post-winter increases in A1C levels. 
Original Article: A recent report prepared by the Oregon Evidence-based Practice Center for the AHRQ discusses the role and effectiveness of various NSAIDS, topical agents, over-the-counter medications and non-selective agents used in the treatment of osteoarthritis. This 100 page+ report is an ongoing study with planned future research. The report discusses benefits and harms of some of the most popular NSAIDS used to treat osteoarthritis. The most interesting aspect of this research is the comparative analysis in combined use of various NSAIDS and non- selective NSAIDS with aspirin and cox inhibitors. 
Original Article: The assessment of outcomes from the patients’ perspective becomes more recognized in health care. Also in patients with chronic ankle instability, the degree of present impairments, disabilities and participation problems should be documented from the perspective of the patient. The decision about which patient-assessed instrument is most appropriate for clinical practice should be based upon systematic reviews. Only rating scales constructed for patients with acute ligament injuries were systematically reviewed in the past. The aim of this study was to review systematically the clinimetric qualities of patient-assessed instruments designed for patients with chronic ankle instability. 
A letter by the PIJ was recently sent to PM magazine discussing our start-up for 2007. If you would like to read the submitted letter, just go the the letters section of the PM magazine website. 
ORIGINAL ARTICLE: A case of tarsal tunnel syndrome caused by an amyloidoma arising from the talocalcaneal joint in a 64-year-old man with a long history of haemodialysis. He presented with numbness in the medial plantar area of the right foot without any antecedent trauma. The numbness was minimal at rest but gradually worsened, causing difficulty, when walking. Paraesthesia was present on the medial sole of the right foot. A positive Tinel-like sign was noted 2.5 cm below the medial malleolus. Magnetic resonance imaging demonstrated a round lesion, 1 cm in diameter, in the calcaneus, which was hypointense on T1-weighted images and hyperintense on T2-weighted images. In addition, a mass, 1 cm in diameter with a signal isointense to that of muscle was found adjacent to the talocalcaneal joint. The medial plantar nerve was decompressed after removing a solid, 1-cm diameter mass from the talocalcaneal joint. At 6 months post surgery, the numbness had completely resolved. No recurrence was observed at the 24-month follow-up. 
ORIGINAL ARTICLE: A case report discusses the presentation, diagnosis and treatment of a 45 year old diabetic man with a divergent, Lisfranc’s dislocation of the first metatarsal in a Charcot foot. The patient also presents with associated laterally subluxed lesser metatarsals and multiple fractures. Conservative treatments such as TTC or total contact casting, prefabricated pneumatic walking brace (PPWB), patellar-tendon brace and CROW custom orthosis are discussed. 
ORIGINAL ARTICLE: Caring for patients with vascular illnesses has become increasingly more complex and has changed dramatically over the past 10 years, with a widening array of diagnostic and treatment options. Carotid artery stenting has the potential to become a viable alternative to open surgery in high-risk patients with carotid artery disease (i.e., patients older than 80 years and those with previous neck surgery or irradiation, contralateral carotid artery occlusion, contralateral laryngeal nerve injury, or angina). However, the effectiveness of carotid artery stenting as a therapy is still being evaluated in randomized trials. Endovascular aortic aneurysm repair is an option for patients who desire or require a less invasive modality and who have suitable aortic anatomy. Surgical reconstruction remains the standard treatment for ischemic rest pain and tissue loss (critical limb ischemia). Balloon angioplasty and stenting are treatment options for peripheral vascular disease, although treatment is dependent on the arterial segment or segments involved. (Am Fam Physician 2007;75:85-90). 
Original Article: Case presentations describing a congenital variation of palmoplantar keratosis (PPK) are presented. The majority of these conditions are autosomal dominant with associated nail dystrophy. A variant condition is described with little palmar keratosis; however, finger nail and toe nail dystrophy is the most common identifying feature. Gene identification and treatment protocol are presented. Fortunately, these conditions are rare. A good knowledge of these conditions will help in proper diagnosis and treatment. 
ORIGINAL ARTICLE: Osteochondritis dessicans of the ankle is a condition often encountered by the foot and ankle physician. Many treatments have been described in the literature including cast immobilization, arthroscopic debridement, open debridement, and autogenous grafting. The NEXA OsteoCure bone graft plug allows for immediate lesion excision while avoiding the morbidity associated with obtaining an autograft. The authors provide a brief review of talar dome lesions including staging and classification and their experience and technique involved for utilizing NEXA Orthopedics OsteoCure bone graft plugs. 
ORIGINAL ARTICLE: The incidence of Aneurysmal bone cysts (ABC’s) is rare. About 1% of all primary bone tumors constitute these lesions. They are most common in the upper extremity and rarely are reported in the foot. A case is presented reporting ABC of the middle cuneiform. To date, this appears to be the only documented case of ABC to the middle cuneiform. Surgical presentation and treatment using AlloMatrix ® bone putty as a moldable composite for an small, uncontained defect is described. 
ORIGINAL ARTICLE: Osteomyelitis is a challenging condition to treat in the foot. Although staphylococcal osteomyelitis has been more commonly reported, there appears to be an increasing emergence of streptococcal infections reported in the literature. Streptococcal infections can be much more virulent in their presentation and more difficult to treat. A case is presented describing streptococcal infection of bone in the fifth metatarsal head. A panel discussion includes current concepts on metatarsal resection and the appropriate time to close a surgical wound in the presence of osteomyelitis. Conclusions derived from this case study would support leaving a surgical wound open in the presence of osteomyelitis, especially in the presence of streptococcal organisms. 
Original Article: A 3-year-old girl presented with subungual hyperkeratosis and nail plates with increased transverse curvature, distal elevation, yellow-brown discoloration, and mild thickening. The changes, which affected all 20 nails, had developed during the first year of life. Mucocutaneous examination showed the presence of median rhomboid glossitis. The patient’s mother had similar nail changes, which had been present since infancy as well as a focal plantar keratoderma and hyperhidrosis. The patient’s clinical presentation and history were compatible with a diagnosis of pachyonychia congenita, a rare heritable disease that affects the nails, skin, oral and laryngeal mucosae, teeth, and hair. Dominant-negative mutations in four keratin genes (K6a, K6b, K16, and K17) lead to keratinocyte fragility and the resultant pachyonychia congenita phenotype. Successful targeted therapies are currently lacking for this oftentimes disabling disorder. Although oral manifestations are a common feature of PC, to our knowledge, this represents the first report of median rhomboid glossitis in association with PC. 
Original Article: A 38-year-old woman presented with widespread, hyperkeratotic papules and plaques that had been present since childhood. Her mother, brother, and son have similar lesions. A diagnosis of keratosis follicularis was made, which has been treated with isotretinoin. Palmoplantar lesions of keratosis follicularis have been described as discrete, punctate keratoses, hyperkeratotic papules, small pits, or keratin-filled depressions. This patient has an unusual palmoplantar keratoderma in association with keratosis follicularis. The lesions are elevated, discrete, filiform, hyperkeratotic spires, which coalesce into large, hyperkeratotic plaques on the palms and soles. 
This week, Podiatry Today on-line discusses 1) Can a high-low ratio help prevent amputation?, 2) Survey reveals impact of gout, 3) How to provide physical therapy as an ancillary service and 4) new products including negative pressure therapy.Other HMP open-access articles:
