Background: Debridement of toenails is a common procedure that leads to the production of nail dust aerosols in the work environment. Previous studies indicate that inhaled nail dust can cause respiratory distress and eye irritation. This comprehensive review aimed to assess the available literature on the effect of nail dust exposure and to evaluate nail dust as a potential occupational hazard for podiatric physicians.
Methods: A comprehensive literature search was conducted via PubMed, Google Scholar, CINAHL, Cochrane Library, and ClinicalTrials.gov. Risks of bias of the collected studies were evaluated using various assessment tools to match the type of study design. A qualitative analysis of the included studies was performed, from which primary and secondary outcome measures were extracted: prevalence of symptoms and specific microorganisms in nail dust.
Results: Of 403 articles screened, eight met the inclusion criteria. The primary outcome measure resulted in a pooled prevalence of eye-related symptoms being the most consistent symptom reported (41%–48%). The secondary outcome measure resulted in a pooled prevalence of Trichophyton rubrum (9.52%–38%) and Aspergillus (11.11%–35.48%) as the most common microorganisms present in nail dust.
Conclusions: From the included eight articles, we found that nail dust is a potential occupational hazard, especially for those exposed more often. Aspergillus and T rubrum are most commonly associated with nail dust leading to development of respiratory illness. It is important to take preventive measures in podiatric medical clinics by using improved and efficient personal protective equipment for workers exposed to nail dust. Detailed health safety guidelines can be developed to decrease respiratory symptoms and diseases from nail dust exposure.
Background: Transmetatarsal amputations are limb salvage surgical procedures that preserve limb length and functional ankle joints. Indications for transmetatarsal amputations include forefoot trauma, infection, and ischemia. Prior research demonstrates patients who undergo transmetatarsal amputations have a lower 2-year mortality rate compared to those who undergo more proximal amputations. The aim of this study was to determine whether primary closure of a transmetatarsal amputation is a superior treatment compared to secondary healing of a transmetatarsal amputation for forefoot abnormality of infection, gangrene, or chronic ulceration.
Methods: A retrospective chart review was performed on patients aged 18 years or older requiring a transmetatarsal amputation because of forefoot abnormality between September of 2011 and December of 2019. Foot and ankle surgeons performed transmetatarsal amputations. Outcome variables measured included healing time of transmetatarsal amputation site, recurrent infection, recurrent gangrene, and the need for revision surgery or higher level amputations.
Results: Of the original 112 patients, 76 met the inclusion criteria; 47 of these had primary closure of transmetatarsal amputation and 29 of these had an open transmetatarsal amputation performed. Primarily closed transmetatarsal amputations resulted in a significantly greater overall healing rate of 78.8% (37 of 47) compared to open transmetatarsal amputations, with a healing rate of 37.9% (11 of 29) (P < .01). Closed transmetatarsal amputations were statistically significantly less likely than open transmetatarsal amputations to have recurrent gangrene, require revision pedal operations, or progress to higher level amputations.
Conclusions: Our research demonstrated that primary closure of transmetatarsal amputations is a superior treatment compared with secondary healing of transmetatarsal amputations in specific cases of infection, dry gangrene, or chronically nonhealing ulcerations.
Phlegmons are unencapsulated collections of inflammation that track along soft tissues in various parts of the human body. These soft-tissue lesions are uncommon in the lower extremities and can be difficult to identify and treat. This article presents a case of a plantar foot phlegmon in a nondiabetic patient that was recalcitrant to debridement and antibiotics. The patient’s aseptic phlegmon completely resolved with surgical debridement and iodoform packing. This case report demonstrates the role of advanced imaging in the diagnosis of lower-extremity phlegmons and the importance of thorough surgical debridement and packing for successful resolution.
Background: Many surgical techniques have been reported for the treatment of ingrown toenails. Occurrences of infection after matricectomy procedures could cause clinicians to prefer using external braces to treat ingrown toenails. This study compares patients with ingrown toenails who underwent the nail fixation technique and the Winograd technique.
Methods: Patients who underwent ingrown toenail surgery were retrospectively reviewed. The patients’ demographic characteristics (age, gender, body mass index [BMI] morphology according to Heifetz classification, surgical technique, visual analog scale (VAS) values, time to return to daily activities (days), complications, and satisfaction levels were all recorded.
Results: Seventy patients were included in the study. Of the patients, 33 underwent nail fixation and 37 underwent the Winograd technique. No significant statistical differences were found in terms of patients’ age, gender, BMI, preoperative clinical features, long-term satisfaction, and ingrown toenail recurrence rates between the two groups, but time to return to daily activities and VAS values were statistically significantly lower in patients treated using nail fixation compared with the Winograd technique.
