Background: Vaporous hyperoxia therapy (VHT), a patented US Food and Drug Administration 510 (k)–cleared technology, is an adjunct therapy used in conjunction with standard wound care (SWC). Vaporous hyperoxia therapy is said to improve the health of wounded tissue by administering a low-frequency, noncontact, nonthermal, ionic, antimicrobial hydrating mist alternating with concentrated topical oxygen therapy.
Methods: Vaporous hyperoxia therapy was used to treat 36 subjects with chronic diabetic foot ulcers (DFUs) that were previously treated unsuccessfully with SWC. The average age of DFUs in the study was 11 months and the average size was over 3 cm2. Wounds were Wagner grade 2 or 3 and most commonly on the plantar surface around the midfoot. Treatment consisted of twice-weekly applications of VHT and wound debridement. Subjects were followed to wound closure, 20 weeks, or 40 treatments, whichever came first.
Results: The combination of SWC and VHT in the group that met and maintained compliance throughout the study period achieved an 83% DFU closure rate within a 20-week period. The average time for DFU closure in this study was 9.4 weeks.
Conclusions: Historical analysis of SWC shows a 30.9% healing rate of all wounds, not differentiating chronic wounds. Accordingly, SWC/VHT increases chronic diabetic foot ulcer healing rates by 2.85 times compared with SWC alone. The purpose of this study was two-fold: first, to observe the effect of VHT on healing rates and time to healing in previously nonhealing DFUs; and second, to compare VHT with SWC, topical oxygen therapy, hyperbaric oxygen therapy, and ultrasound therapy.
Background: Historically, distal fifth metatarsal diaphyseal fractures have been treated with conservative management, with only limited research evaluating surgical treatment of these fractures. This study was performed to compare surgical versus conservative treatment of distal fifth metatarsal diaphyseal fractures in athletes and nonathletes.
Methods: A retrospective review of 53 patients with surgical or conservative treatment of isolated fifth metatarsal diaphyseal fractures was performed. Data recorded included age, sex, tobacco use, diagnosis of diabetes mellitus, time to clinical union, time to radiographic union, athletic versus nonathletic status, time to return to full activity, surgical fixation method, and complications.
Results: Patients treated surgically had a mean clinical union time of 8.2 weeks, radiographic union time of 13.5 weeks, and return to activity time of 12.9 weeks. Patients treated conservatively had a mean clinical union time of 16.3 weeks, radiographic union time of 25.2 weeks, and return to activity time of 20.7 weeks. Delayed unions and nonunions occurred in 27.0% of patients (10 of 37) treated conservatively and in none in the surgical group.
Conclusions: Surgical treatment significantly decreased time to radiographic union, clinical union, and return to activity by an average of 8 weeks compared with conservative treatment. We suggest that surgical treatment of distal fifth metatarsal fractures is a viable option that may significantly decrease the patient’s time to clinical union, radiographic union, and return to activity.
Background: Sinus tarsi syndrome is characterized by permanent pain on the anterolateral side of the ankle due to chronic inflammation characterized by fibrotic tissue remnants and synovitis accumulation after repeated traumatic injuries. Few studies have documented the outcome of injection treatments for sinus tarsi syndrome. We sought to determine the effects of corticosteroid and local anesthetic (CLA), platelet-rich plasma (PRP), and ozone injections on sinus tarsi syndrome.
Methods: Sixty patients with sinus tarsi syndrome were randomly divided into three treatment groups: CLA, PRP, and ozone injections. Outcome measures were visual analog scale, American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS), Foot Function Index, and Foot and Ankle Outcome Score before injection compared with 1, 3, and 6 months after injection.
Results: At the end of months 1, 3, and 6 after injection, significant improvements were observed in all three groups compared with baseline (P < .001 for all). At months 1 and 3, improvements in AOFAS scores were similar in the CLA and ozone groups; those in the PRP group were lower (P = .001 and P = .004, respectively). At month 1, improvements in Foot and Ankle Outcome Score were similar in the PRP and ozone groups and higher in the CLA group (P < .001). At 6-month follow-up, there were no significant differences in visual analog scale and Foot Function Index results among the groups (P > .05).
Conclusions: Ozone, CLA, or PRP injections could provide clinically significant functional improvement for at least 6 months in patients with sinus tarsi syndrome.
Background: Ankle joint dorsiflexion range of motion is essential to normal gait. Ankle equinus has been implicated in a number of foot and ankle pathologies included Achilles tendonitis, plantar fasciitis, ankle injury, forefoot pain, and foot ulceration. Reliable measurement of ankle joint dorsiflexion range of motion, both clinically and in a research setting, is important.
Methods: The primary aim of this study was to investigate the intertester reliability of an innovative device for measuring ankle joint dorsiflexion range of motion. A total of 31 (n = 31) participants volunteered to take part in this study. A paired t-test was performed to assess for systematic differences between the mean measures of each rater. Intertester reliability was evaluated using the intraclass correlation coefficient (ICC) and their 95% confidence intervals.
Results: A paired t-test demonstrated that the mean ankle joint dorsiflexion range of motion did not significantly differ between raters. The ankle joint ROM mean for rater 1 was 4.65 SD (3.71) and rater 2 was 4.67 SD (3.91). Intertester reliability for the use of the Dorsi-Meter was excellent and demonstrated a very narrow range of error. The ICC (95%CI) was 0.991 (0.980 to 0.995) the SEM (in degrees) was 0.07, the MDC95, in degrees was 0.19 and 95% LOA, degrees was –1.49 to 1.46.
