Increasing amounts of diabetes-focused content is being posted to YouTube with little regulation as to the quality of the content. Diabetic education has been shown to reduce the risk of ulceration and amputation. YouTube is a frequently visited site for instructional and demonstrational videos posted by individuals, advertisers, companies, and health-care organizations. We sought to evaluate the usefulness of diabetic foot care video information on YouTube.
YouTube was queried using the keyword phrase diabetic foot care. Original videos in English, with audio, less than 10 min long within the first 100 video results were evaluated. Two reviewers classified each video as useful or nonuseful/misleading. A 14-point usefulness criteria checklist was used to further categorize videos as most useful, somewhat useful, or nonuseful/misleading. Video sources were categorized by user type, and additional video metrics were collected.
Of 87 included videos, 56 (64.4%), were classified as useful and 31 (35.6%) as nonuseful/misleading. A significant difference in the mean length of useful videos vs nonuseful/misleading videos was observed (3.33 versus 1.73 min; P < .0001). There was no significant difference in terms of popularity metrics (likes, views, subscriptions, etc) between useful and nonuseful/misleading videos.
This study demonstrates that although most diabetic foot care videos on YouTube are useful, many are still nonuseful/misleading. More concerning is the lack of difference in popularity between useful and nonuseful videos. Podiatric physicians should alert patients to possibly misleading information and offer a curated list of videos.
Background: A feasibility study was conducted to characterize the effects of noncontact low-frequency ultrasound therapy for chronic, recalcitrant lower-leg and foot ulcerations.
Methods: The study was an open-label, nonrandomized, baseline-controlled clinical case series. Patients were initially treated with the Mayo Clinic standard of care before the addition of or the switch to noncontact low-frequency ultrasound therapy. We analyzed the medical records of 51 patients (median ± SD age, 72 ± 15 years) with one or more of the following conditions: diabetes mellitus, neuropathy, limb ischemia, chronic renal insufficiency, venous disease, and inflammatory connective tissue disease. All of the patients had lower-extremity ulcers, 20% had a history of amputation, and 65% had diabetes. Of all the wounds, 63% had a multifactorial etiology, and 65% had associated transcutaneous oximetry levels below 30 mm Hg.
Results: The mean ± SD treatment time of wounds during the baseline standard of care control period versus the noncontact low-frequency ultrasound therapy period was 9.8 ± 5.5 weeks versus 5.5 ± 2.8 weeks (P < .0001). Initial and end measurements were recorded, and percent volume reduction of the wound was calculated. The mean ± SD percent volume reduction in the baseline standard of care control period versus the noncontact low-frequency ultrasound therapy period was 37.3% ± 18.6% versus 94.9% ± 9.8% (P < .0001).
Conclusions: Using noncontact low-frequency ultrasound improved the rate of healing and closure in recalcitrant lower-extremity ulcerations. (J Am Podiatr Med Assoc 97(2): 95–101, 2007)
Enchondroma is the most common benign cartilage bone tumor of the toes. In contrast, the foot is a rare region for chondrosarcoma, and the involvement of phalanges is extremely rare. In this article, we report an unusual case of intermediate chondrosarcoma involving the proximal phalanx of the great toe of a 52-year-old woman who was previously treated with curettage and bone grafting because of misinterpretation of enchondroma at a local hospital. She presented complaining of pain and swelling that she had experienced for a period of 1 year after the first operation. Radiography revealed a lytic lesion with a subtle punctuate calcification and endosteal scalloping in the proximal phalanx of the great toe. Gadolinium-enhanced magnetic resonance imaging confirmed soft-tissue involvement and cortical destruction. Staging evaluation with computed tomographic scan of the chest, abdomen, and pelvis was performed to ensure that there was no metastatic disease. Subsequently, a bone biopsy was performed, and the diagnosis was grade 2 chondrosarcoma. The patient was informed about the recurrence of the lesion and the clinical context on the basis of tumor biology of chondrosarcoma and was offered the option of either amputation or wide resection. She preferred the latter. The patient was treated with wide resection and underwent reconstruction with cement and Kirschner wire. She remains free of disease after 1 year of follow-up.
There is an increased prevalence of foot ulceration in patients with diabetes, leading to hospitalization. Early wound closure is necessary to prevent further infections and, ultimately, lower-limb amputations. There is no current evidence stating that an elevated preoperative hemoglobin A1c (HbA1c) level is a contraindication to skin grafting. The purpose of this review was to determine whether elevated HbA1c levels are a contraindication to the application of skin grafts in diabetic patients.
A retrospective review was performed of 53 consecutive patients who underwent split-thickness skin graft application to the lower extremity between January 1, 2012, and December 31, 2015. A uniform surgical technique was used across all of the patients. A comparison of HbA1c levels between failed and healed skin grafts was reviewed.