Conclusion: Nail fixation can be an effective surgical treatment option for an ingrown toenail.
Background: Although tarsal coalition represents the most common cause of peroneal spastic flatfoot, its existence cannot be verified in several cases. In some patients with rigid flatfoot, no cause can be detected after clinical, laboratory, and radiologic examination, and the condition is called idiopathic peroneal spastic flatfoot (IPSF). This study aimed to present our experience with surgical management and outcomes in patients with IPSF.
Methods: Seven patients with an IPSF, who were operated on between 2016 and 2019, and followed for at least 12 months were included, whereas those with known etiologies, such as tarsal coalition or other etiologies (traumatic, etc.) were excluded. All patients were followed up for 3 months with botulinum toxin injection and cast immobilization as a routine protocol, and clinical improvement was not achieved. The Evans procedure and grafting with tricortical iliac crest bone graft in 5 patients and subtalar arthrodesis in 2 patients were performed. The American Orthopaedic Foot and Ankle Society ankle-hindfoot scale scores (AOFAS) and Foot & Ankle Disability Index (FADI) scores were obtained pre- and postoperatively from all patients.
Results: In physical examination, all feet manifested by rigid pes planus with varying degrees of hindfoot valgus and limited subtalar motion. Overall, the mean AOFAS and FADI scores significantly increased from 42 (range = 20-76) and 45 (range, 19-68) preoperatively (p = 0.018) to 85 (range = 67-97) and 84 (range, 67-99) (p = 0.043) at the final follow-up, respectively. No major intra- or post-operative complications were observed in any of the patients. All CT and MRI scans revealed no evidence of tarsal coalitions in any of the feet. All radiological workups failed to demonstrate secondary signs of fibrous or cartilaginous coalitions.
Conclusion: Operative treatment seems to be a good option in the treatment of patients with IPSF who do not benefit from conservative treatment. In the future, it is recommended to investigate the ideal treatment options for this group of patients.
Background: Digital deformities represent a common presenting pathology and target for surgical intervention in podiatric medicine and surgery. The objective of this investigation was to compare the radiographic width of the heads of the lesser digit proximal phalanges.
Methods: One hundred and fifty consecutive feet with a diagnosis of digital deformity and performance of weight-bearing radiographs were analyzed. The maximum width of the heads of the lesser digit proximal phalanges were recorded from the radiographs utilizing computerized digital software.
Results: The mean±standard deviation (range) of the head of the second digit proximal phalanx was 9.74±0.87 mm (7.94-11.78), of the head of the third digit proximal phalanx was 9.00±0.91 mm (7.27-10.94), of the head of the fourth digit proximal phalanx was 8.49±1.01 mm (5.57-10.73), and of the head of the fifth digit proximal phalanx was 8.67±0.89 mm (6.50-11.75). The width of the head of the proximal phalanx decreased from the second digit to the third digit (p<0.001), decreased from the third digit to the fourth digit (p<0.001), and then increased from the fourth digit to the fifth digit (p=0.032).
Conclusions: The results of this investigation provide evidence in support of an anatomic and structural contribution to digital deformities. The width of the heads of the lesser digit proximal phalanges decreased from the second to the third to the fourth toes, and then subsequently increased with the fifth proximal phalangeal head.
Background: The objective of this investigation was to evaluate adverse short-term outcomes following partial forefoot amputation with a specific comparison performed based on subject height.
Methods: The American College of Surgeons National Surgical Quality Improvement Program database was analyzed to select those subjects with a 28805 CPT code (amputation, foot; transmetatarsal) that underwent the procedure with “all layers of incision (deep and superficial) fully closed.” This resulted in 11 subjects with a height ≤60 inches, 202 subjects with a height >60 inches and <72 inches, and 55 subjects ≥72 inches.
Results: Results of the primary outcome measures found no significant differences between groups with respect to the development of a superficial surgical site infection (0.0% vs. 6.4% vs. 5.5%; p=0.669), deep incisional infection (9.1% vs. 3.5% vs. 10.9%; p=0.076), or wound disruption (0.0% vs. 5.4% vs. 5.5%; p=0.730). Additionally, no significant differences were observed between groups with respect to unplanned reoperations (9.1% vs. 16.8% vs. 12.7%; p=0.0630) or unplanned hospital readmissions (45.5% vs. 23.3% vs. 20.0%; p=0.190).
Conclusions: The results of this investigation demonstrate no difference in short-term adverse outcomes following the performance of partial forefoot amputation with primary closure based on subject height. Although height has previously been described as a potential risk factor in the development of lower extremity pathogenesis, this finding was not observed in this study from a large US database.
