The surgical records of three podiatric physicians were reviewed to identify all chevron-type osteotomies performed during 2000–2001 for the correction of bunion deformity, and complications were reviewed for each. In the 95 cases identified, 15 complications occurred in 12 patients. Of these 15 complications, 4 were soft-tissue infections (4 patients), 4 were cases of painful hardware (3 patients), 4 were cases of second metatarsal head pain (2 patients), 2 were cases of cystic changes initially interpreted as osteomyelitis but later determined to be degenerative changes (2 patients), and 1 was a case of stiff toe (1 patient). There were no cases of avascular necrosis, hallux varus, or recurrence. (J Am Podiatr Med Assoc 93(6): 499-502, 2003)
The causes of late-onset pain after total ankle replacement (TAR) are various, and include infection, subsidence, polyethylene spacer failure, osteolysis, and wear. There are few reports of late-onset pain caused by gouty attacks after total knee and hip arthroplasty. In addition, no research has reported gouty attacks after total ankle arthroplasty. Therefore, we report a case of a gouty attack after total ankle replacement. A 43-year-old man presented with pain after total ankle arthroplasty performed 5 years previously. We found a white-yellow crystalline deposit within the synovial tissue during ankle arthroscopy, confirmed by histologic examination.
Background: Ingrowing toenail is a common condition treated by general surgeons. Our aim was to analyze the effectiveness of wedge resection with phenolization in the surgical treatment of ingrowing toenails.
Methods: We retrospectively audited 100 patients who underwent wedge resection with phenolization for the treatment of ingrowing toenail between January 2000 and June 2004 by a single surgeon. We reviewed all charts and attempted to contact all patients for a telephone interview to assess patient satisfaction. Outcome measures were: 1) recurrence rate, 2) duration of analgesic use, 3) postoperative complications including wound infection, 4) time to return to normal activities, and 5) satisfaction with the procedure.
Results: A total of 168 wedge resection with phenolization procedures were performed on 100 patients. There was only one recurrence (0.6%). Two patients (2%) had wound infection and were treated with oral antibiotics. The average time for a single wedge resection with phenolization procedure was 7.3 minutes. The mean time to return to normal activities was 2.1 weeks. The patient response rate for the telephone interview was 60%. Most respondents (93.3%) were satisfied with the overall outcome.
Conclusions: Wedge resection with phenolization is a very effective mode of therapy in the surgical treatment of ingrowing toenail, with a very low recurrence rate and minimal postoperative morbidity. Wedge resection with phenolization should be considered as a good alternative technique in the treatment of ingrowing toenail. (J Am Podiatr Med Assoc 98(2): 118–122, 2008)
The coronavirus disease of 2019 pandemic is driving significant change in the health-care system and disrupting the best practices for diabetic limb preservation, leaving large numbers of patients without care. Patients with diabetes and foot ulcers are at increased risk for infections, hospitalization, amputations, and death. Podiatric care is associated with fewer diabetes-related amputations, emergency room visits, hospitalizations, length-of-stay, and costs. However, podiatrists must mobilize and adopt the new paradigm of shifts away from hospital care to community-based care. Implementing the proposed Pandemic Diabetic Foot Triage System, in-home visits, higher acuity office visits, telemedicine, and remote patient monitoring can help podiatrists manage patients while reducing the coronavirus disease of 2019 risk. The goal of podiatrists during the pandemic is to reduce the burden on the health-care system by keeping diabetic foot and wound patients safe, functional, and at home.
Management of Grade III Open Dislocated Ankle Fractures
Combined Internal Fixation with Bioabsorbable Screws/Rods and External Fixation
Isolated dislocation of the ankle with grade III open fracture has been scarcely reported. These ankle injuries usually involved mortise fractures, complete dislocation of the tibial astragaloid joint, capsuloligamentous structure disruption, and severe soft-tissue damage. There is no well-recognized regimen that would result in desirable outcomes.
Sixteen patients with grade III open dislocated ankle fractures were treated immediately with bioabsorbable implants and an external fixator between January 2003 and June 2007. According to the classification system of Gustilo and Anderson, five patients were grade IIIA, seven were grade IIIB, and four were grade IIIC. Surgical interventions included combined internal fixation with bioabsorbable screws/rods and external fixation.
Patients underwent clinical and radiologic examination at an average of 18.1 months after surgery. Outcomes were excellent in seven patients (three IIIA, three IIIB, and one IIIC), good in four (one IIIA, two IIIB, and one IIIC), fair in three (one IIIA, one IIIB, and one IIIC), and poor in two (one IIIB, and one IIIC). In the two patients with poor outcomes, bone defect and cartilage exfoliating in the distal tibia were found during surgery. Painful osteoarthritis in the ankle was discovered 2 years after surgery. Another case had pin tract infections in the external fixator 3 months after surgery. There was no case of late deep infection.
