Podiatry Today

Podiatry Today






CLINICAL EVENTS CALENDAR

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Non-Accredited Education

Managing the Diabetic Foot: A Clinical and Economic View Complimentary Archived Webcast
Non-Accredited


Understanding Collagen Dressings and their Benefit in Wound Care

Complimentary Archived Webcast
non-accredited

Feature

How To Diagnose Peripheral Arterial Disease

This diabetic patient on dialysis has a small chronic wound on the left foot and was referred to a vascular surgeon.Wound and amputation site healing potential are correlated in a sigmoid curve as shown at the left. Wound healing potential drops dramatically when skin perfusion pressure (SPP) is below 40 mm Hg.Here one can see the SensiLase® System (Väsamed), which the author uses for comprehensive, non-invasive vascular testing of the lower extremities. The system measures SPP in mmHg (microcirculation test) and records PVR waveforms (macrocirculation tesThis diabetic patient on dialysis presented with a non-healing great toe wound with exposed bone.The PVR and SPP tests on this patient indicated severe PAD but led to the patient avoiding a planned matrixectomy, which could have caused a partial amputation.Skin perfusion pressure testing is widely used for the diagnosis of PAD/CLI in Japan, as well as for the assessment and validation of the lower extremities in catheter labs, before and after percutaneous transluminal angioplasty (PTA). (Photo courtesy of
VOLUME: 20 PUBLICATION DATE: Apr 01 2007
Issue Number: 
4

Peripheral arterial disease (PAD) affects 10 to 20 percent of the United States senior citizen population, approximately 8 million people. These PAD patients experience significant and costly morbidity such as leg amputation and death.1 There is a 20 percent incidence rate of PAD in patients 75 years of age and older. Despite the prevalence of the disease and associated cardiovascular risk, only 25 percent of these patients with PAD undergo treatment.2
Early diagnosis and treatment of PAD not only improves one’s quality of life, it can save lives. According to the REA

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Understanding The Biomechanical Effects Of Hallux Limitus

These two Tekscan images demonstrate that a specific orthotic device can reduce sub-hallux pressure at heel lift.As one can see here, the movement of the big toe joint axis from dorsal in the plantarflexed metatarsal (top) to plantarly in the dorsiflexed metatarsal (bottom) is theorized to cause the jamming and lack of dorsiflexion.This algorithm shows the pathomechanics and progression of functional hallux limitus, hallux abducto valgus and hallux rigidus.
VOLUME: 20 PUBLICATION DATE: Aug 01 2007
Issue Number: 
8

Given the multifaceted nature of hallux limitus, having a strong understanding of the subject is vital for anyone who treats the feet. Indeed, hallux limitus is part of the discussion for a variety of conditions including hallux rigidus, hallux valgus, first MPJ arthritis, osteochondritis and first ray hypermobility. There are countless treatment solutions for hallux limitus depending on the nature of the pathology.Can one make any sense of the variety of topics related to hallux limitus? Is there a common ancestor to this pathology? If we know more about hallux limitus, is there a

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A Guide To Surgical Offloading In The Neuropathic Foot

Here one can see a distal hallux ulceration secondary to a hallux hammertoe.As one can see here, overlengthening of the Achilles tendon can lead to a calcaneal gait and heel breakdown.Here one can see an inferior fifth metatarsal head ulceration.As one can see here, overlengthening of the Achilles tendon can lead to a calcaneal gait and heel breakdown.
VOLUME: 20 PUBLICATION DATE: Mar 01 2007
Issue Number: 
3

      The neuropathic foot presents unique challenges when treating and preventing chronic wounds. One of the most difficult challenges is offloading the neuropathic foot without compromising function or causing a transfer of pressure that leads to further ulceration. When performing a limb salvage procedure, the goal is to provide the patient with a stable, plantargrade foot while still allowing for ambulation.1

      In choosing the appropriate procedure to offload the foot, it is important to consider minimal bone resection versus a partial pedal

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Continuing Medical Education Post-Test