Conclusions: We found the intertester reliability of the Dorsi-Meter to demonstrate higher levels of intertester reliability compared to previous studies investigating other devices. We reported the MDC values to provide an estimate of the smallest amount of change in the ankle joint dorsiflexion range of motion that must be achieved to reflect a true change, outside the error of the test. The Dorsi-Meter has been established as an appropriate reliable device to measure ankle joint dorsiflexion for clinicians and researchers with very small minimal detectable change and limits of agreement.
Eccrine poroma is a benign adnexal neoplasm often mistaken for pyogenic granuloma, skin tag, squamous cell carcinoma, and other soft-tissue tumors. We describe a 69-year-old woman with a soft-tissue mass on the lateral aspect of her right hallux that was initially clinically diagnosed as a pyogenic granuloma. Histologic examination proved that this mass was instead an eccrine poroma, the rare benign sweat gland tumor. This case exemplifies the importance of a broad differential diagnosis, especially regarding soft-tissue masses of the lower extremity.
Background: The purpose of this study was to evaluate the effectiveness of tap water iontophoresis as a treatment for plantar hyperhidrosis.
Methods: Thirty participants living with idiopathic plantar hyperhidrosis and consented to undergo treatment using iontophoresis were recruited. The Hyperhidrosis Disease Severity Score was used to evaluate the severity of the condition before and after treatment.
Results: Tap water iontophoresis was found to be effective in the treatment of plantar hyperhidrosis in the study group (P = .005).
Conclusions: Treatment with iontophoresis led to the reduction of disease severity and improvement of quality of life, and it is a safe, easy-to-use method with minimal side effects. This technique should be considered before the use of systemic or aggressive surgical interventions, which could have potentially more severe side effects.
People at risk for diabetic foot ulcer (DFU) often misunderstand why foot ulcers develop and what self-care strategies may help prevent them. The etiology of DFU is complex and difficult to communicate to patients, which may hinder effective self-care. Thus, we propose a simplified model of DFU etiology and prevention to aid communication with patients. The Fragile Feet & Trivial Trauma model focuses on two broad sets of risk factors: predisposing and precipitating. Predisposing risk factors (eg, neuropathy, angiopathy, and foot deformity) are usually lifelong and result in “fragile feet.” Precipitating risk factors are usually different forms of everyday trauma (eg, mechanical, thermal, and chemical) and can be summarized as “trivial trauma.” We suggest that the clinician consider discussing this model with their patient in three steps: 1) explain how a patient’s specific predisposing risk factors result in fragile feet for the rest of life, 2) explain how specific risk factors in a patient’s environment can be the trivial trauma that triggers development of a DFU, and 3) discuss and agree on with the patient measures to reduce the fragility of the feet (eg, vascular surgery) and prevent trivial trauma (eg, wear therapeutic footwear). By this, the model supports the communication of two essential messages: that patients may have a lifelong risk of ulceration but that there are health-care interventions and self-care practices that can reduce these risks. The Fragile Feet & Trivial Trauma model is a promising tool for aiding communication of foot ulcer etiology to patients. Future studies should investigate whether using the model results in improved patient understanding and self-care and, in turn, contributes to lower ulceration rates.
Background: We sought to evaluate clinicians’ compliance with national guidelines for tetanus vaccination prophylaxis in patients with high-risk feet.
Methods: We retrospectively evaluated 114 consecutive patients between June 1, 2011, and March 31, 2019, who presented to the emergency department with a foot infection resulting from a puncture injury. Eighty-three patients had diabetes mellitus and 31 patients did not have diabetes mellitus. Electronic medical records were used to collect a broad range of study data on patient demographics, medical history, tetanus immunization history and tetanus status on presentation to the emergency department, peripheral arterial disease, sensory neuropathy, laboratory values, and clinical/surgical outcomes.
Results: Of the 114 patients who presented to the emergency department with a puncture wound, 53 (46.5%) did not have up-to-date tetanus immunization. Of those patients, 79.2% received a tetanus-containing vaccine booster, 3.8% received intramuscular tetanus immunoglobulin, 3.8% received both a tetanus-containing vaccine booster and tetanus immunoglobulins, and 20.8% received no form of tetanus prophylaxis. Comparing data between patients with and without diabetes mellitus, there were no statistically significant differences in tetanus prophylaxis.
Conclusions: Guidelines for tetanus prophylaxis among high-risk podiatric medical patients in this study center are not followed in all patients. Patients with diabetes mellitus are at high risk for exposure to tetanus; therefore, we recommend that physicians take a detailed tetanus immunization history and vaccinate patients if the tetanus history is unclear.
Onychomycosis is the most common nail disorder, with a global prevalence of approximately 5.5%. It is difficult to cure on both short-term and long-term bases. The most common treatments include the use of oral or topical antifungals. Recurrent infections are common, and the use of systemic oral antifungals raises concerns of hepatotoxicity and drug-drug interactions, particularly in patients with polypharmacy. A number of device-based treatments have been developed for onychomycosis treatment, to either directly treat fungal infection or act as adjuvants to increase the efficacy of topical and oral agents. These device-based treatments have been increasing in popularity over the past several years, and include photodynamic therapy, iontophoresis, plasma, microwaves, ultrasound, nail drilling, and lasers. Some, such as photodynamic therapy, provide more direct treatment, whereas others, such as ultrasound and nail drilling, aid the uptake of traditional antifungals. We conducted a systematic literature search investigating the efficacy of these device-based treatment methods. From an initial result of 841 studies, 26 were deemed relevant to the use of device-based treatments of onychomycosis. This review examines these methods and provides insight into the state of clinical research for each. Many device-based treatments show promising results, but require more research to assess their true impact on onychomycosis.