Background: The objective of this investigation was to evaluate adverse short-term outcomes following open lower extremity bypass surgery in subjects with diabetes mellitus with a specific comparison performed based on subject height.
Methods: The American College of Surgeons National Surgical Quality Improvement Program database was analyzed to select those subjects with CPT codes 35533, 35540, 35556, 35558, 35565, 35566, 35570 and 35571 and with the diagnosis of diabetes mellitus. This resulted in 83 subjects ≤60 inches, 1084 subjects >60 inches and <72 inches, and 211 subjects ≥72 inches.
Results: No differences were observed between groups with respect to the development of a superficial surgical site infection (9.6% vs. vs. 6.4% vs. 5.7%; p=0.458), deep incisional infection (1.2% vs. 1.4% vs. 2.8%; p=0.289), sepsis (2.4% vs. 2.0% vs. 2.8%; p=0.751), unplanned reoperation (19.3% vs. 15.6% vs. 21.8%; p=0.071), nor unplanned hospital readmission (19.3% vs. 14.8% vs. 17.1%; p=0.573). A significant difference was observed between groups with respect to the development of a wound disruption (4.8% vs. 1.3% vs. 4.7%; p=0.001). A multivariate regression analysis was performed of the wound disruption outcome with the age, gender, race, ethnicity, height, weight, current smoker and open wound/wound infection variables. Race (p=0.025) and weight (p=0.003) were found to be independently associated with wound disruption, but height was not (p=0.701).
Conclusions: The results of this investigation demonstrate no significant difference in short-term adverse outcomes following the performance of lower extremity bypass surgery based on patient height.
Background: The effectiveness of different energy levels used in extracorporeal shockwave therapy (ESWT) have been investigated in previous studies, but controversy remains regarding which energy levels should be used in the treatment of plantar fasciitis. The objective of this study was to compare the efficacy of different energy levels used in ESWT in the treatment of plantar fasciitis through comparisons of plantar fascia thickness and pressure distribution.
Methods: Between July 2020 and September 2020, a total of 51 patients (71 feet) with plantar fasciitis were randomized into three treatment groups using the sealed envelope method. Group 1 (n = 25) received low energy density (0.09 mJ/mm2 ), Group 2 (n = 25) received medium energy density (0.18 mJ/mm2), and Group 3 (n = 21) received high energy density (0.38 mJ/mm2). All groups received three sessions of ESWT with a frequency of 2,000 shocks/min at one week intervals. The patients were evaluated before and after treatment using a visual analog scale (VAS) for pain, the Foot Function Index (FFI), and plantar fascia thickness measured by ultrasonography, and plantar pressure distribution.
Results: The posttreatment VAS and FFI scores were determined to be statistically significantly lower than the pretreatment values in all three groups (p<0.001). There was no significant difference between the groups in terms of the pre and post treatment values of VAS, FFI scores, plantar fascia thickness and pressure distribution (p>0.05). No statistically significant difference was found between the groups in terms of percentage changes in all the outcome parameters (p>0.05).
Conclusions: The results of the study suggest that neither low, medium, or high levels of ESWT were superior to one another in terms of pain, foot functions, fascia thickness and pressure distribution in the treatment of plantar fasciitis.
Background: The aim of this study was to investigate the relationship between the radiographic
bone morphology of the ankle and the observed fracture type.
Methods: We retrospectively reviewed the patients who had visited our emergency department with ankle injuries between June 2012 and July 2018. All patients were treated with open reduction and internal fixation. Patients were categorized in two groups based on the fracture patterns (groups 1 and 2). Group 1 consisted of isolated lateral malleolar fractures, while group 2 comprised bimalleolar fractures. Group 1 was further divided into two groups; namely group A and B based on their classification into Weber type B and C fractures, respectively. Four radiographic parameters were measured postoperatively by standing whole-leg anteroposterior view of the ankle; talocrural angle (TCA), medial malleolar relative length (MMRL), lateral malleolar relative length (LMRL), and the distance between the talar dome and distal fibula.
Results: One hundred and seventeen patients were included in group 1-A, 89 patients in group 1-B, and 168 patients in group 2. The values of TCA and MMRL were significantly higher in group 2 than in group 1. Lateral malleolar length/medial malleolar length ratio was also significantly different between the two groups. However, there were no significant differences between the groups in terms of LMRL and the distance between the tip of the distal fibula and talar process. LMLR and MMRL values between groups A and B were not significantly different (p=0.402 and p=0.592, respectively). However, there was a significant difference between the two groups in terms of TCA and the distance between the tip of the distal fibula and talar process.
Conclusions: The talocrural angle, medial malleolar relative length, and lateral malleolar length/medial malleolar length were significantly higher in patients with bimalleolar fracture than in patients with isolated lateral malleolar fractures.