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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.
The authors presented an overview of the development of antibiotic-loaded bone cement beads and their indications for usage, method of application, advantages, disadvantages, and causes of failure. This method of treatment for bone and soft tissue infections of the foot is not a panacea and should be used only in selected cases. The vascular status and the physiologic ability of the patient to heal a peripheral wound or infection are the basis for the success of this method of therapy. European literature makes little mention of adjunctive systemic antibiotic therapy with local antibiotic-loaded bone cement bead use. It is the authors' opinion that clinical judgment should be used to determine the necessity for such therapy.
More inpatient hospital days are used for the care of diabetic foot infection than for any other diabetic sequela. Both the number of lower extremity amputations and the overall treatment cost of treating diabetic infections may be reduced by using a team approach in the care of the infected diabetic pedal wound. The authors propose an evaluation and treatment protocol of infected pedal ulcerations in an urban, community teaching institution when admitted to an established, multidisciplinary diabetic foot care team. The hospital course of 111 patients admitted with a primary diagnosis of infected pedal ulceration are retrospectively reviewed. Results revealed an average-length hospital stay of 7.4 days with a 96% limb-salvage rate. The authors suggest that in the treatment of the infected pedal wound, a diabetic foot care team with a well developed treatment protocol may yield a consistently favorable outcome and a cost-effective hospital course.
Tea-tree oil (oil of Melaleuca alternifolia) has recently received much attention as a natural remedy for bacterial and fungal infections of the skin and mucosa. As with most naturally occurring agents, claims of effectiveness have been only anecdotal; however, several published studies have recently demonstrated tea-tree oil's antibacterial activity. This study was conducted to determine the activity of tea-tree oil against 58 clinical isolates: Candida albicans (n = 10), Trichophyton rubrum (n = 8), Trichophyton mentagrophytes (n = 9), Trichophyton tonsurans (n = 10), Aspergillus niger (n = 9), Penicillium species (n = 9), Epidermophyton floccosum (n = 2), and Microsporum gypsum (n = 1). Tea-tree oil showed inhibitory activity against all isolates tested except one strain of E floccosum. These in vitro results suggest that tea-tree oil may be useful in the treatment of yeast and fungal mucosal and skin infections.
The deep fascia of the foot lies beneath the subcutaneous tissue and surrounds the intrinsic foot muscles. Depending on its location, the composition of the deep fascia varies. In some areas it is thin, while in other areas it is greatly thickened to form retinacula and the plantar aponeurosis. Selected clinical considerations that relate to the deep fascia of the foot are described. These include the following: plantar fasciitis, infection, compartment syndrome, calcaneal fracture, and neuroma.
Hand-foot-and-mouth disease is a highly contagious disease most often seen in children during the summer. It is caused most commonly by the virus coxsackie A16, but other enteroviruses have been implicated. It presents with low grade fever, and a vesicular eruption on the hands, feet, and mouth. More serious manifestations are seen less commonly. Diagnosis is most often clinical and treatment is symptomatic in nature. The infection in a male adult is presented.
Ciprofloxacin is the first of the new class of antibiotics known as fluoroquinolones to be approved for use in skin, skin structure, and bone and joint infections. It has an extremely broad spectrum and is particularly effective against traditionally resistant gram-negative rods. As an oral agent, it is as effective as parenteral drugs against a variety of organisms and diseases. Its spectrum, pharmacokinetics, and podiatric indications are reviewed.
Subcutaneous fungal infections are relatively uncommon in the lower extremity. Mycetoma begins as painless papules or nodules that increase in size and progresses to involve the connective tissue. Diagnosis is based on biopsy, with definitive identification of the organism needed for effective treatment. Treatment consists of antifungal medications and surgical debridement. This article provides an overview of this disorder and reports on a case of recurrent mycetoma in a 70-year-old woman.
INTRODUCTION AND OBJECTIVES: Corynebacterium striatum (C. striatum) is known to colonize the skin and mucous membranes of most normal human hosts. While it is frequently isolated in clinical laboratories, the clinical significance of C. striatum is often unknown with respect to diabetic foot infections with osteomyelitis. There have been very few studies published on this topic, and even fewer that report on treatment courses. To our knowledge, there has been no study published reporting diabetic foot osteomyelitis with isolation of C. striatum from bone culture.
METHODS: Four patients were known to have been treated at our facility for C. striatum diabetic foot osteomyelitis. The medical records for each patient were thoroughly reviewed with close attention directed towards the past medical history, wound duration, wound and bone cultures, antimicrobial therapy and clinical outcomes.
RESULTS: Bone cultures of all 4 patients were notable for C. striatum. Diphtheroids were also noted on wound cultures for 3 patients which were not speciated. All bone cultures were obtained during surgical treatment of the diabetic foot infection. All patients were type II diabetics but varied with respect to age and gender. All patients were treated with an extended course of antibiotics and/or surgical resection of osteomyelitis. Patients were followed until complete wound closure.
CONCLUSIONS: We report four cases of diabetic foot osteomyelitis in which C. striatum was noted and treated as a pathogen. Diphtheroids are often overlooked as a potential pathogen in diabetic foot infections and rarely treated as such. However, our findings suggest that clinicians should consider C. striatum as a possible cause of osteomyelitis, especially when patients fail to completely heal wounds in a timely manner that have previously and repeatedly displayed Diphtheroids from cultures.
Acute projectile injuries to the foot can present a challenge for the podiatric physician, especially in terms of their chronic effects. The case of a shrapnel wound to the right foot and ankle that resulted in recurrent episodes of soft tissue infection and disability is presented. Treatment consisted of excision of the shrapnel fragment, debridement, and primary closure of the sinus tract created by the projectile. The authors discuss the acute and chronic effects of projectile injuries, factors responsible for determining the severity of these wounds, and various methods of treatment.