VOLUME: PUBLICATION DATE: Dec 01 2006
Issue Number: 
12A Pfizer Supplement

1. Which of the following has not been identified as a risk factor for developing complicated skin and soft tissue infections (cSSTIs) due to methicillin-resistant Staphylococcus aureus (MRSA)?
a) Recent hospitalization
b) Previous MRSA colonization
c) Prior viral infection
d) Recent antimicrobial therapy

2. Challenges that make surgical site infections (SSIs) difficult to avoid include which of the following?
a) Advanced age
b) Chronic diseases
c) Immunocompromised states
d) All of the above

3. Community-acquired MRSA (CA-MRSA) strains are typically susce

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Pertinent Pointers On Equinus Procedures

Here one can see the identification of the width of the Achilles. One would usually perform the Hoke’s triple hemisection supine with the leg held in an elevated position to gain access to the posterior Achilles while the foot is placed under dorsiflexionAs part of the Hoke triple hemisection, one would transect the middle section of the lateral Achilles fibers with a #11 blade.Here is a lengthening of the gastrocnemius tendon in a tongue and groove fashion. The superior medial and lateral one-third of the gastrocnemius tendon has been transected.As one can see in this tongue and groove procedure, the inferior central one-third of the fibers of the gastrocnemius tendon has been transected.The advantages of the tongue and groove technique include a very controlled lengthening with sliding of the tendon to the appropriate length.Here one can see the transection from medial to lateral of the gastrocnemius aponeurosis.The surgeon has achieved lengthening with transection of the aponeurosis as shown in the above photo.
VOLUME: 20 PUBLICATION DATE: Jun 01 2007
Issue Number: 
6

Equinus is defined as the inability to dorsiflex the ankle sufficiently enough to allow the heel to contact the supporting surface without some form of compensation in the mechanics of the lower limb and foot. During the stance phase of gait, the greatest degree of dorsiflexion required is just before heel lift when the knee is maximally extended and the ankle must dorsiflex past perpendicular for smooth ambulation.

There is a great deal of controversy in the literature as to the amount of dorsiflexion truly necessary for this to occur. It is therefore better to consider a normative range

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What You Should Do If You Get A Summons

When you receive a summons, it is important to contact your insurance carrier and/or lawyer right away. If you do not respond promptly, a default will be entered against you and the charges will be deemed true.Although lawsuits are not won during deposition, the author notes the importance of learning whatever one can from the witness to help your case. Thorough preparation will help in the deposition.
VOLUME: 20 PUBLICATION DATE: Apr 01 2007
Issue Number: 
4

A sheriff comes to your office, asks to see you and hands you a summons and complaint. You have been served with a lawsuit. Welcome to my world. This world is not about the medicine. You will not be judged by your peers. There is no search for the truth. In this world, it is about perception, credibility and spin.

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How To Handle Plantar Fibromas

Large exposure is necessary to uncover the entire lesion. A Z-shaped or an S-shaped surgical incision can give complete exposure to the entire plantar fascia for a radical plantar fasciotomy.As one can see here, smaller solitary lesions often arise from the medical fascial band of the plantar aponeurosis.With removal of the solitary nodule, one can see the medial plantar digital nerve. The nerve runs just deep to the plantar aponeurosis and is a common source of pain with these types of lesions.When excising the lesion, take care not to disrupt tissue deep to the medial fascial band. Notice how close the medial plantar digital nerve and flexor hallucis brevis muscle run to the aponeurosis.Plantar fibromas are generally slow growing lesions that are typically asymptomatic. The condition commonly derives from the medial and central fascial band of the aponeurosis.
VOLUME: 20 PUBLICATION DATE: Aug 01 2007
Issue Number: 
8

Plantar fibroma is a common occurrence in the plantar aponeurosis that usually consists of a solitary lesion or multiple nodules. The condition commonly derives from the medial and central fascial band of the aponeurosis, and is typically non-cancerous. Plantar fibromas are generally slow growing lesions that are typically asymptomatic. Most nodules cause pain because of the irregular contour of the foot with ambulation and standing.

