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Over the past generation, advents in topical antibiotics and oral analgesia have obscured butamen and its family of topical anesthetics. Using a modified version of the McGill University pain questionnaire, this study attempts to establish the efficacy and clinical utility of this overlooked topical anesthetic.
The treating podiatric physician should consider underlying malignant disease when evaluating a child with any slowly healing or nonhealing infection involving the lower extremity. This article reports on an infant who was treated for suspected osteomyelitis involving his right fifth toe that did not improve with standard surgical, medical, and antibiotic treatments. He was later diagnosed as having acute myelogenous leukemia. (J Am Podiatr Med Assoc 97(2): 145–147, 2007)
A case report of hematogenous calcaneal osteomyelitis has been presented along with a brief review. Hematogenous osteomyelitis of the foot is an uncommon but potentially devastating disease that can result in severe long-term sequelae. An index of suspicion in cases such as these can help the physician prevent unnecessary delay in treatment. In pediatric hematogenous osteomyelitis, oral antibiotics can often be sufficient for long-term therapy, provided sufficient surgical decompression is performed.
The Internet offers many resources in the area of wound and ulcer care that are of potential interest to podiatric physicians and students. This article provides an overview of World Wide Web sites that contain factual information, management guidelines, and illustrations pertaining to various aspects of wound and ulcer care. Web sites that emphasize preventive care are also reviewed. Because the prudent use of antimicrobial therapy is an important part of wound care, a few sites that offer antibiotic information are described.
Foot infection is the single most common reason for hospitalization of the diabetic patient. A combination of host factors, including neuropathy, angiopathy, and immunopathy, combine to make the diabetic foot infection the most severe infection commonly seen by podiatrists. If inadequately treated, the likelihood of morbidity or mortality is high. The presence of anaerobic bacteria as a predominant type of organism makes diagnosis and antibiotic selection complicated.
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.
Motile Aeromonas infections of the foot are caused mostly by post-traumatic incidence, occurring mostly during summer months. Serious complications such as osteomyelitis and amputation can result if the infections go untreated or are inadequately treated. The role of each species of motile Aeromonas in pathogenesis and response to antimicrobial agents is not well understood because of taxonomic uncertainty. As a group, motile Aeromonas respond well to aminoglycosides, second-generation and third-generation cephalosporins, quinolones, and some beta-lactam antibiotics.
The presence of subcutaneous nodules in association with rheumatoid arthritis is well documented. In most cases, these nodules occur in association with severe rheumatoid disease. Treatment should be initiated with conservative measures such as custom-molded shoes, nonweightbearing, and oral antibiotic therapy to control infection. The goals of surgery were to alleviate pain, improve function and cosmesis, remove infected bone, and prevent further infection. The surgical sites are completely healed without complications 2 years postoperatively.
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.
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.
