Fungal foot infections are becoming an increasingly common public health problem as the population ages. New studies have shown that some of the traditional therapeutic antifungal agents have multiple actions that enable them to be more efficacious than previously thought, and more efficacious than other agents without multiple actions. In this review article, the pedal infections commonly referred to as tinea pedis, or athlete's foot, are described. The etiologic agents involved in the pathogenesis, the methodologies for proper diagnosis, and the therapeutic agents commercially available for treatment are reviewed.
We surveyed the podiatric medicine professional and academic leadership concerning podiatric medicine professionals as disaster surge responders.
All US podiatric medical school deans and state society presidents were mailed a self-administered structured questionnaire. The leaders were asked to complete the questionnaire and return it by mail; two repeated mailings were made. Descriptive statistics were produced, and differences between deans and society presidents were tested by the Fisher exact test.
The response rate was 100% for the deans and 53% for the society presidents. All of the respondents agreed that podiatric physicians have skills applicable to catastrophe response, are ethically obligated to help, and should receive additional training in catastrophe response. Deans and society presidents agreed with the statements that podiatric physicians should provide basic first aid and place sutures, obtain medical histories, and assist with maintaining infection control. With one exception, all of the society presidents and deans agreed that with additional training, podiatric physicians could interpret radiographs, start intravenous lines, conduct mass casualty triage, manage a point of distribution, prescribe medications, and provide counseling to the worried well. There was variability in responses across the sources for training.
These findings suggest that deliberations regarding academic competencies at the podiatric medical school level and continuing education should be conducted by the profession for a surge response role, including prevention, response, mitigation, and recovery activities. After coordination and integration with response agencies, podiatric medicine has a role in strengthening the nation’s catastrophic event surge response. (J Am Podiatr Med Assoc 103(1): 87–93, 2013)
An essential skill for podiatrists is conservative sharp debridement of foot callus. Poor technique can result in lacerations, infections and possible amputation. This pilot trial explored whether adding simulation training to a traditional podiatry clinical placement improved podiatry student skills and confidence in conservative sharp debridement, compared with traditional clinical placement alone.
Twenty-nine podiatry students were allocated randomly to either a control group or an intervention group on day 1 of their clinical placement. On day 4, the intervention group (n = 15) received a 2-hour simulation workshop using a medical foot-care model, and the control group (n = 14) received a 2-hour workshop on compression therapy. Both groups continued to learn debridement skills as opportunities arose while on clinical placement. The participants' debridement skills were rated by an assessor blinded to group allocation on day 1 and day 8 of their clinical placement. Participants also rated their confidence in conservative sharp debridement using a questionnaire. Data were analyzed using logistic regression (skills) and analysis of covariance (confidence), with baseline scores as a covariate.
At day 8, analysis showed that those in the intervention group were 16 times more likely to be assessed as competent (95% confidence interval, 1.6–167.4) in their debridement skills and reported increased confidence in their skills (mean difference, 3.2 units; 95% confidence interval, 0.5–5.9) compared with those in the control group.
This preliminary evidence suggests that incorporating simulation into traditional podiatry clinical placements may improve student skills and confidence with conservative sharp debridement.
Background: Generally, posterior malleolar fragments are fixed either with percutaneous anteroposterior screws or through a posterolateral approach using screws and/or a buttress plate. Both surgical methods have some shortcomings, and the use of anteroposterior screws to fix osteoporotic posterior malleolar fractures carries a risk of failure.
Methods: Nine elderly patients (average age, 67 years) with posterior malleolar fractures were treated with transfibular Kirschner wire tension band fixation. According to the Lauge-Hansen classification, all fractures were of the supination-external rotation type. The operative duration, intraoperative blood loss, and wound healing outcome were recorded. During the follow-up period, clinical outcomes were measured using the American Orthopaedic Foot and Ankle Society ankle-hindfoot score, and the occurrence of complications was observed.
Results: The patients were followed up for 12 to 18 months (mean, 15 months). The operative duration ranged from approximately 30 to 95 minutes, with an average of 70 minutes. Anatomical reduction was achieved in nine cases, and there were no complications, such as skin necrosis, wound infection, or skin sensory disturbance. There was one case of delayed wound healing caused by fat liquefaction, which was cured by a dressing change. The functional scores were excellent in four cases, good in four cases, fair in one case, and poor in zero cases. The rate of excellent and good results was 88.89% (eight of nine), with an average of 78.78 points.
Conclusion: Kirschner wire tension band fixation through a transfibular approach for the treatment of posterior malleolar fractures does not require a change in patient posture. It facilitates the reduction and internal fixation of the posterior malleolar fragment; furthermore, it is easier to remove internal fixation after fracture healing, which provides a new surgical method for elderly patients with posterior malleolus fracture. Thus, this has potential as a new surgical method for elderly patients with posterior malleolar fractures.
The deep plantar (D-PL) artery originates from the dorsalis pedis artery in the proximal first intermetatarsal space, an area where many procedures are performed to address deformity, traumatic injury, and infection. The potential risk of injury to the D-PL artery is concerning. The D-PL artery provides vascular contribution to the base of the first metatarsal and forms the D-PL arterial arch with the lateral plantar artery.
