Search Results
BACKGROUND: Normative studies on the Arch Height Index (AHI), Arch Rigidity Index (ARI), and arch stiffness have primarily focused on healthy populations, with little consideration of pathology. The purpose of this study was to create a normative sample of the aforementioned measurements in a pathological sample and to identify relationships between arch structure measurements and pathology. METHODS: AHI was obtained bilaterally at 10% and 90% weightbearing conditions using the Arch Height Index Measurement System (AHIMS). ARI and arch stiffness were calculated using AHI measurements. Dependent t-tests compared right and left, dominant and non-dominant, and injured and non-injured limbs. Measurements of the dominant foot were compared between sexes using independent t-tests. Relationships between arch stiffness and age, sex, and AHI were examined using the coefficient of determination (R2). One-way ANOVAs were used to determine differences between arch structure measurements and number of pathologies or BMI. RESULTS: A total of 110 participants reported either one (n=55), two (n=38), or three or more (n=17) pathologies. Plantar fasciitis (n=31) and hallux valgus (n=28) were the most commonly reported primary concerns. AHI, ARI, and arch stiffness did not differ between limbs for any comparisons, nor between sexes. Between subgroups of BMI and number of pathologies, no differences exist in AHI or ARI; however, BMI was found to have an impact on AHI (10%WB) and arch stiffness (p<.05). Arch stiffness showed a weak relationship to AHI, where a higher AHI was associated with a stiffer arch (R2=0.06). CONCLUSIONS: Normative AHI, ARI and arch stiffness values were established in a pathological sample with a large incidence of plantar fasciitis and hallux valgus. Findings suggest relationships between arch stiffness and both BMI and arch height; however, few trends were noted in AHI and ARI. Determining relationships between arch structure and pathology is helpful for both clinicians and researchers.
Background: Studies of arch height index (AHI), arch rigidity index (ARI), and arch stiffness have primarily focused on healthy populations. Normative values of the aforementioned measurements in a pathologic sample may be useful in identifying relationships between arch structure and pathology.
Methods: AHI was obtained bilaterally at 10% and 90% weightbearing conditions using the AHI measurement system. ARI and arch stiffness were calculated using AHI measurements. Dependent t tests compared right and left, dominant and nondominant, and injured and noninjured limbs. Dominant feet were compared between sexes using independent t tests. Relationships between arch stiffness and subcategories were examined using the coefficient of determination (R2 ). One-way analyses of variance determined differences between arch structure and number of pathologies or body mass index (BMI).
Results: A total of 110 participants reported one (n = 55), two (n = 38), or three or more (n = 17) pathologies. Plantar fasciitis (n = 31) and hallux valgus (n = 28) were the most common. AHI, ARI, and arch stiffness did not differ between limbs or sexes for any comparisons. Between subgroups of BMI and number of pathologies, BMI influenced AHI (10% weightbearing) and arch stiffness (P < .05). Arch stiffness showed a weak relationship to AHI, where a higher AHI was associated with a stiffer arch (R2 = 0.06).
Conclusions: Normative arch structure values were established in a pathologic sample with a large incidence of plantar fasciitis and hallux valgus. Understanding relationships between arch structure and pathology is helpful for clinicians and researchers.
Staphylococcus pseudintermedius is an emerging zoonotic pathogen that is very similar to human Staphylococcus pathogens, particularly multidrug-resistant Staphylococcus aureus. Recent reports have indicated that S pseudintermedius is easily transmitted between pets (mainly dogs) and owners because of these similarities. Although this pathogen has been associated with diabetic foot infections, it has not yet been described in the podiatric medical literature. In this case report, we present a diabetic foot infection in a 61-year-old man that was refractory to multiple rounds of antibiotic drug therapy. Deep wound cultures eventually grew S pseudintermedius, which was the first known case of this pathogen reported in our hospital system.
Background:
A universally accepted histopathologic classification of diabetic foot osteomyelitis does not currently exist. We sought to evaluate the histopathologic characteristics of bone infection found in the feet of diabetic patients and to analyze the clinical variables related to each type of bone infection.
Methods:
We conducted an observational prospective study of 165 diabetic patients with foot ulcers who underwent surgery for bone infection. Samples for microbiological and histopathologic analyses were collected in the operating room under sterile conditions.
Results:
We found four histopathologic types of osteomyelitis: acute osteomyelitis (n = 46; 27.9%), chronic osteomyelitis (n = 73; 44.2%), chronic acute osteomyelitis (n = 14; 8.5%), and fibrosis (n =32; 19.4%). The mean ± SD time between the initial detection of ulcer and surgery was 15.4 ± 23 weeks for acute osteomyelitis, 28.6 ± 22.4 weeks for chronic osteomyelitis, 35 ± 31.3 weeks for chronic acute osteomyelitis, and 27.5 ± 27.3 weeks for the fibrosis stage (analysis of variance: P = .03). Bacteria were isolated and identified in 40 of 46 patients (87.0%) with acute osteomyelitis, 61 of 73 (83.5%) with chronic osteomyelitis, 11 of 14 (78.6%) with chronic acute osteomyelitis, and 25 of 32 (78.1%) with fibrosis.
Conclusions:
Histopathologic categorization of bone infections in the feet of diabetic patients should include four groups: acute, chronic, chronic acute, and fibrosis. We suggest that new studies should identify cases of fibrosis to allow comparison with the present results. (J Am Podiatr Med Assoc 103(1): 24–31, 2013)
We describe a 70-year-old nonimmunocompromised woman with spontaneous bilateral ankle and midfoot sepsis and a deep-space abscess of the right lower leg. Salvage of both limbs was achieved by aggressive bilateral soft-tissue and osseous debridement, including a four-compartment fasciotomy of the right lower leg, antibiotic-loaded polymethyl methacrylate bone cement implantation, delayed allogeneic bone grafting of the osseous defects impregnated with autologous platelet-rich plasma bilaterally, and external fixation immobilization, implantable bone growth stimulation, and split-thickness skin graft coverage of the right lower leg, ankle, and foot. Osseous incorporation of the bone grafts bilaterally occurred 8 weeks after surgery. No soft-tissue or osseous complications occurred during the postoperative period or at 18-month follow-up except for arthrofibrosis in the right ankle; there was no evidence of recurrent abscesses, sequestrum, or wound-related problems. A review of the literature regarding bilateral pedal sepsis and the techniques used for limb salvage in this patient are presented in detail. (J Am Podiatr Med Assoc 96(2): 139–147, 2006)
