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Forty-eight Austin bunionectomies were fixated by using an absorbable fixation device. Twenty-three were fixated with a 1.5- or 2.0-mm diameter Biofix rod and twenty-five were fixated with a 1.3-mm diameter Orthosorb pin. To be included in this project, all patients were followed radiographically for a minimum of 3 months. One foot (4%) fixated with Biofix developed a sterile sinus discharge 3 months postoperatively after uneventful wound healing. There were no clinical or radiographic changes seen in the feet in which Orthosorb was used. Also, there were no infections or osteotomy dislocations with either fixation device.
Osteoid osteoma is a primary benign bone tumor that consists of a central area (nidus), surrounded by sclerotic bone. The most relevant symptom is pain that increases during the night and improves after salicylates or nonsteroidal anti-inflammatory drug administration. Osteoid osteoma is frequently misdiagnosed because it mimics juvenile idiopathic arthritis, bone infection, or malignancy. A 14-year-old girl presented to our department with a history of chronic pain in her left ankle. Juvenile idiopathic arthritis was diagnosed and anti-inflammatory treatment was prescribed. Because of persistence of ankle pain, the patient underwent further examinations, in particular, bone scintigraphy and computed tomography. As a result, osteoid osteoma of the talar neck was diagnosed. The patient underwent surgical treatment and her condition improved. Osteoid osteoma should also be considered in patients with chronic ankle pain to avoid misdiagnosis and start adequate treatment. This condition should be suspected in a patient with chronic bone pain and normal complete blood count and inflammatory parameters.
Multiple surgical strategies are available for managing the infected diabetic foot at risk for amputation. The authors present their experience with the closed instillation system in the management of 30 such cases in 29 patients over a 5-year period. Data were collected from the hospital records of neuropathic patients presenting with deep-plantar-space infections or presumed acute osteomyelitis. All 29 patients were male; 57% had marginal or poor vascular supply, and 83% were nutritionally compromised or had proteinuria. At the conclusion of the study, 34% of the patients were dead, reflecting the severity of comorbid conditions found in this population. Despite the marginal healing capacity of these patients, the procedure had a 90% success rate, as defined by expeditious return to prior level of functioning and residential living situation without need for re-operation or higher-level amputation.
Understanding the physiology and function of the nail unit and its potential avenues of invasion, and properly identifying invading organisms are two key aspects of using the newer therapies available for the treatment of onychomycosis. This article discusses the most common pathologies of onychomycosis, as classified by the sites of entry of the invading fungi. Susceptibility factors leading to infection are also discussed. Obtaining proper tissue samples, using appropriate tests and culture media, and accurately interpreting test results are all paramount to correct identification of the invading organism and, in turn, to effective prescribing. When fungal-growth results do not support the clinical symptoms, or if a more specific identification of the organism is required, additional diagnostic tests are available and are outlined here.
This article presents a critical review of the Dockery procedure (autogenous peroneus longus free graft technique) for the treatment of lateral ankle instability. Those patients with gastrocnemius equinus were treated with gastrocnemius recession during surgery. The authors reviewed 33 stabilizations performed over a period of 7 years to analyze the effectiveness of the procedure with and without the addition of the gastrocnemius recession. Assessed were the type and length of conservative therapy, the time to return to regular activity, complications experienced, and the recurrence rate. The results show a reinjury rate of 3%. The complications included infection, prolonged healing, and occasional screw irritation requiring screw removal. In light of the low incidence of reinjury, this technique is a valid procedure for treating lateral ankle instability.
Plantar verrucae, caused by human papillomavirus (HPV), are commonly found in patients who have tested positive for the antibodies to human immunodeficiency virus (HIV). A better understanding of the characteristics of plantar verrucae in HIV+ patients in needed. A pilot study was conducted concentrating on three characteristics--the size, the number, and the clinical type--of verrucae present in this population. These parameters were studied in HIV+ and HIV- populations, and they were evaluated in relation to the CD4 levels of HIV+ individuals. The HIV+ individuals presented with plantar verrucae that were larger and more numerous than those found in HIV- individuals. The HIV+ population presented with all three clinical types of plantar verrucae and had significantly more mosaic-type warts than did HIV- individuals. The three characteristics did not correlate with CD4 cell counts, suggesting that the severity and extent of HPV infection do not depend on the level of immunosuppression of the HIV+ patient.
A 10-month, hospital-based, open-label clinical study was undertaken of a unique antimicrobial nail solution containing surfactant, allantoin, and benzaikonium chloride to determine its effectiveness, in conjunction with periodic debridement, against pedal onychomycosis. Forty patients with microbial infection of the nails were enrolled in this study, in which a new, objective nail-scoring system was used. At the start of the study, the mean nail score was 8.3, and 79.8% of the nails scored had severe disease (on a scale of 0 to 10, with 10 defined as total nail involvement, accompanied by pain and thickening). By the conclusion of the study, the mean score had decreased to 2.5, 32.6% of the patients' nails were scored 0 or 1, and 90% of the patients subjectively judged their improvement as excellent or good.
The authors performed a retrospective study of the safety and efficacy of toenail phenol and alcohol chemical matrixectomy in diabetic versus nondiabetic patients. Participating in the study were 66 patients, who underwent 137 nail procedures. The diabetic group consisted of 18 patients who underwent 39 procedures; the nondiabetic group consisted of 48 patients who underwent 98 procedures. The mean (+/- SD) healing time was 44 +/- 25 days for the diabetic group and 43 +/- 24 days for the nondiabetic group. The infection rate was 10.3% (4 of 39 procedures) for the diabetic group and 12.2% (12 of 98 procedures) for the nondiabetic group. In addition to validating this procedure for diabetic patients, this study showed no significant differences in the rate of postoperative complications between the two groups.
This article discusses the advantages and disadvantages of primary wound healing as compared with primary amputation in individuals with chronic diabetic foot wounds. The authors review the potential benefits of vascular surgical procedures and advanced dressings, including two of the most promising modalities in modern wound care: growth factors and bioengineered skin. In this era of cost-conscious health-care administration, it is incumbent on the practitioner to consider not only the basic science of wound care, but also the economic aspect of treatment rendered. These various interventions, dressings, growth factor delivery systems, and new modalities could significantly reduce healing time, thereby reducing the risk of infection, hospitalization, and amputation while improving quality of life. If so, they may be truly cost-effective.
Acquired immune deficiency syndrome (AIDS) and human immunodeficiency virus (HIV) were first noticed in the US in 1981 and continue to spread today. Initially a disease associated completely with homosexual males, it is increasing in incidence and prevalence among heterosexual males and females, particularly, but not limited to, injection drug users. This disease is much more prevalent among blacks and Hispanics. Podiatric physicians are at risk of acquiring the disease as a result of their frequent use of injections and surgical intervention, particularly involving bone. In addition, the foot is a potential portal of entry for HIV infection because of contamination by blood on the feet of podiatric surgeons and their assistants during surgery.