In an effort to improve our understanding of the positional relationship of the D-PL artery to the first metatarsal, dissections were performed on 43 embalmed cadaver feet to measure the location of the D-PL artery with respect to the base of the first metatarsal. Digital images of the dissected specimens were acquired and saved for measurement using in-house software. Means, standard deviations, and 95% confidence intervals (CIs) were calculated for all of the measurement parameters.
We found that the origin of the D-PL artery was located at a mean ± SD of 11.5 ± 3.9 mm (95% CI, 4.5–24.7 mm) distal to the first metatarsal base and 18.6% ± 6.5% (95% CI, 8.1%–43.4%) of length in reference to the proximal base. The average interrater reliability across all of the measurements was 0.945.
This study helps clarify the anatomical location of the D-PL artery by providing parameters to aid the surgeon when performing procedures in the proximal first intermetatarsal space. Care must be taken when performing procedures in the region to avoid unintended vascular injury to the D-PL artery.
The anterolateral thigh (ALT) flap, which can be applied as a free or pedicled flap, is supplied by musculocutaneous or septocutaneous perforators belonging to the descending branch of the lateral circumflex femoral artery. Because local or regional flap options that can be used for the reconstruction of large tissue losses in the distal third of the tibia and foot are limited, ALT and other free flaps are frequently used when needed. The aim of this report is to present our experience with and clinical results of free ALT flaps in a tertiary health-care institution. Between June of 2017 and April of 2020, lower extremity reconstruction with free ALT flaps was performed in seven patients. In the preoperative period, dominant perforators were determined in each patient by Doppler ultrasonography, and surgery was planned considering the size and localization of the defect. All the patients were men, with an average age of 41.7 years. Three patients were operated on for implant exposition on the distal-medial third of the tibia after fracture repair, one patient for posttraumatic calcaneal deformity with osteomyelitis, and two patients because of localized posttraumatic tissue loss in the anterior aspect of the tibia and one patient in the dorsum of the foot. Secondary recovery was achieved in two patients and localized linear necrosis was observed at the flap suture line. No infection was observed in the donor or recipient site. In all patients, the donor site was closed primarily and no wound healing problem was encountered. This is one of the primary reconstruction options for the free ALT flap, especially in cases of large tissue losses in which local and/or regional flap alternatives are insufficient.
Xerosis (dryness) of the foot is commonly encountered in clinical care and can lead to discomfort, pain, and predisposition to infection. Many moisturizing products are available, with little definitive research to recommend any particular formulation.
We compared two commonly prescribed moisturizing products from different ends of the price spectrum (sorbolene and 25% urea cream) for their effectiveness in reducing xerosis signs using the Specified Symptom Sum Score. A randomized clinical trial of parallel design was conducted over 28 days (February–May 2015) on 41 participants with simple xerosis. Participants, therapists, assessors, and data entry personnel were blinded to treatment, and allocation was determined via a randomization table.
Thirty-four participants completed the study (19 urea and 15 sorbolene), with one reporting minor adverse effects. There were statistically significant improvements in both groups after 28 days. Mean differences between pre and post scores were 3.50 (95% confidence interval [CI], 2.80 to 4.20) for the urea group and 2.90 (95% CI, 2.00 to 3.80) for the sorbolene group. There was a slightly lower mean posttreatment score in the urea group (1.16; 95% CI, 0.67 to 1.64) than in the sorbolene group (1.80; 95% CI, 1.25 to 2.35), but this difference was not significant (P ≤ .09). Effect size of difference was –0.48 (95% CI, –1.16 to 0.22).
In this study, there was no difference between using sorbolene or 25% urea cream to treat symptoms of foot xerosis. A recommendation, therefore, cannot be made based on efficacy alone; however, sorbolene treatments are invariably cheaper than urea-based ones.
Drug based treatment of superficial fungal infections, such as onychomycosis, is not the only defense. Sanitization of footwear such as shoes, socks/stockings, and other textiles is integral to the prevention of recurrence, and reduction of spread for superficial fungal mycoses. The goal of this review was to examine the available methods of sanitization for footwear and textiles against superficial fungal infections. A systematic literature search of various sanitization devices and methods that could be applied to footwear and textiles using PubMed, Scopus, and MEDLINE was performed. Fifty-four studies were found relevant to the different methodologies, devices, and techniques of sanitization as it pertains to superficial fungal infections of the feet. These included topics of basic sanitization, antifungal and antimicrobial materials, sanitization chemicals and powder, laundering, ultraviolet, ozone, non-thermal plasma, microwave radiation, essential oils, and natural plant extracts. In management of onychomycosis it is necessary to think beyond treatment of the nail, as infections enter through the skin. Those prone to onychomycosis should examine their environment, including surfaces, shoes, and socks, and ensure that proper sanitization is implemented.
Bite wounds of the lower extremities present a challenge in diagnosis and management. Primary care of the initial injury remains controversial. Innocuous as these wounds may appear, severe infections are frequent. The microbial flora of the animal mouth harbor a multitude of unusual bacteria, aerobic and anaerobic, that make antibiotic selection difficult. A protocol for initial management and antibiotic selection is presented.
To the authors' knowledge, this is the first reported case of alternariosis involving the subcutaneous tissues of the foot. Podiatrists are likely to see more of this condition and other unusual fungi causing deep foot infections in the future because of the increasing population of immunocompromised patients.