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How To Address Predislocation Syndrome Of Lesser MPJs

This X-ray depicts a short first metatarsal caused by prior bunion surgery. This patient’s complaints were pain under the second toe joint.This photo illustrates the anatomic location of the plantar plate and metatarsal head. X indicates the plantar plate and Y indicates the metatarsal head.Here one can see a typical callus under the second metatarsal head as an example of mechanically induced metatarsalgia. Note this patient’s pain and lesion were under the metatarsal head, far from the plantar plate.This photo depicts crossover taping and accommodative padding for sub-second metatarsal pain.These X-rays show a woman who had been treated by another physician. She reported at least three cortisone injections from a dorsal approach. She had frank rupture of the plantar plate with a very impressive positive Lachman test.This photo depicts a woman with sub-second metatarsal pain following arthrodesis of the second PIPJ and flexor tendon transfer. Note the transverse plane deformity is resolved and the toe had good purchase.
VOLUME: 20 PUBLICATION DATE: Mar 01 2007
Issue Number: 
3

     Metatarsalgia is a diagnostic term used to describe pain in the ball of the foot. Gerard V. Yu, DPM, eloquently described and illustrated predislocation syndrome in 1995. What Dr. Yu described was a clinical syndrome characterized by focal pain under a lesser metatarsophalangeal joint (MPJ), most often affecting the second toe joint.1

     Subjective symptoms reported by those afflicted with this syndrome would be described as a “grape-like” swelling under the affected toe joint, and a feeling as if there were a stone bruise on the ball of

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New Advances In Predicting Wound Healing

This two-dimensional map illustrates the state of tissue oxygenation of the localized tissue of interest.The most sensitive quantification methods are done by real time polymerase chain reaction (real time PCR), where the amount of DNA is measured after each cycle of PCR by use of fluorescent markers.One can easily obtain a wound sample during routine wound debridement. Only a minute sample of approximately 100 µl is needed for real time PCR.As seen here, one can place the wound sample in a vial containing a nucleic acid stabilizer. It may be stored and preserved at 4°C for up to 30 days.
VOLUME: 20 PUBLICATION DATE: Jul 01 2007
Issue Number: 
7

Chronic lower extremity skin ulcerations affect millions of people in the United States alone. These ulcerations are defined by the Wound Healing Society as wounds that have “failed to proceed through an orderly and timely process to produce anatomic and functional integrity, or proceeded through the repair process without establishing a sustained anatomic and functional result.”1 The relapsing course of wound healing poses a significant management challenge to healthcare professionals and imposes an astounding economic burden on healthcare.2
The total direct cost o

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How To Address Complications Of Hammertoe Surgery

The interdigital splaying (shown above), which results from lateral destabilization of both the PIPJ and MPJ, can be worse than the original hammertoe deformity.Here one can see a patient with crossover toe deformity, perhaps the most challenging of the digital deformities.This patient has a painful scar. Topical steroids and over-the-counter topical scar care agents are among the first-line agents of choice to relax and reduce the prominence of localized scar irritation.Sausage toe, as shown above, is a potential complication of hammertoe surgery. The development of chronic swelling that interferes with normal venous return and lymphatic flow commonly occurs after digital surgery.Surgeons should be wary of postoperative infections (as shown above) following hammertoe surgery.Here one can see a patient with a mallet toe deformity following hammertoe surgery.
VOLUME: 20 PUBLICATION DATE: Jun 01 2007
Issue Number: 
6

A host of potential complications may result from hammertoe surgery and the most common list includes but is not limited to: infection, neuritis, painful or unsightly scarring, chronic swelling, malunion or nonunion of bone, and recurrence of deformity. While these untoward results can occur, they are unlikely if both the surgeon and the patient follow the basic principles of surgery and postoperative care. Other complications of hammertoe surgery are possible and many of these are the result of technical failures in performing the procedure.
Complications in hammertoe surgery often have mor

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CME Showcase

"Current Concepts In Healing Chronic Diabetic Foot Ulcerations"

A Complimentary On-Demand CE/CME Webcast

This activity is supported by an educational grant from Advanced Biohealing.
This activity is sponsored by the North American Center For Continuing Medical Education (NACCME).

To access this Webcast, visit www.naccme.com/program/n-550/





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