It may be a reasonable and desirable option that bioabsorbable implants combined with an external fixator be applied for treatment of severe open dislocated ankle fractures. (J Am Podiatr Med Assoc 101(4): 307–315, 2011)
Background: A high rate of false-negative dermatophyte detection is observed when the most common laboratory methods are used. These methods include microscopic observation of potassium hydroxide–digested nail clippings and culture methods using agar-based media supplemented with cycloheximide, chloramphenicol, and gentamicin to isolate dermatophytes. Microscopic detection methods that use calcofluor white staining or periodic acid–Schiff staining may also be substituted for and have previously been reported to be more sensitive than potassium hydroxide–digested nail clippings.
Methods: Trichophyton rubrum infections were detected directly from nails in a double-round polymerase chain reaction assay that uses actin gene–based primers. This method was compared with detection of fungal hyphae by using calcofluor white fluorescence microscopy of nail samples collected from 83 patients with onychomycosis who were undergoing antifungal drug therapy.
Results: Twenty-six of 83 samples (31.3%) were found to be positive by calcofluor white fluorescence microscopy, and 21 of 83 samples (25.3%) yielded positive results for T rubrum when actin gene–based primers in a double-round polymerase chain reaction assay were used. When calcofluor white fluorescence microscopy and polymerase chain reaction assay were used, the combined detection was 46.9% compared with 31.3% when calcofluor microscopy and culture of nail samples on Sabouraud’s dextrose agar supplemented with cycloheximide, chloramphenicol, and gentamicin were used.
Conclusions: These results suggest that the use of a direct DNA protocol is an alternative method for detecting Trichophyton infections. When this protocol is used, the presence of T rubrum DNA is directly detected. However, the viability of the dermatophyte is not addressed, and further methods need to be developed for the detection of viable T rubrum directly from nail samples. (J Am Podiatr Med Assoc 98(3): 224–228, 2008)
Although scanning electron microscope technology has been used for more than 60 years in many fields of medical research, no studies have focused on obtaining high-resolution microscopic images of onychomycosis of the toenail caused by Trichophyton rubrum in a geriatric population. To provide new insight into the intricate structure and behavior of chronic toenail onychomycosis, we produced three-dimensional images of onychomycosis obtained from two geriatric patients with confirmed growth of T rubrum. The photomicrographs illustrate the pervasive integration and penetration of the fungus hyphal elements, underscoring the clinical difficulty of obtaining rapid treatment of fungal infections in the distal and lateral subungual space of the human toenail. Although the scanning electron microscope may not be a practical diagnostic tool for most physicians, it remains invaluable for the researcher to obtain insight into the spatial orientation, behavior, and appearance of onychomycosis. (J Am Podiatr Med Assoc 94(4): 356–362, 2004)
Treatment for Simple Plantar Verrucae
Monochloroacetic Acid and 10% Formaldehyde versus 10% Formaldehyde Alone
Verrucae are small, benign, highly vascular epithelial neoplasms that occur singly or in a multiple presentation. Plantar verrucae are usually caused by infection with human papillomavirus types 1, 2, and 4. A clinical trial was conducted to assess the safety and efficacy of monochloroacetic acid and 10% formaldehyde versus 10% formaldehyde alone in the treatment of simple plantar verrucae. Of 57 patients enrolled in the study, 26 were in the monochloroacetic acid and 10% formaldehyde group and 31 were in the 10% formaldehyde alone group. The overall cure rate for this population was 61.4%. There was no statistically significant difference in the cure rate between treatment groups. (J Am Podiatr Med Assoc 96(1): 53–58, 2006)
Retained Viable Plant Material in the Calcaneus
A Case Report of a 22-Year-Old Soldier with Atypical Heel Pain
Foreign bodies can be difficult to diagnose and should be considered in the differential diagnosis of unexplained pain, even in the absence of recalled trauma. We present the case of a 22-year-old male with a painful left heel. The patient did not recall a specific traumatic incident, and there were no clinical signs of trauma or infection. Plain films of the foot were nonrevealing, but magnetic resonance imaging revealed a sinus tract and left calcaneal defect. A biopsy of the calcaneal defect revealed viable woody material embedded and partially integrated with the surrounding bone. Postoperatively the patient's pain completely resolved. This case illustrates the importance of radiopathologic pursuit of an etiology of unexplained foot pain in an otherwise healthy person.
Onychomycosis is an extremely common condition that is increasing in prevalence. Although often innocuous, it may be complicated by discomfort and secondary bacterial infections. Recently introduced oral medications may be highly effective in the eradication of this condition; however, they may carry with them significant expense and potentially serious side effects. Prior to the initiation of antifungal oral therapy, definitive diagnosis is mandatory. This study compares the sensitivity of potassium hydroxide (KOH) preparations, surgical pathology diagnostic testing (SPDT), and culture techniques for the detection of onychomycosis in 50 cases of clinically suspected onychomycosis. Analysis showed that SPDT was significantly more sensitive when compared to KOH and culture. The results suggest that SPDT may be the true gold standard for the diagnosis of onychomycosis. (J Am Podiatr Med Assoc 91(7): 351-355, 2001)