The authors present a case of massive fatal pontine hemorrhage as a complication of hypertension in a patient treated for an infected diabetic ulcer. The podiatric physician must be aware of the risks associated with concomitant medical problems such as hypertension and ensure that proper therapeutic measures are taken to avoid the potential for catastrophic complications.
Plantar pressure-measurement technology may provide the clinician with valuable objective information for monitoring the effects of therapeutic intervention on the foot. The use of this technology is described in the preoperative and postoperative assessment of a patient undergoing hallux valgus surgery for the treatment of a chronic neuropathic skin ulcer over the medioplantar aspect of her first metatarsophalangeal joint.
A review of the literature on brown recluse spider bite is presented, including clinical presentation and treatment. Emphasis is placed on the treatment of local tissue necrosis. A case report of a severe necrotic ulcer secondary to a spider bit is presented. Tissue necrosis following a brown recluse spider bit can be debilitating, and healing may be prolonged for many months. Even with early treatment, prognosis often is poor. Future studies might help establish better treatment regimens.
The effect of electrical currents on living cellular systems has been studied by many researchers and is becoming useful in clinical medicine. Alteration of cellular activity with externally applied currents can positively or negatively influence the status of a healing tissue, thereby directing the healing process to a desired outcome. A review of the literature pertaining to the effect of electrical currents on tissue healing is presented and the relevance of this modality to ulcer healing is discussed.
Neuropathic osteoarthropathy, i.e., Charcot's joint, has not previously been reported as a sequela of elective foot surgery. The authors present a challenging case of a patient with long-standing diabetes mellitus and peripheral neuropathy who developed neuropathic osteoarthropathy after a Keller arthroplasty for a recalcitrant hallux ulcer. The radiographic findings, diagnostic tests, and histopathology are discussed. Finally, the authors offer suggestions for surgeons contemplating a Keller arthroplasty for patients with peripheral neuropathy.
The sequelae of human immunodeficiency virus (HIV) disease include a host of devastating conditions involving the lower extremity. These include rheumatologic dysfunction, Kaposi's sarcoma, peripheral neuropathies, and skin ulcers. Pain, weakness, and loss of range of motion caused by these conditions can lead to changes in gait pattern, loss of mobility and function, and limited quality of life. The role of the rehabilitation specialist in the care and treatment of HIV disease as it affects the lower extremity, and the treatment strategies, precautions, and suggestions will be discussed.
The infected diabetic lower extremity has enjoyed a surge in popularity in the medical literature. There have been numerous papers outlining classification systems for ulcer depth, surgical approaches, and microbiology. Discussions on antibiotic use have usually been directed toward therapy of the "diabetic foot infections" as a group, without regard to differences in severity and location of these infections. These infections can vary from the most superficial of processes to a severe life- and limb-threatening sepsis. The author presents a review of the processes involved in the diabetic lower extremity infection and suggests a classification system for selection of empiric antibiotic therapy based on the severity of the infection.
Myxoinflammatory fibroblastic sarcoma of the soft tissues is a rare low-grade tumor of uncertain origin that most often occurs on the extremities of adults. The tumor predominantly involves the subcutaneous tissues of the hands and feet. Despite being a rare neoplasm, owing to its varied histologic appearance, myxoinflammatory fibroblastic sarcoma should be differentiated from various benign and malignant soft-tissue lesions. Myxoinflammatory fibroblastic sarcoma has been well described in pathology journals but not in the surgical literature. We report a case of myxoinflammatory fibroblastic sarcoma in a 19-year-old man with a plantar ulcer lesion in his left foot. To our knowledge, this is the first reported case in the literature involving the epidermis. (J Am Podiatr Med Assoc 100(6): 497–501, 2010)
Clinicians may have poor sensitivity in determining whether a given diabetic patient with a foot ulcer has osteomyelitis. Thus many turn to diagnostic tests. The literature was reviewed and data on the sensitivity and specificity of five commonly used diagnostic tests were compiled. Using Bayes' theorem, the authors' analysis suggests that pretest probability may be more important in the decision-making process than individual test characteristics. Also, a positive probe-to-bone test is as predictive of osteomyelitis as the other four tests. A negative magnetic resonance imaging test most likely rules out osteomyelitis. Interpretation of any test result is greatly influenced by the pretest probability of disease. Future work needs to focus on aiding the clinician in determining the patient's probability of disease prior to testing in order to optimize patient care.
INTRODUCTION AND OBJECTIVES: Melanoma is one of the most common primary malignant tumors arising in the lower extremity. It is crucial to diagnose melanoma as quickly and as efficiently as possible for a better prognosis. The use of dermoscopy is helpful in diagnosing such conditions. Dermoscopy is a non-invasive, in-vivo technique primarily used in the examination of pigmented skin lesions. This procedure allows the visualization of subsurface skin structures in the epidermis, dermoepidermal junction, and upper dermis - structures not visible to the naked eye. This poster presents the advantages of dermoscopy in the field of podiatry by assessing the dermoscopic criteria with positive predictive values for distinguishing acral melanoma from acral nevus. Additionally it analyzes cases of melanomas misdiagnosed as a plantar-pigmented wart and a diabetic ulcer.
METHODS: The authors used PubMed to perform an English language literature search. The exclusion criteria included articles older than 10 years. Inclusion criteria consisted of research done on humans and the terms dermoscopy and foot lesions or melanoma. After retrieving a total of 140 articles, 14 articles were found to meet both the inclusion and exclusion criteria.
RESULTS: Qualitative analysis of relevant articles demonstrates that the detection of malignant dermoscopic patterns enhances quick and correct diagnosis.
CONCLUSIONS: The use of dermoscopy is slowly evolving in podiatry. It aims to minimize the amount of biopsies taken, thereby decreasing the risk of creating an ulcer and reducing the patients exposure to anesthesia. While controversy remains over sensitivity and specificity of using a dermatoscope alone to diagnose pedal lesions, particular attention should be paid to the accuracy of diagnosing a lesion when dermoscopy is used in conjunction with a biopsy. With the continued usage of a dermatoscope along with experience and expertise in the field, the need for a biopsy could eventually be eliminated.