Of 43 surgical sites (41 patients) that met the inclusion criteria, 27 healed with greater than 90% graft take and 16 had a skin graft that failed. There was no statistically significant difference in HbA1c levels in the group that healed a skin graft compared with the group in which skin graft failed to adhere.
Preliminary data suggest that an elevated HbA1c level is not a contraindication to application of a skin graft. The benefits of early wound closure outweigh the risks of skin graft application in patients with diabetes.
The biomechanical effects of talectomy on the foot were investigated in seven fresh below-the-knee amputation specimens using pressure-sensitive films placed on the facets of the calcaneus, footprints, and loading-pattern diagrams in the intact foot and after talectomy with anterior and posterior displacement of the foot. Both talectomy techniques distorted the loads carried by the facets of the calcaneus. In the intact foot, 65.6% of the loads were carried by the posterior facet of the calcaneus and 34.4% by the anterior and middle facets. After talectomy with anterior displacement of the foot, although the loads carried by the anterior and middle facets decreased significantly (P = .018), the increase in the loads carried by the posterior facet was not significant compared with the intact foot (P = .176). Similarly, the loads carried by the posterior facet decreased significantly after talectomy with posterior displacement of the foot (P = .028), but the increases in the loads carried by the anterior and middle facets were not significant (P = .735). Comparing the two types of talectomy, the loads carried by each facet changed significantly (P = .018). Talectomy with posterior displacement of the foot also changed the loading patterns and resulted in significant pronation of the foot. These results suggest that talectomy should be performed only as a salvage procedure and that talectomy with anterior displacement of the foot may be preferred when talectomy is indicated. (J Am Podiatr Med Assoc 96(6): 495–498, 2006)
Foot infections are a common and serious problem in persons with diabetes. Diabetic foot infections (DFIs) typically begin in a wound, most often a neuropathic ulceration. While all wounds are colonized with microorganisms, the presence of infection is defined by ≥2 classic findings of inflammation or purulence. Infections are then classified into mild (superficial and limited in size and depth), moderate (deeper or more extensive), or severe (accompanied by systemic signs or metabolic perturbations). This classification system, along with a vascular assessment, helps determine which patients should be hospitalized, which may require special imaging procedures or surgical interventions, and which will require amputation. Most DFIs are polymicrobial, with aerobic gram-positive cocci (GPC), and especially staphylococci, the most common causative organisms. Aerobic gram-negative bacilli are frequently copathogens in infections that are chronic or follow antibiotic treatment, and obligate anaerobes may be copathogens in ischemic or necrotic wounds.
Wounds without evidence of soft tissue or bone infection do not require antibiotic therapy. For infected wounds, obtain a post-debridement specimen (preferably of tissue) for aerobic and anaerobic culture. Empiric antibiotic therapy can be narrowly targeted at GPC in many acutely infected patients, but those at risk for infection with antibiotic-resistant organisms or with chronic, previously treated, or severe infections usually require broader spectrum regimens. Imaging is helpful in most DFIs; plain radiographs may be sufficient, but magnetic resonance imaging is far more sensitive and specific. Osteomyelitis occurs in many diabetic patients with a foot wound and can be difficult to diagnose (optimally defined by bone culture and histology) and treat (often requiring surgical debridement or resection, and/or prolonged antibiotic therapy). Most DFIs require some surgical intervention, ranging from minor (debridement) to major (resection, amputation). Wounds must also be properly dressed and off-loaded of pressure, and patients need regular follow-up. An ischemic foot may require revascularization, and some nonresponding patients may benefit from selected adjunctive measures. Employing multidisciplinary foot teams improves outcomes. Clinicians and healthcare organizations should attempt to monitor, and thereby improve, their outcomes and processes in caring for DFIs.
Background: Plantar first metatarsal ulcerations pose a difficult challenge to clinicians. Etiologies vary and include first metatarsal declination, cavus foot deformity, equinus contracture, and hallux limitus/rigidus. Our pragmatic, sequential approach to the multiple contributing etiologies of increased plantar pressure sub–first metatarsal can be addressed through minimal skin incisions.
Methods: A retrospective review was performed for patients with surgically treated preulcerations or ulcerations sub–first metatarsal head. All of the patients underwent a dorsiflexory wedge osteotomy, and the need for each additional procedure was independently assessed. Equinus contracture was treated with Achilles tendon lengthening, cavovarus deformity was mitigated with Steindler stripping, and plantarflexed first ray was treated with dorsiflexory wedge osteotomy.
Results: Eight patients underwent our pragmatic, sequential approach for increased plantar pressure sub–first metatarsal, four with preoperative ulcerations and four with preoperative hyperkeratotic preulcerative lesions. The preoperative ulcerations were present for an average of 25.43 weeks (range, 6.00–72.86 weeks), with an average size of 0.19 cm3 (median, 0.04 cm3). Procedure breakdown was as follows: eight first metatarsal osteotomies, four Achilles tendon lengthenings, and six Steindler strippings. Postoperatively, all eight patients returned to full ambulation, and the four ulcerations healed at an average of 24 days (range, 15–38 days). New ulceration occurred in one patient, and postoperative infection occurred in one patient. There were no ulceration recurrences, dehiscence of surgical sites, or minor or major amputations.
