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Dermatologic, vascular, neurologic, and musculoskeletal complications are common among persons with acquired immunodeficiency syndrome (AIDS). These manifestations frequently involve the lower extremities and may be the initial presenting symptoms of human immunodeficiency virus (HIV) infection. It is important that practitioners of podiatric medicine be aware of these syndromes to facilitate early diagnosis of AIDS and to provide the best possible care for immunodeficient patients. The author provides a review of the manifestations of AIDS frequently encountered in podiatric practice, along with guidelines for treatment.
Gonococcal arthritis is a frequently occurring clinical entity that should be included routinely in a differential diagnosis of pedal joint pain. Unfortunately, the lack of specificity in the presentation makes gonococcal arthritis difficult to diagnose. Indices of suspicion should rise with any sexually active patient, particularly when septic arthritis is suspected without a detectable portal of entry. The authors emphasize again the importance of carefully choosing empiric antibiotic coverage for gonococcal arthritis. Three factors that should be considered are regional epidemiology, the anatomical site of the primary infection, and the possible coexistence of other infectious agents. Understanding the clinical staging of this condition will help to achieve a timely diagnosis and successful treatment.
Although cutaneous larva migrans is more commonly seen in the southeastern US and tropical regions of the world, patients with such parasitic involvement may present in other non-endemic areas for various reasons, particularly travelers returning from tropical vacations. Awareness of the clinical presentation and symptomatology of cutaneous larva migrans is important for all physicians, including those practicing in northern climates, for prompt recognition and effective treatment of the disease. Furthermore, cutaneous larva migrans should be of particular interest to podiatrists, because the infestation commonly involves the feet, and a patient may initially present for treatment of secondary manifestations, ie, dermatitis, pruritus, or infection, as in this case report.
The authors describe a new approach to Austin bunionectomy fixation using the 3M Staplizer. Twenty cases are examined retrospectively for various postoperative results. The Staplizer technique is compared and contrasted to other modes of fixation that are described in the literature. The authors suggest that internal fixation with the Staplizer provides decreased risk of infection, early ambulation, high patient acceptance, and fewer complications. A detailed description of the technique used to insert the staples is presented, and mechanical analysis of the osteotomy and optimal staple position are discussed.
An unusual presentation of calcaneal osteomyelitis is described, where-by the infection remained undiagnosed for 25 years. The 36-year-old patient recently sought medical treatment for a reported ankle sprain, but the pain was recalcitrant to conservative care. Further investigation yielded a history significant for stepping on a chicken bone as a child, which entered the inferior lateral heel. Magnetic resonance imaging revealed what plain radiographs did not: a well demarcated lytic lesion in the body of the calcaneus. Intraoperative findings were consistent with an abscess of chronic osteomyelitis. The treatment included incision and drainage, antibiotic beads, and a tricortical bone graft.
Through a discussion of the etiology and pathology of diabetic foot lesions with particular emphasis on ulceration and osteoarthropathy, the author will develop a plan for treatment and prevention using a multidisciplinary approach to such problems. Underlying risk factors including neuropathy, ischemia, infection, and, especially high pressures must be evaluated and appropriately ameliorated in order to promote resolution and avoidance of recidivism. Accordingly, conservative management with pressure-relieving devices, topical therapies, and prophylactic surgery on structural deformities plays an integral part in the overall podiatric management of the high-risk foot in diabetes mellitus.
A prospective clinical trial was conducted to evaluate the efficacy of a collagen-alginate wound dressing in the postoperative management of chemical matricectomies. The study involved 20 patients and 23 separate procedures. The collagen-alginate-dressing treatment group had an average healing time of 24.4 days, compared with 35.8 days for the control group, which received treatment consisting of soaks and daily dressing changes (P < .05). The authors suggest that using a collagen-alginate wound dressing in the postoperative management of chemical matricectomies will shorten healing time, thus reducing infection rates and increasing patient compliance and satisfaction.
Heel pain in children is common, and its evaluation is challenging. Medical history and physical examination may be unrevealing owing to children's limited communication skills. Often, advanced laboratory and imaging studies are required to make an accurate diagnosis. The most common causes of heel pain in children are apophysitis, enthesopathy, and overuse syndromes such as tendinitis. Juvenile rheumatoid arthritis is relatively uncommon. In very active children, occult fractures must also be evaluated. Pain unrelated to activity may indicate tumors, infection, or congenital problems. In general, heel pain in children is treated nonoperatively. For fractures in particular, children are less likely than adults to receive surgical treatment.
The authors address current issues regarding use of antiseptics and disinfectants with particular emphasis on the problems associated with claims made by manufacturers of various chemical agents. Other issues include the efficacy and limitations of commercial products, selecting the most appropriate formulation for proper disinfection, especially with instruments that come in contact with the patient, and preventing or minimizing iatrogenic infections in clinical practices. The authors stress that low-level and some intermediate-level disinfectants are unreliable because of their narrow safety margin and that chemical agents with a high level of activity should be used by all practitioners because of multi-drug resistant microorganisms and acquired immune deficiency syndrome (AIDS).
In March 1949, McKittrick described the use of the transmetatarsal amputation for the diabetic foot, along with specific indications. Infection, ischemia, and neuropathic ulcerations of the toes and forefoot were all treated with this procedure. In the past 30 years, however, advances in the management of these problems have led to a decrease in the number of transmetatarsal amputations performed at the New England Deaconess Hospital. With these advances, the current approach to the transmetatarsal amputation has changed, leading to significant modifications in the basic indications for this procedure.
