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The authors discuss Internet sites that provide information on podiatric medicine relevant to practitioners and students. Before going online, the podiatric health professional should be aware that the information located at these sites may vary in quality, reliability, and level of sophistication. A brief introduction to the history of the Internet is presented, along with useful sites and general medical resources.
Background:
Foot and ankle health among the homeless is an important public health concern. There are limited studies done thus far on foot and ankle conditions and the podiatric medical needs of homeless populations. A literature review was undertaken to evaluate any studies published about the lower-extremity health needs among the homeless.
Methods:
We did a literature search through PubMed, the US National Library of Medicine’s database of biomedical citations and abstracts for relevant publications from 1988 through 2008. We also searched the references cited in the articles found for any studies relevant to podiatric needs for homeless populations.
Results:
We found three relevant articles that addressed the needs of podiatric care for the homeless. The articles highlighted the community health importance of foot care for homeless populations, especially in helping prevent potentially limb-threatening pathologies.
Conclusions:
The small number of studies published so far all emphasize the major public health need for podiatric care among homeless populations. More studies are needed to help address this important public health concern. (J Am Podiatr Med Assoc 102(1): 54–56, 2012)
Abstract
Osteonecrosis is acknowledged as a relatively uncommon disorder caused by various factors, including autoimmune diseases, drug-induced diseases, inherited metabolic disorders, coagulation disorders, and underlying malignancies. To our knowledge, no previous research has investigated osteonecrosis stemming from extracorporeal membrane oxygenation. Herein, we report a rare case of postperipheral venoarterial extracorporeal membrane oxygenation–induced multifocal osteonecrosis in the foot and ankle that demonstrated a low serpiginous peripheral signal on T1-weighted images and a double-line sign on fat-suppressed or T2-weighted magnetic resonance images. Conservative treatment was applied, and the patient was mostly recuperated after 6 months.
“Step Up for Foot Care”
Addressing Podiatric Care Needs in a Sample Homeless Population
Background
Studies have shown that lower-extremity problems in the homeless population have significant public health and economic implications. A combined community service and research project was performed to identify and address the foot and ankle care needs in a sample homeless population in San Francisco, California.
Methods
A 37-question survey regarding general demographic characteristics, foot hygiene practices, associated risk factors, and self-reported lower-extremity pathologic conditions was completed by 299 homeless individuals who met the inclusion criteria. The service project included education on proper foot care and the distribution of footwear.
Results
The participants demonstrated mostly good efforts regarding foot hygiene but had high-risk factors, including smoking, alcohol use, and extended hours on their feet. More than half of the homeless individuals surveyed experienced foot pain. Approximately one in five had edema and neuropathic symptoms. The most commonly reported foot problems were dermatologic, but these conditions could pose serious sequelae in the setting of risk factors. The community service project was well received by the homeless community.
Conclusions
This study demonstrates lack of resources and high-risk factors for lower-extremity complications in the homeless individuals studied. It is important in the realm of public health to keep lower-extremity health in mind because it plays an important role in preventing the spread of infection and lowering the social economic burden.
Osteonecrosis is acknowledged as a relatively uncommon disorder caused by various factors, including autoimmune diseases, drug-induced diseases, inherited metabolic disorders, coagulation disorders, and underlying malignancies. To our knowledge, no previous research has investigated osteonecrosis stemming from extracorporeal membrane oxygenation. Herein, we report a rare case of postperipheral venoarterial extracorporeal membrane oxygenation–induced multifocal osteonecrosis in the foot and ankle that demonstrated a low serpiginous peripheral signal on T1-weighted images and a double-line sign on fat-suppressed or T2-weighted magnetic resonance images. Conservative treatment was applied, and the patient was mostly recuperated after 6 months.
Soft-tissue tumors in the foot include a range of benign and malignant pathologies. In the clinical setting, the list of differential diagnoses can be exhausting, and the treatment plan is not always straightforward. In this article, we present a case of a 22-year-old female with a soft-tissue mass on her plantar foot that has been slowly growing since adolescence and is now causing increased pain with ambulation. Her pathology results demonstrated an intramuscular hemangioma. Intramuscular hemangiomas are rare benign tumors that tend to present in youth or early adulthood. Diagnosis is often delayed for months to years, depending on the patient's symptoms. Treatment varies from conservative to surgical, depending on size, location, and proximity to vital structures. Literature on intramuscular hemangiomas is very limited. Intramuscular hemangiomas provide a diagnostic and treatment quandary for the clinician and must be considered in the differential diagnoses when presented with a soft-tissue mass.
Angiokeratoma Presenting as Plantar Verruca
A Case Study
One of the more frequent pathologic conditions that podiatric physicians are confronted with is plantar verrucae. Plantar verrucae have been studied extensively in terms of morphological features and incidence in the population at large and in patients with human immunodeficiency virus infection. Solitary angiokeratomas can be morphologically similar to plantar verrucae, presenting as hyperkeratotic pedunculated lesions. We present a unique case study of a 40-year-old man with human immunodeficiency virus with a painful solitary angiokeratoma masquerading as plantar verrucae. The lesion demonstrated clinical signs consistent with those highlighted in the literature for verrucae, namely, showing as red and black lacunae, punctuated hyperkeratotic epidermis. We propose that solitary angiokeratomas should be an important part of a podiatric physician’s differential diagnosis in the lower extremity owing to the similarity of morphological features with plantar verrucae. (J Am Podiatr Med Assoc 100(6): 502–504, 2010)
The Rare Lesser Metatarsal Bipartite Sesamoid
A Case Report
Sesamoid bones and accessory ossicles are common incidental findings on radiographs. These can occasionally become symptomatic, usually after a precipitating event such as an injury or overuse, or they can be incidental findings unrelated to the presenting pathology. The aim of this study was to highlight a rare case of a bipartite fifth metatarsal sesamoid bone and to review previous literature regarding sesamoid bones and accessory ossicles.
Medical and Economic Impact of a Free Student-Run Podiatric Medical Clinic
A Preliminary Analysis
Background
Data from the free student-run podiatric medical clinic at Clínica Tepati at the University of California, Davis, were used to analyze medical and economic impacts on health-care delivery and to extrapolate the economic impact to the national level. Clínica Tepati also provides an excellent teaching environment and services to the uninsured Hispanic population in the Greater Sacramento area.
Methods
In this analysis, we retrospectively reviewed patient medical records for podiatric medical encounters during 15 clinic days between November 2010 and February 2012. The economic impact was evaluated by matching diagnoses and treatments with Medicare reimbursement rates using International Classification of Diseases codes, Current Procedural Terminology codes, and the prevailing Medicare reimbursement rates.
Results
Sixty-three podiatric medical patients made 101 visits during this period. Twenty patients returned to the clinic for at least one follow-up visit or for a new medical concern. Thirty-nine different diagnoses were identified, and treatments were provided for all 101 patient encounters/visits. Treatments were limited to those within the clinic's resources. This analysis estimates that $17,332.13 worth of services were rendered during this period.
Conclusions
These results suggest that the free student-run podiatric medical clinic at Clínica Tepati had a significant medical and economic impact on the delivery of health care at the regional level, and when extrapolated, nationally as well. These student-run clinics also play an important role in medical education settings.
