Acroangiodermatitis
Dermatology Online Journal
ORIGINAL ARTICLE: A 26-year-old man with a history of chronic primary lymphedema of the left lower extremity presented with elephantiasis, confluent, violaceous, mascerated plaques, and ulcers on the dorsal aspects of the toes of the left foot. Histopathologic examination showed a proliferation of small blood vessels associated with extravasated erythrocytes and hemosiderin deposits consistent with the diagnosis of acroangiodermatitis. Treatment of the focal ulcers includes compression therapy, local wound care, and surgical elimination of the shunt if there is an associated arteriovenous malformation.
An unusual cause for chronic foot pain
Annals of Indian Academy of Neurology 
ORIGINAL ARTICLE:A 68-year-old man presented with severe shooting, lancinating pain over the medial half of sole of his right foot. He was suffering from this symptom for the last seven years. Occasionally the pain radiated upwards along the posterior aspect of the leg. There was severe nocturnal aggravation of pain interrupting his sleep.
Expert agreement confirms that negative changes in hand and foot radiographs are a surrogate for repair in patients with rheumatoid arthritis
Arthritis Research & Therapy
ORIGINAL ARTICLE: The objective of the studies was to test the hypothesis that experts recognize repair of erosions and, if so, determine which if any morphologic features permitted them to recognize repair. We also tested whether scoring by a standard method detected repair. Seven experienced readers of radiographs in RA were presented 64 sets of single joints-of-interest at two time points, randomized and blinded for correct sequence. They assessed which joint was better, and recorded whether any of six specific features were seen. Afterwards, two independent readers experienced in scoring by the van der Heijde-modified Sharp method who were not on the expert panel, scored the complete films that included the joint-of-interest. The panel agreed very well on which of two joints was better, and, even though they did not know the true sequence, accurately assigned a sequence slightly better than chance alone (58%) but worse than their agreement on which image was “better or worse” (78%). Therefore the readers indirectly assigned repair by choosing the second film as the best. Putative repair features were seen in cases of both repair and progression, and were not discriminatory. Similar results were obtained when the experts were presented with the entire hand or foot containing the joint-of-interest. In the third repair exercise two independent readers who scored whole hands and feet using a standard method found a mean negative score in 22/60 joints-of-interest. All 22 joints were also scored as repair by the panel. In conclusion, repair was detected reliably by a majority of the panel on viewing paired images based on a better/worse decision and assigning sequence in a set of images that were blinded for sequence by an independent project manager. In this test set of images repair was manifested by a reduction in the size of an erosion in many cases and size was one feature that aided the experts to detect repair but cannot be the only one; the experts had to find other features to tell whether a smaller erosion was the first in a sequence of radiographs in a patient with progressive damage or the second film in a patient exhibiting repair. Change in size of erosion, also was picked up by independent readers applying the van der Heijde-modified Sharp scoring method and was reflected in their scores.
Arthritis and pain. Current approaches in the treatment of arthritic pain
Arthritis Research & Therapy
ORIGINAL ARTICLE: Current evidence suggests that although persistent arthritic pain is initiated and maintained by articular pathology, it is also heavily influenced by a range of other factors. Strategies for treating arthritic pain are therefore different from those adopted for acute pain. Although published guidelines offer general assistance, the complexity of underlying mechanisms requires that measures designed to relieve pain must take into account individual biological, psychological and societal factors. It follows that a combination of both pharmacological and non-pharmacological approaches offers the best opportunity for therapeutic success, although determining the effectiveness of such complex interventions remains difficult. Pharmacological therapy is often prolonged, and safety and tolerability issues become as important as efficacy over time. This article reviews mechanisms of pain including pain classification, arthritic pain, general approaches to pain management including its clinical guidelines and educational and behavioral changes. It also discusses the latest pharmacological therapies and additional therapies such as topical NSAIDS, steroidal joint injections, acupunture and transcutaneous electrical stimulation.
Podiatry Today ENews
Podiatry Today-July 2007
Harkless Heads up New Podiatry School
By Brian McCurdy, Senior Editor The podiatry profession will welcome its ninth collee under the leadership of a DPM with decades of experience in education. Western University of Health Sciences School of Podiatric Medicine will start classes in 2009 under the helm of Lawrence Harkless, DPM. At the Western University Health Sciences Center School of Podiatric Medicine, which will start classes in 2009, Lawrence Harkless, DPM, says he wants to integrate podiatry further into the medical environment.
New Advances In Predicting Wound Healing
By Stephanie C. Wu, DPM
With the preponderance of wounds and the cost of chronic wound healing continuing to soar, this author offers a provocative look at emerging innovations such as medical hyperspectral technology and real-time polymerase chain reaction that may reinvent the diagnostic workup of chronic wounds.
Can Maggot Debridement Help Treat Wounds With MRSA?
By Brian McCurdy, Senior Editor
For ages, doctors have used biological debridement in wound care. Can such treatment be effective against the rising tide of methicillin resistant Staphylococcus aureus (MRSA)? A recent study in Diabetes Care has demonstrated the efficacy of maggot debridement in wounds with MRSA.