Conclusions: The outcomes in patients surgically treated for increased plantar first metatarsal head pressure were evaluated. This case series demonstrates that our pragmatic, sequential approach yields positive results. In diabetic or high-risk patients, it is our treatment algorithm of choice for increased plantar first metatarsal pressure.
Foot ulcers are among the most serious complications of diabetes and can lead to amputation. Diabetic foot ulcers (DFUs) often fail to heal with standard wound care, thereby making new treatments necessary. This case series describes the addition of a dehydrated amniotic membrane allograft (DAMA) to standard care in unresolved DFUs.
This is a single-center retrospective chart review of eight patients who had one to three applications of DAMA to nine DFUs that had failed to resolve despite offloading, other standard care, and adjuvant therapies. Following initial DAMA placement, wound size (length, width, depth) was measured every 1 to 2 weeks until closure. The principal outcome assessed was mean time to wound closure; other outcomes included mean percent reduction from baseline in wound area and volume at weeks 2 to 8.
All wounds were closed a mean of 9.2 weeks after the first DAMA application (range, 3.0–13.5 weeks). Compared with baseline, wound area and volume, respectively, were reduced by a mean of 48% and 60% at week 2 and by 89% and 91% at week 8. Time to closure was shorter among four patients who had three DAMA applications (mean, 8.3 weeks; range, 4.0–11.0 weeks) than among three patients who had only one application (mean, 12.1 weeks; range, 9.5–13.5 weeks).
Chronic, unresolved DFUs treated with DAMA rapidly improved and reached closure in an average of 9.2 weeks. These cases suggest that DAMA can facilitate closure of DFUs that have failed to respond to standard treatments.
Background: We aim to share our popliteal sciatic nerve block (PSB) experience, which we applied to diabetic and nondiabetic patients in the operating room of our hospital.
Methods: The patients who underwent PSB for foot and ankle surgery between October 1, 2021, and December 31, 2021, in Sakarya University Training and Research Hospital were evaluated retrospectively. All nerve blocks were administered by a single anesthesiologist. Demographic data of the patients and the duration of the operation, the type of operation, the time of application of the nerve block, whether it was single or bifurcation block, and the onset times of motor and sensory block were also recorded in the perioperative period.
Results: It was determined that PSB was applied to 49 patients over a 3-month period. The mean age of the patients was 61.33 ± 14.03 years, and 12 patients (24.5%) were women. The reason why the patients were operated on was amputation in 21 (42.9%) and wound debridement in 27 (55.1%). There were 37 patients in the diabetic group and 12 patients in the nondiabetic group. There was no significant difference between the two groups in terms of demographic data and operation characteristics, but it was observed that there was a significant difference in both sensory and motor block formation times between the two groups (P < .001).
Conclusions: In conclusion, we think that popliteal sciatic nerve block is easy to apply, the complication rate is low, and it is a suitable anesthesia method for patients who will undergo day surgery for foot ulcer.
Background: More than half of opioid misusers last obtained opioids from a friend or relative, a problematic reflection of the commonly known opioid reservoir maintained by variable prescription rates and, notably, excessive postoperative prescription. We examined the postoperative opioid-prescribing approaches among podiatric physicians.
Methods: We administered a scenario-based, anonymous, online questionnaire via an online survey platform. The questionnaire consisted of five patient–foot surgery scenarios aimed at discerning opioid-prescribing approaches. Respondents were asked how many opioid “pills” (dosage units) that they would prescribe at the time of surgery. We divided respondents into two opioid-prescribing approach groups: one-size-fits-all (prescribed the same dosage units regardless of the scenario) and patient-centric and procedure-focused (prescribed varied amounts of opioid dosage units based on the patient’s opioid history and the procedure provided in each scenario). We used the Mann-Whitney U test to determine the difference between the opioid dosage units prescribed at the time of surgery by the two groups.
Results: Approximately half of the respondents used a one-size-fits-all postoperative opioid-prescribing approach. Podiatric physicians who used a patient-centric and procedure-focused approach reported prescribing significantly fewer opioid dosage units in scenarios 1 (partial toe amputation; –9.1; P = .0087) and 2 (incision and drainage with partial fifth-ray resection; –12.3; P = .0024), which represented minor procedures with opioid-naive patients.
Conclusions: Podiatric physicians who used a one-size-fits-all opioid-prescribing approach prescribed more postoperative opioid dosage units regardless of the scenario. Given that the patient population requiring foot surgery is diverse and may have multiple comorbidities, the management of postoperative pain, likewise, should be diverse and nuanced. The patient-centric and procedure-focused approach is suited to limit excess prescribing while defending the physician-patient relationship.