Wound Care Q&A: Expert Pointers On Negative Pressure Wound Therapy
Clinical Editor: Lawrence Karlock, DPM
Given the increasing use of negative pressure wound therapy (NPWT) to spur wound healing, our expert panelists return for the second part of this Q&A discussion on NPWT (see “Inside Insights On Negative Pressure Wound Therapy,” page 24, May issue). They offer specific pearls on the use of NPWT, how to combine the modality with skin grafts and silver dressings, and tips for avoiding wound maceration.
The Foot Blog News
The Foot Blog
Issue 19-July 2007:
- Alcohol Injections For Common Cause Of Foot Pain Highly Successful, Study Proves
- European Medicines Agency Recommends Restricted Use For Piroxicam
- US trampoline injuries on the rise
- Lost Orthopedic Screws Found by Medical Metal Detector
- Diabetes and Wounds: Caring for Sores
- Largest National U.S. Healthcare Facility MRSA Study Reveals Infection Rates Eight Times Greater Than Previous Estimates
- Motion Analysis Helps Teen With Cerebral Palsy Regain Ability To Walk
- Generic Lamisil Tablets, Cream Approved
- Blood Thinner Rescues Frostbitten Fingers And Toes
- New Dynamic Brace Developed To Advance Clubfoot Treatment
Podiatry Related Abstracts
Entrez Pub Med, Wiley Interscience, Ingenta Connect, Blackwell Synergy and more . . .
A review of a bi-layered living cell treatment (Apligraf®) in the treatment of venous leg ulcers and diabetic foot ulcersDove Med Press
Crossover Replantation of the Foot After Bilateral Traumatic Lower Extremity Amputation. Annals Plastic Surg
Spontaneous Tibialis Anterior Tendon Rupture: A rare cause of Foot DropNeurology
Treatment of long-standing, poor- healing diabetic foot ulcers with topical negative pressure in the Torres StraitAust J Rural Health
Reduction of the Incidence of Amputation in Frostbite Injury With Thrombolytic TherapyArch Surg
High-resolution ultrasonography of the first metatarsal phalangeal joint in gout: a controlled studyAnnals Rheum Diseases
Effects of foot care intervention including nail drilling combined with topical antifungal application in diabetic patients with onychomycosisThe J of Dermatology
A New Dynamic Foot Abduction Orthosis for Clubfoot Treatment. J of Ped Ortho
© Podiatry Internet Communications (PICOMM)
ORIGINAL ARTICLE: Salter Harris Type II ankle injuries are reviewed in 10 cases. Potential premature physeal closure (PPC) is a real complication in most open reductions of this fracture. In this study, closed reduction offered the best clinical outcomes with no evidence of premature physeal closure. Restoring the congruency of the physeal plate is imperative in preventing long term complications such as talar tilts, post traumatic ankle stiffness and other angular and limb-length discrepancies. 
ORIGINAL ARTICLE:A case report is presented describing clear cell sarcoma of the foot (Malignant melanoma of soft parts). Melanoma is most commonly associated with pigmented lesions and nodules of the skin. Clear cell sarcoma (CCS) is an anaplastic tumor consisting of cells derived from melanoblasts not forming melanin in the skin, but rather mitotic changes more consistent with malignant melanoma in subcutaneous tissue, tendons and aponeurosis. The tumor is very rare and can pose clinical challenges in early diagnosis since the tumor lacks pigment and obvious color changes and can clinically appear as a benign, soft tissue tumor. A case report including surgical excision, histologic features and survival prognosis is presented. 
ORIGINAL ARTICLE: Chronic diabetic patients with wounds have deficient growth factors and impaired local and systemic cellular immunity. Treatment with growth factors is expensive with risk of infection transmission, and these factors may not achieve optimum wound concentration. We evaluated the role of generalized immunomodulation in diabetic ulcers by using Tinospora cordifolia as an adjuvant therapy and studied its influence on parameters/determinants of healing, on bacterial eradication and on polymorphonuclear phagocytosis. A prospective double-blind randomized controlled study lasting for over 18 months in 50 patients. The ulcer was classified by wound morphology and severity with Wound Severity Score (Pecoraro-Reiber system). Mean ulcer area, depth and perimeter were measured and swabs taken for culture. Blood was collected to assess polymorphonuclear % phagocytosis (PMN function by Lehrer-Cline C. albicans method). Medical therapy, glycemic control, debridement, wound care were optimized. At 4 weeks, parameters were reassessed. PMN function was reviewed at 3 months. 
ORIGINAL ARTICLE: Open wounds present unique clinical problems for the reconstructive surgeon. Skin wounds contract by stretching the surrounding skin to close the defect and not by the production of new skin. In areas subjected to significant skin loss exceeding the available supply, especially in burns, wound coverage becomes a challenge. In such situations many options for coverage including dressing materials ranging from nonbiological to biological products exist, [1],[2] but the current gold standard remains coverage by patient’s own skin. Over the years, coverage after excision by cultured epidermal autografts (CEA) has become an established and standardized method practiced in several centers worldwide. [3],[4] Today, from a single biopsy measuring 2×3 cm, enough keratinocytes can be cultivated to cover the entire body of an adult in three to four weeks. Currently, use of skin culture and substitutes, though quite prevalent around the world has surprisingly not been developed enough and practiced in Indian plastic surgery and burn units. At this time to the best of our knowledge, it is limited to a handful of select centers. We would like to share our early experience with epidermal culture of skin in close collaboration with a state-of-the-art tissue culture laboratory with an aim to benefit our colleagues and their patients with difficult wounds. 
